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During the 20 th century, infectious disease morbidity and mortality generally waned while chronic degenerative diseases posed a growing burden at the global level. The population on Saba, Netherlands Antilles, has recently experienced such an epidemiologic transition, and hypertension was reported to be extraordinarily high, although no prevalences have been reported and relationships with lifestyle factors associated with rapid modernization have not been explored.

In this study, a medical and demographic questionnaire, as well as body composition and blood pressure measures were collected from Saban men and women aged years. In a second phase, individuals of the were invited to receive a longer questionnaire on individual exposure to modernizing influences such as travel and education. Higher blood pressure was associated with having lived in fewer different places in the past; those who stayed only on Saba or Statia had higher blood pressures than those who had also lived in more modernized areas.

However, this was no longer statistically significant after adjustment for age and BMI. Lifestyle incongruity was positively associated with higher blood pressure in that those with more discord between material wealth and income were more likely to be hypertensive, and this remained statistically significant after adjustment for age and adiposity. In summary, hypertension is highly prevalent on Saba, and tended to be associated with greater age, adiposity, Afro-Caribbean ancestry and lifestyle incongruity.

Natural experimental models of disease are becoming increasingly useful to biomedical scientists Garruto et al. By studying a population in a relatively homogeneous environment, such as island isolates, it is possible to eliminate some factors, and focus on others thought to contribute to a specific disease.

Island models of modernization and chronic disease have been successfully developed for Samoa Baker, , Trinidad Miller et al. Lucia Dressler, among others. The island of Saba, Netherlands Antilles, is an example of a natural experimental model area, being of small size 5. Until the 's, Saba was relatively isolated due to lack of air service and little tourism or other sources of revenue.

Following a population boom in the late 19 th century, Saba subsequently experienced rapid depopulation, as men predominantly left the island for work MacQueen, Because of the high prevalence of hypertension that has been reported on the island Miller et al. Reprinted with permission from MacQueen Map of The Caribbean with Saba position noted.

Of particular importance in the epidemiology of hypertension, Saba has proceeded through a period of rapid economic modernization over the past years. