A COVID-19 vaccination program for high-risk children aged 12-17 years in Curacao.

Objective: This study aimed to describe and critically evaluate the COVID-19 vaccination program for high-risk children in Curacao and provide information about important factors such as parents' vaccination hesitancy and effective strategies for communicating and delivering information about vaccination. Methods: This was a cross-sectional study. It was important to identify children aged 12-17 years who were at high risk of severe COVID-19 infection because of the limited medical facilities on the island; children considered to be at high risk were those with diseases such as obesity, hypertension or diabetes mellitus type 2. These children or their caregivers were invited by their pediatricians to be vaccinated as part of a program run by the Public Health Department of Curacao. These high-risk patients were vaccinated between 30 May 2021 and 25 February 2022 in designated child-friendly spaces, with a pediatrician present for guidance and reassurance. Children received the Pfizer-BioNTech COVID-19 vaccine at the recommended dose for their age. The primary outcome was a description and evaluation of the attendance for vaccination. The secondary outcomes were side effects after vaccination for the age groups 12-15 years and 16-17 years. Reasons for refusal or nonadherence were also registered. Results: Altogether 51% (24/47) of those aged 16-17 years who were invited were vaccinated compared with 42% (26/69) of those aged 12-15 years who were invited. Altogether, 46% of these high-risk children were vaccinated compared with 48% of children aged 12-17 years without risk factors. In our population, most patients did not experience any side effects and if they did, the side effects were mild. No cases of myocarditis or pericarditis were observed. A lack of trust in the vaccine and a lack of prioritization of vaccination when scheduling daily activities were important factors in refusal and nonadherence. Conclusions: To organize a successful vaccination program in a small community with limited resources for treating high-risk children it is crucial for medical professionals to provide reliable information. Public health initiatives should focus on assuaging parents' fears about vaccines. In addition, ensuring there is good cooperation between doctors and the Public Health Department can help to make implementation successful. Finally, involving pediatricians and using dedicated areas for vaccinating children can help build trust with parents and caregivers.

Frequency of epistaxis and telangiectasia in patients with hereditary hemorrhagic telangiectasia (HHT) in comparison with the general population: Curaçao diagnostic criteria revisited.

PURPOSE: The Curaçao criteria are well-established diagnostic criteria for hereditary hemorrhagic telangiectasia (HHT), but they lack details regarding a predictive presentation of epistaxis and telangiectasias. This study collects and compares data in HHT and population cohorts to inform the application of these criteria. METHODS: In-person interviews regarding epistaxis and targeted examination for telangiectases in a general population cohort (n = 204) and an HHT cohort (n = 432) were conducted. RESULTS: Frequency of epistaxis, rather than intensity or duration, was the best discriminator of HHT. A cutoff of ≥4 nosebleeds per year alone yielded a diagnostic sensitivity of 97%, and specificity of 84%. The mean number of telangiectases at the sites investigated was 0.4 in the general population cohort and 26.5 in the HHT cohort. The most distinctive sites for telangiectases in HHT were lips and palmar fingers, whereas telangiectases of the face and dorsum of the hand were comparable in both cohorts. CONCLUSION: We propose that the Curaçao criteria be modified to include the following cutoffs: (1) epistaxis frequency of ≥4 nosebleeds per year and (2) telangiectasia count of at least 2 in characteristic locations (palmar aspect of fingers, lips, and oral cavity), and that cutaneous telangiectases at other sites not be considered relevant for diagnostic purposes.

The validity of the BDHI translated into Papiamento in pre-trial defendants in Curaçao.

The Buss-Durkee Hostility Inventory (BDHI) is an important assessment scale of hostility in forensic psychiatry. We analyzed the validity and reliability of a Papiamento translation of the BDHI in 134 pre-trial defendants in Curaçao using Exploratory Structural Equation Modeling (ESEM). The reliability of the Direct and Indirect Hostility BHDI-P subscales were good and the reliability of the Social Desirability poor. There was a negative correlation between Direct Hostility and Agreeableness and a positive correlation between Indirect Hostility and Anxiety. We conclude that the BDHI-P has an acceptable measurement quality when used in defendants.

A COVID-19 vaccination program for high-risk children aged 12-17 years in Curacao / Programa de vacunación contra la COVID-19 para adolescentes de alto riesgo de 12 a 17 años en Curazao / Programa de vacinação contra a COVID-19 para adolescentes de alto risco com idades entre 12 e 17 anos em Curaçao

