Eiland op drift : de sociale organisatie van een kleine Caribische samenleving : St. Eustatius

The island of St. Eustatius is one of the least known and forgotten places within the Kingdom of the Netherlands. Yet the island does have an illustrious history and it played an important part in trade within the Caribbean area, particularly in the eighteenth century. St. Eustatius was an important intermediary in the smuggling trade - especially of weapons - between Europe and the English colonies of North ,America who were fighting for their independence. From the nineteenth century onwards, however, the social economy of the island has, for a variety of reasons, continuously gone downhill. The construction of the oil refineries on Curaçao and Aruba, which also created jobs for many inhabitants of St. Eustatius, was not able to bring this economic decline to a halt.At the present time the island has to contend with numerous social and economic problems. There are few sources of income: agriculture and fishing stagnate, there is no industry of any importance and the island's Public Works Service functions as a disguised form of relief employment. it must be feared that the execution of infrastructural works, in particular the restorations of buildings of historic interest, can only offer incidental relief for the unemployment problem. In any event it is no real financial-economic reorganisation, since the necessary funds are largely made available by the Netherlands on an ad hoc basis. It is possible that small scale tourism can offer more perspective in the future.There is little social cohesion within the Statian society. This does not mean that the different social levels live in conflict or enmity with each other, but rather that there are certain social forces present within the society which stand in the way of a co-operative spirit or feelings of solidarity. The absence of these feelings is not coupled to particular characteristics inherent to the separate strata, but appear in all levels of society. We are thinking here principally of the autochthonic population. In particular, the character of the local politics and the religious diversity within this society determine to a large extent this absence of social cohesion.In many respects the island finds itself in a very dependent position. This dependence is not only of a geographical, but also of a socio -economic and cultural nature. This study aims at describing this precarious position as fully as possible. Besides this it will attempt to subject the backgrounds and the more fundamental causes of the socio -economic problems to a more thorough analysis. In the light of this we have set ourselves the task of seeking clarification in the following problem areas.1. How has the society of St. Eustatius developed throughout its history from a socio -economic viewpoint?2. What are the determinants and the characteristics of the present socio -economic position of the island, and in particular, what determinative aspects may be distinguished as arising from the political and religious processes within this society?3. What external forces help to determine the present socio -economic position of the island?The formulation of these questions gives direction to our sociographical work and is not in the first instance intended to form the basis for pioneering theoretical work within the field of Caribbean sociology.From the very beginning we have always believed that our study should have a clear practical relevance.The coming independence of the Netherlands Antilles demands studies that can contribute to an improvement and a strengthening of the socio -economic situation of the member communities within the new independent state. This justification is clearly described in the introduction to this study. The necessary attention to the formulation of the problems and the methodsand instruments of investigation is also given there.For the sake of familiarisation a short description of the location is given in the introductory paragraphs. Numerous problems which are to be discussed in more detail later on are touched upon there.The book consists further of four parts: the history of the island is described in part I; the economy of St. Eustatius is discussed in part II; a description and analysis of the social organization of this society follows in part Ill and in part IV a final review is given in which we attempt to present an integrated analysis of the material introduced so far.The history of the island has been somewhat turbulent. In the first chapter we will describe the colonisation of the island and its development from an agricultural colony to an important transit harbour for slaves and other "items of trade". This period reached a climax in the seventies of the eighteenth century. The year 1781 marks a turning point in the history of the island. In that year it was overrun and dismantled by a British fleet under the command of admiral Rodney. This is certainly not the only nor the most important reason why the island drifted slowly but surely into poverty during the nineteenth century. These developments are comprehensively treated in the second chapter of part I, in which equal attention is paid to the social and economic developments in our own century. Since the Second World War, (financial) aid to St. Eustatius has developed slowly but surely. This aid, however, did not, unfortunately, make an end of the poor socio -economic climate on the island.As already stated, part II of the book discusses the economy of the island. Describing this economic situation is a sad occasion. Structurally the situation can only be called very poor. In the recent past numerous reports have been published and advices given but, in our view, they are insufficiently based on a thorough study of the underlying causes of the socio -economic impasse. We describe the incomes situation and the problems connected with forms of employment in this part. Further the primary sources of income are reviewed and here it is noticed that the island government plays an important rôle as employer. In anticipation of what is to be remarked in the final review in this book, we consider the possible economic perspectives for this island in respect of its present economic situation. After having recorded some theoretical