Population Health in the Dutch Caribbean: A comparative study of political context and health policy performance

This thesis focuses on population health in the Dutch Caribbean islands of Aruba and Curaçao, as compared to the Netherlands and to other Caribbean states. It aims to provide a better insight into the health situation in the Dutch Caribbean, and the factors related to this health situation, in particular the role of the political context and health policy performance. In order to address this aim, we have made use of data that are derived from cross-sectional health surveys, mortality registration systems, harmonized international databases and country reports and cover theory from the fields of public health, medicine, political science, organization science, economics and sociology. The main conclusion of this thesis is that the health of the Dutch Caribbean population is poorer than in the Netherlands and other politically affi

Differences in life expectancy between four Western countries and their Caribbean dependencies, 1980-2014

Background: In the Caribbean, life expectancy in politically independent territories has increasingly diverged from that of territories that remained affiliated to their former colonizers. Because these affiliated territories differ in degree of political independence, they are not all governed in the same way. We assessed whether differences in life expectancy trends between Caribbean dependencies and their Western administrators were related to their degree of political independence, and which causes of death contributed to divergence or convergence in life expectancy. Methods: Analysis of age-standardized death rates and decomposition of life expectancy differences between France, the Netherlands, UK, USA and their Caribbean dependencies by age and cause-of-death during the period 1980-2014. Results: Life expectancy differences between Western countries and their dependencies have generally increased for men and narrowed for women, but trends have been much more favorable in the French- than in the Dutch-administered territories. The strongest contributions to widening gaps in life expectancy between Western countries and their dependencies were from mortality from cardiovascular diseases (ischemic heart disease) and external causes (homicide and traffic accidents). Conclusion: Dependencies with a stronger political affiliation to a Western country experienced more favorable life expectancy developments than dependencies that had more autonomy during the 1980-2014 period. The underlying mortality differences with Western countries are largely comparable among Caribbean territories but differ in magnitude, most notably for cardiovascular disease and external causes. This suggests that increases in a territory's political autonomy impairs the diffusion of new knowledge and techniques, and/or reduces government's effectiveness in implementing policies

Modelling the rotation period distribution of M dwarfs in the Kepler field

McQuillan et al. (Mon. Not. R. Astron. Soc.432:1203, 2013) presented 1570 periods P of M dwarf stars in the field of view of the Kepler telescope. It is expected that most of these reflect rotation periods, due to starspots. It is shown here that the data can be modelled as a mixture of four subpopulations, three of which are overlapping log-normal distributions. The fourth subpopulation has a power law distribution, with P −1/2. It is also demonstrated that the bulk of the longer periods, representing the two major sub-populations, could be drawn from a single subpopulation, but with a period-dependent probability of observing half the true period

Epilepsy in Dcx Knockout Mice Associated with Discrete Lamination Defects and Enhanced Excitability in the Hippocampus

Patients with Doublecortin (DCX) mutations have severe cortical malformations associated with mental retardation and epilepsy. Dcx knockout (KO) mice show no major isocortical abnormalities, but have discrete hippocampal defects. We questioned the functional consequences of these defects and report here that Dcx KO mice are hyperactive and exhibit spontaneous convulsive seizures. Changes in neuropeptide Y and calbindin expression, consistent with seizure occurrence, were detected in a large proportion of KO animals, and convulsants, including kainate and pentylenetetrazole, also induced seizures more readily in KO mice. We show that the dysplastic CA3 region in KO hippocampal slices generates sharp wave-like activities and possesses a lower threshold for epileptiform events. Video-EEG monitoring also demonstrated that spontaneous seizures were initiated in the hippocampus. Similarly, seizures in human patients mutated for DCX can show a primary involvement of the temporal lobe. In conclusion, seizures in Dcx KO mice are likely to be due to abnormal synaptic transmission involving heterotopic cells in the hippocampus and these mice may therefore provide a useful model to further study how lamination defects underlie the genesis of epileptiform activities

De vele uitdagingen van de gezondheidszorg in Suriname sinds 1975

Suriname inherited a weak colonial health system after political independence in 1975. In the decades that followed, political and economic developments have had an undeniable influence on the health situation and healthcare in Suriname, as well as on the (feasibility of the implementation of) plans to reform the healthcare system. The Surinamese health outcomes are not only particularly unfavorable compared to the Netherlands, but also compared to other states in the Caribbean region. Some national determinants strongly related to the implementation of effective health measures contribute to this: a low GDP, low control on corruption, sparsely populated areas and high ethnic diversity. The enormous impact of the COVID-19 pandemic in Suriname appears to have been the tipping point for a renewed relationship with the Netherlands. Almost 50 years after political independence, the Surinamese Ministry of Health, with the support of funding and expertise from the Netherlands, is embarking on an ambitious program to restore the health system

Contribution of amenable mortality to life expectancy differences between the Dutch Caribbean islands of Aruba and Curacao 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 calculate