ABSTRACT Objective. This study aimed to describe and critically evaluate the COVID-19 vaccination program for high-risk children in Curacao and provide information about important factors such as parents' vaccination hesitancy and effective strategies for communicating and delivering information about vaccination. Methods. This was a cross-sectional study. It was important to identify children aged 12-17 years who were at high risk of severe COVID-19 infection because of the limited medical facilities on the island; children considered to be at high risk were those with diseases such as obesity, hypertension or diabetes mellitus type 2. These children or their caregivers were invited by their pediatricians to be vaccinated as part of a program run by the Public Health Department of Curacao. These high-risk patients were vaccinated between 30 May 2021 and 25 February 2022 in designated child-friendly spaces, with a pediatrician present for guidance and reassurance. Children received the Pfizer-BioNTech COVID-19 vaccine at the recommended dose for their age. The primary outcome was a description and evaluation of the attendance for vaccination. The secondary outcomes were side effects after vaccination for the age groups 12-15 years and 16-17 years. Reasons for refusal or nonadherence were also registered. Results. Altogether 51% (24/47) of those aged 16-17 years who were invited were vaccinated compared with 42% (26/69) of those aged 12-15 years who were invited. Altogether, 46% of these high-risk children were vaccinated compared with 48% of children aged 12-17 years without risk factors. In our population, most patients did not experience any side effects and if they did, the side effects were mild. No cases of myocarditis or pericarditis were observed. A lack of trust in the vaccine and a lack of prioritization of vaccination when scheduling daily activities were important factors in refusal and nonadherence. Conclusions. To organize a successful vaccination program in a small community with limited resources for treating high-risk children it is crucial for medical professionals to provide reliable information. Public health initiatives should focus on assuaging parents' fears about vaccines. In addition, ensuring there is good cooperation between doctors and the Public Health Department can help to make implementation successful. Finally, involving pediatricians and using dedicated areas for vaccinating children can help build trust with parents and caregivers.

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RESUMO Objetivo. Este estudo teve como objetivo descrever e avaliar de maneira crítica o programa de vacinação contra a COVID-19 para adolescentes de alto risco em Curaçao e dar informações sobre fatores importantes, como a hesitação vacinal dos pais e estratégias efetivas para comunicar e fornecer informações sobre a vacinação. Métodos. Este foi um estudo transversal. Era importante identificar os adolescentes entre 12 e 17 anos que tinham alto risco de infecção grave por COVID-19 devido à escassez de estabelecimentos de saúde na ilha; os adolescentes considerados de alto risco tinham obesidade, hipertensão arterial ou diabetes mellitus tipo 2. Esses adolescentes e seus cuidadores foram convidados por seus pediatras a serem vacinados como parte de um programa do Departamento de Saúde Pública de Curaçao. Esses pacientes de alto risco foram vacinados entre 30 de maio de 2021 e 25 de fevereiro de 2022 em espaços adaptados para adolescentes e com a presença de um pediatra para orientação e segurança. Os adolescentes receberam a vacina Pfizer-BioNTech COVID-19 na dose recomendada para a idade. O desfecho primário foi a descrição e a avaliação do comparecimento à vacinação. Os desfechos secundários foram os efeitos colaterais após a vacinação nas faixas etárias de 12 a 15 anos e de 16 a 17 anos. Os motivos de recusa ou não adesão também foram registrados. Resultados. No total, 51% (24/47) dos adolescentes convidados de 16 a 17 anos de idade foram vacinados, em comparação com 42% (26/69) dos adolescentes convidados de 12 a 15 anos de idade. No total, 46% desses adolescentes de alto risco foram vacinados, em comparação com 48% dos adolescentes de 12 a 17 anos sem fatores de risco. Na população do estudo, a maioria dos pacientes não apresentou nenhum efeito colateral e, quando presentes, os efeitos colaterais foram leves. Não foram observados casos de miocardite ou pericardite. A falta de confiança na vacina e a falta de priorização da vacinação ao programar as atividades diárias foram fatores importantes para recusa e não adesão. Conclusões. Para organizar um programa de vacinação bem-sucedido em uma pequena comunidade com recursos limitados para o tratamento de adolescentes de alto risco, é fundamental que os profissionais médicos apresentem informações confiáveis. As iniciativas de saúde pública devem se concentrar em aliviar o medo dos pais em relação às vacinas. Além disso, garantir que haja boa cooperação entre os médicos e o Departamento de Saúde Pública pode ajudar no sucesso da implementação. Por fim, o envolvimento de pediatras e o uso de áreas exclusivas para a vacinação de adolescentes podem ajudar a criar confiança nos pais e cuidadores.

Frequency of Chlamydia trachomatis and Neisseria gonorrhoeae in Patients with Imminent Preterm Delivery on the Island of Curaçao.

Sexually transmitted infections are one of the important risk factors for preterm delivery, which is among the important contributors to perinatal morbidity and mortality. The aim of this study was to assess the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections in women with imminent preterm delivery in Curaçao, an island of the Dutch Caribbean. All women from Curaçao with either preterm premature rupture of the membranes or preterm labor, common indications of imminent preterm delivery, and presenting at the Curaçao Medical Center between 15 November 2019 and 31 December 2020, were included in this single cohort study. Data were retrospectively collected from medical records. The presence of Chlamydia trachomatis and Neisseria gonorrhoeae was assessed by Cepheid GeneXpert ® (Xpert) CT/NG assay (Sunnyvale, CA, USA). In the included cohort, the prevalence of Chlamydia trachomatis infection was 15.5% and of Neisseria gonorrhoeae infection was 2.1%. All patients infected with Neisseria gonorrhoeae were co-infected with Chlamydia trachomatis. The prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections in patients with imminent preterm delivery in Curaçao is high. It is recommended to test all patients with imminent preterm delivery for these sexually transmitted infections and possibly consider testing all women in early pregnancy on the island.