comments on the concept "culture of poverty,' we come to the conclusion that it is undesirable and dangerous to maintain this concept as a possible explanation for the economic malaise. The following part of the study describes and analyses the social organisation of the society. We pay attention to the social stratification in the first chapter of this part. Comments are placed by the different social layers making up the society, amongst other things differentiating between the autochthonic and allochthonic populations. Following this there is a fairly detailed description of some community services in which schooling particularly is placed in the broader context of the educational problems of the Netherlands Antilles as a whole.We have already remarked that the absence of social cohesion results to a large extent from both the nature and content of the island politics and from the religious diversity. This circumstance is sufficient reason for us to examine both institutions thoroughly in separate chapters. The concept "political patronage" is treated fairly deeply and theoretically in the discussionof politics on St. Eustatius. This theoretical excursion does have an instrumental rather than a theory-forming character. A better understanding of the functioning of the (political) patronage system as such will clarify, in our opinion, the insight in the way in which politics are carried on within the society described. Besides this we pay special attention to the historical development of the political life on the island as well as the growth of the party system.A theoretical excursion is also appropriate in the analysis of religious life on St. Eustatius. This excursion is principally directed to the development of sectarian groupings, of which the Seventh-Day Adventists are a striking example. There are three religious groups on St. Eustatius, the Methodists, the Roman Catholics and the Seventh-Day Adventists. The Seventh-DayAdventists through their pronounced way of life and their implacable attitude towards dissenters heavily influence the island's social organization.The nature and the origin of religious organization are subjected to an extensive review, whilst the manner in which religion helps structure community life is investigated.A sociographically oriented study is not complete without paying attention to the pattern of primary relations. We do this in the last chapter of part III by treating in detail the characteristics of the primary groups such as the family and the peer group.Before analysing the relationships within Statian family life we briefly describe how this material is treated in the relevant Caribbean sociology and anthropology.This theoretical intermezzo is not intended ot add new concepts to the still increasing store of theoretical ideas. The notes serve in the first place to give the reader more background information regarding the wide diversity of thought concerning Caribbean family life. We attempt to make our review as concrete as possible by treating fairly deeply what one might call "the round of life". Every day life in all its aspects is reviewed, with separate attention being given to the life styles of the young, the adult and the aged.This is backed up by demographic statistical material, partly taken from the results of the mini-census conducted by us on the island. The living conditions of the population are also given the necessary attention.The study is closed with a number of final comments in which we attempt to make a connection between the different socio -economic developments and the related psychological effects.We arrive at this synthesis through an analysis from three different viewpoints. In the first place we pay some attention to a number of important historical developments of a material nature as well as the psychological effects that accompany them. Following this we attempt to show how those island in stitutions have helped induce particular material developments. Here again psychological aspects play a significant rôle. Finally the connection that exists between particular material developments and the position that the island occupies within wider socio -economic and constitutional areas is treated in more depth.We do not give an analysis of possible causal relations in a strict statistical sense in this last chapter. We also do not attempt to determine the importances of the different connections relative to each other. The method used in the investigation and the character of our data do not permit such a thoroughgoing analysis. In these final thoughts we do, however, confront the material developments and the psychological effects stemming from different sources with each other. This is done with the help of a simple relation matrix in which four meaningful relation possibilities are anchored;- The effect of the historical development on the institutional form of the society.- The effect of the historical development on the external relations of the society.- The effect of the institutional forms on the external relations and- the effect of the external relations m the institutional forms.In these final considerations we of necessity consider more deeply the dependent position of the island. This more detailed treatment is coupled to a theoretical and critical discussion of the so-called "dependency theories".From our final reviewing we may conclude that only an integrated approach to the socio -economic development of the island has any chance of succes. Such a strategy should offer the means which both in combination and simultaneously can serve to reduce and/or remove the material and psychological barriers resulting from the historical developments, the institutional forms and the external dependence respectively. Only then is there a chance that the willingness of the population for change can be increased, after which the realisation of this change can be carried through in a fruitful manner. It is evident that this has important consequences for the manner in which the aid to St. Eustatius should be given.In the last paragraph of this study we attempt to formulate a programme of starting points and lines of action which can serve as the "Leitbild" for an adequate development strategy for an island which, although unintentionally, has without a doubt gone adrift.<p/