A Rare Case of Upper Gastrointestinal Bleeding: Osler-Weber-Rendu Syndrome.

Osler-Weber-Rendu disease, also known as hereditary hemorrhagic telangiectasia (HHT), is a rare, autosomal dominant condition that affects approximately 1 in 5000 patients causing abnormal blood vessel formation. HHT patients have mucocutaneous telangiectasias and arteriovenous malformations in various organs. The most prominent symptom of HHT is epistaxis, which, together with gastrointestinal bleeding, may cause iron deficiency anemia. This study is a case report of a 62-year-old patient who was admitted to the Department of Gastroenterology due to acute upper gastrointestinal bleeding and a history of recurrent epistaxis and melena for 4 days, which was confirmed in digital rectal examination. Urgent upper gastrointestinal endoscopy revealed active bleeding from multiple angioectatic spots with bright-looking salmon-colored patches in the antrum and the body suggestive of HHT. The bleeding from two angioectatic spots was stopped by argon plasma coagulation, and four clips were placed to provide good hemostasis. The patient was treated with a proton pomp inhibitor infusion and iron infusion. She was discharged with no signs of GI bleeding, normalized iron levels and a diagnosis of HHT. She was referred to further genetic testing, including evaluation of first-degree relatives. She also had performed unenhanced thin-cut computed tomography (CT) with angiography to exclude the presence of pulmonary arteriovenous malformations (PAVMs). Due to the fact that the patient did not manifest any other HHT-related symptoms and that the instrumental screening discloses no silent AVMs in other organs, the "watch-and-wait strategy" was applied. Although, Osler-Weber-Rendu syndrome is widely described in the medical literature, effective treatment of gastrointestinal telangiectasias is not always available and still lacks standardization to date, which makes the management of gastroenterological involvement still a challenging issue.

Connective Tissue Disorders and Cardiovascular Complications: The Indomitable Role of Transforming Growth Factor-ß Signaling.

Marfan Syndrome (MFS) and Loeys-Dietz Syndrome (LDS) represent heritable connective tissue disorders that segregate with a similar pattern of cardiovascular defects (thoracic aortic aneurysm, mitral valve prolapse/regurgitation, and aortic dilatation with regurgitation). This pattern of cardiovascular defects appears to be expressed along a spectrum of severity in many heritable connective tissue disorders and raises suspicion of a relationship between the normal development of connective tissues and the cardiovascular system. With overwhelming evidence of the involvement of aberrant Transforming Growth Factor-beta (TGF-ß) signaling in MFS and LDS, this signaling pathway may represent the common link in the relationship between connective tissue disorders and their associated cardiovascular complications. To further explore this hypothetical link, this chapter will review the TGF-ß signaling pathway, the heritable connective tissue syndromes related to aberrant TGF-ß signaling, and will discuss the pathogenic contribution of TGF-ß to these syndromes with a primary focus on the cardiovascular system.

Current Status of Clinical and Genetic Screening of Hereditary Hemorrhagic Telangiectasia Families in Hungary.

Hereditary hemorrhagic telangiectasia (HHT) is a rare germline vascular malformation syndrome with a prevalence of 1:5000-1:10,000 [...].

Nasal Endoscopy in the Clinical Diagnosis of Hereditary Hemorrhagic Telangiectasia.

OBJECTIVES: To evaluate the role of nasal endoscopy for early clinical diagnosis of hereditary hemorrhagic telangiectasia (HHT) in children and to investigate the characteristics of epistaxis and mucocutaneous telangiectases in our pediatric population. STUDY DESIGN: From May 2016 to December 2019, a cross-sectional observational study was conducted, recruiting children aged 2-18 years with a parent affected by HHT. To identify the Curaçao criteria, all children underwent collection of clinical history, mucocutaneous examination, and nasal endoscopy. The clinical data were then compared with the genetic data acquired subsequently. RESULTS: Seventy children (median age, 10.8 years) were included. All underwent nasal endoscopy without complications. Forty-six children were positive by genetic testing; of these, 26 % had skin and oral telangiectases and 91 % had nasal telangiectases. The diagnostic sensitivity of the Curaçao criteria increased from 28 % (95 % CI, 16%-43 %) to 85 % (95 % CI, 71%-94 %; P < .0001) when the nasal telangiectases were included. CONCLUSIONS: The magnified and complete endoscopic view of the nasal cavities proved useful in increasing the diagnostic sensitivity of the Curaçao criteria. Such an examination turned out to be feasible and safe. For this reason, we believe that nasal endoscopy should be included in the diagnostic assessment of pediatric patients with suspected HHT.

Associations of number of victimizations with mental health indicators and health-risk behaviours among a nationally representative sample of in-school adolescents in Curaçao.

PURPOSE: The study aimed to estimate the association of experiencing a higher number of victimizations with mental health and health-risk behaviours among adolescents in the 2015 Curaçao Global School-Based Student Health Survey (GSHS). METHODS: In all, 2,765 in-school adolescents with a median age of 15 years from Curaçao responded to the cross-sectional GSHS. RESULTS: Results indicate that from six forms of victimization (bullied, parental physical victimization, physically attacked, physical intimate partner violence victimization, forced sex and violent injury) assessed, 29.6 % reported one type of victimization, 11.3 % two types and 4.9 % three or more types of victimization. In adjusted logistic regression analyses, PV was associated with four poor mental health indicators (worry-induced sleep disturbance, suicidal ideation, loneliness, and suicide attempt) and eleven health-risk behaviours (current tobacco use, current alcohol use, current cannabis use, early sexual debut, sex among students who were drunk, multiple sexual partners, non-condom use at last sex, school truancy, carrying a weapon, short sleep and skipping breakfast). CONCLUSION: Almost one in six students reported poly-victimization (≥2 types). Higher frequency of victimization was positively associated with four poor mental health indicators and eleven health-risk behaviours.

Profile of durable and successful marriages: A new competency-based marital education program / Perfil de los matrimonios largos y exitosos: un nuevo programa de educación marital basado en competencias

Abstract The aim of this study was to assess the impact of a newly developed competency-based marital and relationship education (MRE) program for couples in Curaçao, Dutch Caribbean. In consideration to the 57% divorce rate in Curaçao, and the view that intuition or cohabitation are the sole alternatives to marriage preparation in the Dutch Caribbean, a new additional alternative that is both intellectually defensible and empirically based was proposed. This quasi-experimental study used a sample of 310 participants aged 19-63 years. Using the Solomon design and planned contrast for one-way ANOVA, we compared pre-, post-intervention and follow-up results after 2.5 years of couples in a distress and adjusted group. Statistically significantly increased scores were obtained for (1) marital satisfaction, with an effect size (Cohen's d) of 2.18 for the adjusted group and 4.44 for the distressed group; (2) commitment (adjusted group d = 1.98, distressed group d = 2.90); and (3) the 12 profiled relationship competencies for marital durability (adjusted group d = 1.62, distressed group d = 6.27). Follow-up measurements conducted 2.5 years upon MRE program completion indicated that its effects were durable. We concluded that participation in the Profile of Durable and Successful Couples (PDSC) program resulted in increased marital satisfaction, relationship commitment, and mastery of the 12 profiled family and relationship competencies, that contribute to relationship durability. This implicate that the PDSC program under study can be adopted to prevent relationship erosion, while also assisting those experiencing relationship distress in finding satisfactory solutions. The competency-based focus of the program could be considered the matrix in maximizing the sustainable success of MRE program.

Resumen El objetivo de este estudio es evaluar el impacto de un nuevo programa de educación marital o relacional basado en el desarrollo de competencias familiares para parejas en Curazao, Caribe Holandés. La tasa de divorcio del 57% y la opinión de que la intuición o la cohabitación son las únicas alternativas a la preparación para el matrimonio en el Caribe Holandés demandan una alternativa adicional que no solamente sea intelectualmente defendible, sino que además tenga base empírica. Por esta razón hemos realizado un estudio tipo cuasi experimental en el cual se usó una muestra de 310 individuos de 19 a 63 años. Además, se implementó el diseño de Solomon y el contraste planeado para el ANOVA de una vía, en el cual comparamos los resultados obtenidos de antes y después de una intervención (i.e. curso de educación de parejas). Posteriormente hemos comparado los resultados después de 2.5 años para evaluar el carácter permanente de los resultados en dos grupos de parejas, parejas ajustadas y parejas con dificultades relaciones/ angustiados. Los resultados obtenidos indican puntuaciones significativamente elevadas para la variable (1) de satisfacción marital, con un tamaño de efecto (d=Cohen) de 2.18 para el grupo ajustado y 4.44 para el grupo angustiado; (2) compromiso (d del grupo ajustado = 1.98, d del grupo angustiado 2,90); y (3) las 12 competencias perfiladas para la durabilidad marital (d del grupo ajustado = 1.62 y grupo angustiado = 6.27). Hemos concluido que el programa aumentó la satisfacción marital, el sentido de compromiso con la relación y el dominio de las 12 competencias perfiladas para la familia o relaciones duraderas. Este estudio tiene la siguiente implicación: la sensibilidad cultural y el enfoque basado en desarrollo de competencias pueden ser cruciales y la matriz en la maximación del éxito sostenible de programas de educación relacional y marital como herramienta de intervención preventiva y/o de tratamiento.

Contribution of amenable mortality to life expectancy differences between the Dutch Caribbean islands of Aruba and Curaçao and the Netherlands.