The global financial crisis and its aftermath: Economic and political recalibration in the non-sovereign Caribbean

© 2017, © 2017 CALACS. The small non-sovereign island jurisdictions (SNIJs) of the Caribbean have a privileged position in the global political economy, with significant political and economic autonomy on the one hand, and useful protections and support structures provided by their metropolitan powers on the other. However, the global financial and economic crisis of 2007–2008 highlighted starkly some of the fragilities of this privileged status; in particular their economic vulnerability and the unequal and often fractious relationship with their metropolitan powers. This article considers the British, Dutch, French, and US jurisdictions and the short- and longer-term impacts of the crisis. The article’s key concern is to assess the extent to which the instability in the global economy over the last decade has affected both the economic and political dynamic of these jurisdictions, and to what extent their unique position in the global political economy has been compromised

Effects of CYP3A4*22 and CYP3A5 on clinical outcome in patients treated with ticagrelor for ST-segment elevation myocardial infarction: POPular Genetics sub-study

Aims: To determine the clinical efficacy, adverse events and side-effect dyspnea of CYP3A4*22 and CYP3A5 expressor status in ticagrelor treated patients.Methods and results: Ticagrelor treated patients from the POPular Genetics randomized controlled trial were genotyped for CYP3A4*22 and CYP3A5*3 alleles. Patients were divided based on their genotype. In total 1,281 patients with ST-segment elevation myocardial infarction (STEMI) were included. CYP3A4*22 carriers (n = 152) versus CYP3A4*22 non-carrier status (n = 1,129) were not found to have a significant correlation with the primary thrombotic endpoint: cardiovascular death, myocardial infarction, definite stent thrombosis and stroke [1.3% vs. 2.5%, adjusted hazard ratio 1.81 (0.43–7.62) p = 0.42], or the primary bleeding endpoint: PLATO major and minor bleeding [13.2% vs. 11.3%, adjusted hazard ratio 0.93 (0.58–1.50) p = 0.77]. Among the CYP3A4*1/*1 patients, CYP3A5 expressors (n = 196) versus non-expressors (n = 926) did not show a significant difference for the primary thrombotic [2.6% vs. 2.5%, adjusted hazard ratio 1.03 (0.39–2.71) p = 0.95], or the primary bleeding endpoint [12.8% vs. 10.9%, adjusted hazard ratio 1.13 (0.73–1.76) p = 0.58]. With respect to dyspnea, no significant difference was observed between CYP3A4*22 carriers versus CYP3A4*22 non-carriers [44.0% vs. 45.0%, odds ratio 1.04 (0.45–2.42) p = 0.93], or in the CYP3A4*1/*1 group, CYP3A5 expressors versus CYP3A5 non-expressors [35.3% vs. 47.8%, odds ratio 0.60 (0.27–1.30) p = 0.20].Conclusion: In STEMI patients treated with ticagrelor, neither the CYP3A4*22 carriers, nor the CYP3A5 expressor status had a statistical significant effect on thrombotic and bleeding event rates nor on dyspnea.Clinical Trial Registration:ClinicalTrials.gov, identifier NCT01761786

Tuberculosis mortality and the male survival deficit in rural South Africa:An observational community cohort study

BACKGROUND: Women live on average five years longer than men, and the sex difference in longevity is typically lower in populations with high mortality. South Africa-a high mortality population with a large sex disparity-is an exception, but the causes of death that contribute to this difference are not well understood. METHODS: Using data from a demographic surveillance system in rural KwaZulu-Natal (2000-2014), we estimate differences between male and female adult life expectancy by HIV status. The contribution of causes of death to these life expectancy differences are computed with demographic decomposition techniques. Cause of death information comes from verbal autopsy interviews that are interpreted with the InSilicoVA tool. RESULTS: Adult women lived an average of 10.4 years (95% confidence Interval 9.0-11.6) longer than men. Sex differences in adult life expectancy were even larger when disaggregated by HIV status: 13.1 (95% confidence interval 10.7-15.3) and 11.2 (95% confidence interval 7.5-14.8) years among known HIV negatives and positives, respectively. Elevated male mortality from pulmonary tuberculosis (TB) and external injuries were responsible for 43% and 31% of the sex difference in life expectancy among the HIV negative population, and 81% and 16% of the difference among people living with HIV. CONCLUSIONS: The sex differences in adult life expectancy in rural KwaZulu-Natal are exceptionally large, atypical for an African population, and largely driven by high male mortality from pulmonary TB and injuries. This is the case for both HIV positive and HIV negative men and women, signalling a need to improve the engagement of men with health services, irrespective of their HIV status

Gender differences in the use of cardiovascular interventions in HIV-positive persons; the D:A:D Study

Peer reviewe