OBJECTIVE: To identify specific health care areas whose optimization could improve population health in the Dutch Caribbean islands of Aruba and Curaçao. METHODS: Comparative observational study using mortality and population data of the Dutch Caribbean islands and the Netherlands. Mortality trends were calculated, then analyzed with Joinpoint software, for the period 1988-2014. Life expectancies were computed using abridged life tables for the most recent available data of all territories (2005-2007). Life expectancy differences between the Dutch Caribbean and the Netherlands were decomposed into cause-specific contributions using Arriaga's method. RESULTS: During the period 1988-2014, levels of amenable mortality have been consistently higher in Aruba and Curaçao than in the Netherlands. For Aruba, the gap in amenable mortality with the Netherlands did not significantly change during the study period, while it widened for Curaçao. If mortality from amenable causes were reduced to similar levels as in the Netherlands, men and women in Aruba would have added, respectively, 1.19 years and 0.72 years to their life expectancies during the period 2005-2007. In Curaçao, this would be 2.06 years and 2.33 years. The largest cause-specific contributions were found for circulatory diseases, breast cancer, perinatal causes, and nephritis/nephrosis (these last two causes solely in Curaçao). CONCLUSIONS: Improvements in health care services related to circulatory diseases, breast cancer, perinatal deaths, and nephritis/nephrosis in the Dutch Caribbean could substantially contribute to reducing the gap in life expectancy with the Netherlands. Based on our study, we recommend more in-depth studies to identify the specific interventions and resources needed to optimize the underlying health care areas.

Curaçao diagnostic criteria for hereditary hemorrhagic telangiectasia is highly predictive of a pathogenic variant in ENG or ACVRL1 (HHT1 and HHT2).

PURPOSE: Determine the variant detection rate for ENG, ACVRL1, and SMAD4 in individuals who meet consensus (Curaçao) criteria for the clinical diagnosis of hereditary hemorrhagic telangiectasia. METHODS: Review of HHT center database for individuals with three or more HHT diagnostic criteria, in whom molecular genetic analysis for ENG, ACVRL1, and SMAD4 had been performed. RESULTS: A variant known or suspected to be causal was detected in ENG in 67/152 (44.1%; 95% confidence interval [CI], 36.0-52.4%), ACVRL1 in 79/152 (52.0%; 95% CI, 43.7-60.1%), and SMAD4 in 2/152 (1.3%; 95% CI, 0.2-4.7%) family probands with definite HHT. Only 4/152 (2.6%; 95% CI, 0.7-6.6%) family probands did not have a variant in one of these genes. CONCLUSION: Previous reports of the variant detection rate for ENG and ACVRL1 in HHT patients have come from laboratories, which receive samples from clinicians with a wide range of expertise in recognizing clinical manifestations of HHT. These studies suggest a significantly lower detection rate (~75-85%) than we have found in patients who meet strictly applied consensus criteria (96.1%). Analysis of SMAD4 adds an additional detection rate of 1.3%. HHT as defined by the Curaçao criteria is highly predictive of a causative variant in either ENG or ACVRL1.

Contribution of amenable mortality to life expectancy differences between the Dutch Caribbean islands of Aruba and Curaçao and the Netherlands / Contribución de la mortalidad por causas evitables mediante la atención de salud a la diferencia de la esperanza de vida entre las islas del Caribe holandés de Aruba y Curaçao y los Países Bajos / Contribuição da mortalidade evitável para as diferenças na expectativa de vida entre as ilhas de Aruba e Curaçao, no Caribe holandês, e os Países Baixos

ABSTRACT Objective. To identify specific health care areas whose optimization could improve population health in the Dutch Caribbean islands of Aruba and Curaçao. Methods. Comparative observational study using mortality and population data of the Dutch Caribbean islands and the Netherlands. Mortality trends were calculated, then analyzed with Joinpoint software, for the period 1988-2014. Life expectancies were computed using abridged life tables for the most recent available data of all territories (2005-2007). Life expectancy differences between the Dutch Caribbean and the Netherlands were decomposed into cause-specific contributions using Arriaga's method. Results. During the period 1988-2014, levels of amenable mortality have been consistently higher in Aruba and Curaçao than in the Netherlands. For Aruba, the gap in amenable mortality with the Netherlands did not significantly change during the study period, while it widened for Curaçao. If mortality from amenable causes were reduced to similar levels as in the Netherlands, men and women in Aruba would have added, respectively, 1.19 years and 0.72 years to their life expectancies during the period 2005-2007. In Curaçao, this would be 2.06 years and 2.33 years. The largest cause-specific contributions were found for circulatory diseases, breast cancer, perinatal causes, and nephritis/nephrosis (these last two causes solely in Curaçao). Conclusions. Improvements in health care services related to circulatory diseases, breast cancer, perinatal deaths, and nephritis/nephrosis in the Dutch Caribbean could substantially contribute to reducing the gap in life expectancy with the Netherlands. Based on our study, we recommend more in-depth studies to identify the specific interventions and resources needed to optimize the underlying health care areas.(AU)

RESUMEN Objetivo. Determinar las áreas específicas de atención de salud cuya optimización podría mejorar la salud de la población en las islas del Caribe holandés de Aruba y Curaçao. Métodos. Estudio de observación comparativo en el que se utilizaron datos demográficos y de mortalidad de las islas del Caribe holandés y de los Países Bajos. Se calcularon las tendencias de mortalidad y luego se analizaron con programas de computación Jointpoint de regresión lineal segmentada, para el período 1988-2014. La esperanza de vida se calculó utilizando tablas de mortalidad abreviadas con los datos más recientes disponibles de todos los territorios (2005-2007). Las diferencias de esperanza de vida entre el Caribe holandés y los Países Bajos se desglosaron, usando el método de Arriaga, en contribuciones por causas específicas. Resultados. En el período 1988-2014, los niveles de mortalidad por causas evitables mediante la atención de salud han sido sistemáticamente mayores en Aruba y Curaçao que en los Países Bajos. En el caso de Aruba, la brecha en la mortalidad por causas evitables mediante la atención de salud con respecto a los Países Bajos no varió significativamente durante el período de estudio; en el caso de Curaçao, la brecha fue mayor. Si la mortalidad por causas evitables mediante la atención de salud se redujese a un nivel similar al de los Países Bajos, los hombres y las mujeres en Aruba habrían sumado, respectivamente, 1,19 años y 0,72 años a su esperanza de vida en el período 2005-2007. En Curaçao, el aumento hubiese sido de 2,06 años y de 2,33 años. Según el estudio, las causas específicas que más contribuyen a esta diferencia son las enfermedades circulatorias, el cáncer de mama, las complicaciones perinatales, y la nefritis/nefrosis (estas últimas dos causas solamente en Curaçao). Conclusiones. Una mejora en los servicios de salud en relación con las enfermedades circulatorias, el cáncer de mama, las complicaciones perinatales, y la nefritis/nefrosis en el Caribe holandés podría contribuir sustancialmente a la reducción de la brecha en la esperanza de vida con respecto a los Países Bajos. Por tanto, con base en nuestro estudio, recomendamos que se realicen más estudios exhaustivos a fin de determinar las intervenciones específicas y los recursos que se necesitan para optimizar las áreas de atención de salud involucradas.(AU)

RESUMO Objetivo. Identificar áreas específicas da atenção à saúde cuja otimização poderia melhorar a saúde da população nas ilhas de Aruba e Curaçao, no Caribe holandês. Métodos. Estudo observacional comparativo baseado em dados de mortalidade e populacionais das ilhas do Caribe holandês e dos Países Baixos. As tendências de mortalidade foram calculadas e então analisadas com o software Joinpoint, no período de 1988 a 2014. As expectativas de vida foram computadas usando tábuas de mortalidade resumidas com os dados disponíveis mais recentes de todos os territórios (2005-2007). As diferenças na expectativa de vida entre o Caribe holandês e os Países Baixos foram desagregadas segundo as contribuições específicas por causa usando o método de Arriaga. Resultados. No período de 1988 a 2014, os níveis de mortalidade evitável foram consistentemente mais elevados em Aruba e Curaçao do que nos Países Baixos. Em Aruba, a diferença na mortalidade evitável em comparação com os Países Baixos não mudou significativamente durante o período do estudo, enquanto que em Curaçao a diferença aumentou. Se a mortalidade por causas evitáveis fosse reduzida a níveis semelhantes aos dos Países Baixos, os homens e mulheres de Aruba teriam aumentos respectivos de 1,19 e 0,72 anos nas suas expectativas de vida durante o período 2005-2007. Em Curaçao, o aumento seria de 2,06 e 2,33 anos. As maiores contribuições de causas específicas foram as de doenças circulatórias, câncer de mama, causas perinatais e nefrite/nefrose (estas duas últimas causas somente em Curaçao). Conclusões. Melhorias nos serviços de saúde relacionados com doenças circulatórias, câncer de mama, mortes perinatais e nefrite/nefrose no Caribe holandês poderiam contribuir substancialmente para reduzir as disparidades na expectativa de vida em comparação com os Países Baixos. Com base neste trabalho, recomendamos estudos mais aprofundados para identificar as intervenções e recursos específicos necessários para otimizar estas áreas da atenção à saúde.(AU)

Zika Virus Outbreak on Curaçao and Bonaire, a Report Based on Laboratory Diagnostics Data.

Background: Zika virus (ZIKV) emerged in May 2015 in Brazil, from which it spread to many other countries in Latin America. Cases of ZIKV infection were eventually also reported in Curaçao (January 2016) and Bonaire (February 2016). Methods: In the period of 16 December 2015 until 26 April 2017, serum, EDTA-plasma or urine samples were taken at Medical Laboratory Services (MLS) from patients on Curaçao and tested in qRT-PCR at the Erasmus Medical Centre (EMC) in the Netherlands. Between 17 October 2016 until 26 April 2017 all samples of suspected ZIKV-patients collected on Curaçao, as well as on Bonaire, were tested at MLS. Paired urine and/or serum samples from patients were analyzed for ZIKV shedding kinetics, and compared in terms of sensitivity for ZIKV RNA detection. Furthermore, the age and gender of patients were used to determine ZIKV incidence rates, and their geozone location to determine the spatial distribution of ZIKV cases. Results: In total, 781 patients of 2820 tested individuals were found qRT-PCR-positive for ZIKV on Curaçao. The first two ZIKV cases were diagnosed in December 2015. A total of 112 patients of 382 individuals tested qRT-PCR-positive for ZIKV on Bonaire. For both islands, the peak number of absolute cases occurred in November 2016, with 247 qRT-PCR confirmed cases on Curaçao and 66 qRT-PCR-positive cases on Bonaire. Overall, a higher proportion of women than men was diagnosed with ZIKV on both islands, as well as mostly individuals in the age category of 25-54 years old. Furthermore, ZIKV cases were mostly clustered in the east of the island, in Willemstad. Conclusions: ZIKV cases confirmed by qRT-PCR indicate that the virus was circulating on Curaçao between at least December 2015 and March 2017, and on Bonaire between at least October 2016 and February 2017, with peak cases occurring in November 2016. The lack of preparedness of Curaçao for the ZIKV outbreak was compensated by shipping all samples to the EMC for diagnostic testing; however, both islands will need to put the right infrastructure in place to enable a rapid response to an outbreak of any new emergent virus in the future.

Health systems strengthening for noncommunicable disease control and healthy aging: integrated actions in Aruba and Curaçao.

Caribbean countries are experiencing social, epidemiological, and demographic transitions shaped by the growing elderly population and the rise of noncommunicable diseases (NCDs)-now responsible for 78% of all deaths. These circumstances demand rethinking the model of care to improve health outcomes and build more sustainable health systems with new orientations in policy, service delivery, organization, training, technology, and financing. Policy must be aimed towards healthy living, leveraging interventions that ensure healthy aging. The health system must proactively structure interventions to reduce the incidence of new NCD cases and to prevent related complications. Interventions should be focused on optimizing the individual's capacity, functional ability, and autonomy within adapted environments, as well as with the necessary preventive, long-term care, self-care, community care, and health system support.

Los países del Caribe están experimentando transiciones sociales, epidemiológicas y demográficas como resultado del envejecimiento de la población y el aumento de la prevalencia de las enfermedades no transmisibles (ENT), que en la actualidad causan el 78% de todas las defunciones. Estas circunstancias exigen replantear el modelo de atención para mejorar los resultados de salud y establecer sistemas de salud más sostenibles mediante nuevos enfoques en políticas, prestación de servicios, organización, capacitación, tecnología y financiamiento. Las políticas deben tener como propósito procurar una vida saludable, aprovechando las intervenciones que garanticen el envejecimiento saludable. El sistema de salud debe ser proactivo, estructurando las intervenciones para reducir la incidencia de nuevos casos de ENT y para prevenir las complicaciones relacionadas. Las intervenciones deben centrarse en optimizar la capacidad funcional, la autonomía y el desenvolvimiento general de la persona dentro de un entorno adaptado y con el apoyo necesario del sistema de salud en materia de atención preventiva, cuidados a largo plazo, de autocuidado y de atención en la comunidad.

Os países do Caribe estão passando por transições sociais, epidemiológicas e demográficas configuradas pela população de idosos cada vez maior e a ascensão das doenças não transmissíveis (DNTs), já responsáveis por 78% de todas as mortes. Essas circunstâncias exigem repensar o modelo de atenção para melhorar os desfechos de saúde e construir sistemas de saúde mais sustentáveis, com novas orientações de política, prestação de serviços, organização, treinamento, tecnologia e financiamento. As políticas devem ser orientadas para a vida saudável, alavancando intervenções que asseguram o envelhecimento saudável. O sistema de saúde deve estruturar proativamente intervenções para reduzir a incidência de novos casos de DNT e a prevenir as complicações relacionadas. As intervenções devem se concentrar na otimização da capacidade do indivíduo, das habilidades funcionais e da autonomia dentro de ambientes adaptados, e também nas ações preventivas a para assistência de longa duração, no autocuidado, na atenção na comunidade e no apoio pelos sistemas de saúde.

Benefits and limitations of three-dimensional printing technology for ecological research.

BACKGROUND: Ecological research often involves sampling and manipulating non-model organisms that reside in heterogeneous environments. As such, ecologists often adapt techniques and ideas from industry and other scientific fields to design and build equipment, tools, and experimental contraptions custom-made for the ecological systems under study. Three-dimensional (3D) printing provides a way to rapidly produce identical and novel objects that could be used in ecological studies, yet ecologists have been slow to adopt this new technology. Here, we provide ecologists with an introduction to 3D printing. RESULTS: First, we give an overview of the ecological research areas in which 3D printing is predicted to be the most impactful and review current studies that have already used 3D printed objects. We then outline a methodological workflow for integrating 3D printing into an ecological research program and give a detailed example of a successful implementation of our 3D printing workflow for 3D printed models of the brown anole, Anolis sagrei, for a field predation study. After testing two print media in the field, we show that the models printed from the less expensive and more sustainable material (blend of 70% plastic and 30% recycled wood fiber) were just as durable and had equal predator attack rates as the more expensive material (100% virgin plastic). CONCLUSIONS: Overall, 3D printing can provide time and cost savings to ecologists, and with recent advances in less toxic, biodegradable, and recyclable print materials, ecologists can choose to minimize social and environmental impacts associated with 3D printing. The main hurdles for implementing 3D printing-availability of resources like printers, scanners, and software, as well as reaching proficiency in using 3D image software-may be easier to overcome at institutions with digital imaging centers run by knowledgeable staff. As with any new technology, the benefits of 3D printing are specific to a particular project, and ecologists must consider the investments of developing usable 3D materials for research versus other methods of generating those materials.

Human papillomavirus (HPV) types prevalence in cervical samples of female sex-workers on Curaçao.

Sex-workers have an increased risk for high-risk HPV(hrHPV) cervical cancer. On Curaçao, legal and illegal prostitution practice is high and the promiscuous lifestyle is common. We aimed to gain insight in HPV-genotype prevalence in cervical scrapes of female sex workers (FSW) and related risk factors in comparison with women not working in the sex industry. Cervical samples were taken from 76 FSW and 228 non-FSW (NFSW) age matched controls in the period between 2013 and 2015. HPV was detected by GP5+/6+ PCR-EIA followed by genotyping via reverse line-blot. HPV prevalence in FSWs was 25.0% and in NFSWs 29.4% (p = 0.14). NFSW had more often untypable HPV-genotypes (HPV-X:5.3% vs 0.0%; p = 0.042). A trend for statistical difference was observed in HPV prevalence between FSWs from Dominican Republic (42.1%) and FSWs from Colombia (19.2%; p = 0.067). Young age was the only risk factor related to HPV prevalence in FSWs. (Mean age FSW 29.2 y ±7.8 and NFSW 33 y ±6.2) Smoking and drugs consumption were significantly higher among FSW. A significant higher number of women with history of any STD was reported by NFSWs. In addition, >90% of FSW had their previous Pap smear <3 years ago, while >35% NFSW never had a previous Pap smear (p < 0.001). IN CONCLUSION: no significant difference in HPV prevalence is observed between FSW and NFSW. HPV prevalence in FSW was associated with a lower age. During interviews, FSW seemed more aware about prevention strategies, reported less history of STD's and were more updated with cervical cancer screening, compared to NFSWs.

Bioaccumulation of mercury and other metal contaminants in invasive lionfish (Pterois volitans/miles) from Curaçao.

A wide range of ecological and environmental factors influence metal bioaccumulation in fish. Studies of mercury and other metal contaminants in invasive Indo-Pacific lionfish are limited, yet consumption of the invasive predator is increasingly utilized as a management strategy. In this study, we examined the effects of body size, body condition, sex, trophic level, carbon source, diet, depth and capture location on mercury concentrations in lionfish collected from Curaçao. In addition, we examined whether or not a local petroleum refinery is the source of metal contamination in lionfish. Mercury concentrations ranged from 0.008 to 0.106 mg/kg and we found no effect of the petroleum refinery on metal bioaccumulation in lionfish. Low concentrations of metal contaminants indicate lionfish from Curaçao are safe for human consumption.

High prevalence of high-risk HPV genotypes other than 16 and 18 in cervical cancers of Curaçao: implications for choice of prophylactic HPV vaccine.

BACKGROUND: Curaçao is a Dutch-Caribbean Island located in a high-risk area for cervical cancer.Prior to introduction of a prophylactic human papillomavirus (HPV) vaccine, knowledge of the prevalence of high-risk HPV vaccine genotypes (HPV16, 18, 31, 33, 45, 52 and 58) in cervical (pre)cancer is required. OBJECTIVE: To investigate the prevalence of HPV genotypes in invasive cervical cancers (ICC) and cervical intraepithelial neoplasia (CIN) grade 1, 2 and 3 in Curaçao. METHODS: Paraffin-embedded blocks of 104 cervical cancers (89 squamous, 15 adenocarcinoma), 41 CIN3, 39 CIN2 and 40 CIN1 lesions were analysed for the presence of HPV. Sections were stained by H&E for histopathological evaluation, and DNA was extracted using proteinase K. HPV genotypes were detected using Short PCR Fragment (SPF10) PCR DNA enzyme immunoassay and a Line Probe Assay (LiPA25) . RESULTS: HPV was found in 92 (88.5%) ICC; 87 (94.6%) had a single HPV infection and 86 (93.5%) were high-risk human papillomavirus (hrHPV)-type positive.The three most common HPV types in ICC were 16 (38.5%), 18 (13.5%) and 45 (6.7%), covering 58.7%.HrHPV vaccine genotypes 16, 18, 31, 35, 45, 52 and 58 were responsible for 73.1% of ICC. For precancerous lesions, the HPV attribution was 85.4% for CIN3, 66.7% for CIN2% and 42.5% for CIN1. CONCLUSIONS: Our study, the largest in the Caribbean region in (pre)cancer, shows that the prevalence of HPV-type 16 and 18 in cervical cancer is lower compared with the world population but no differences in prevalence of these two HPV types are seen in precancerous lesions.When considering HPV vaccination in Curaçao, the relatively high contribution of non-HPV 16/18 genotypes in ICC should be taken into account.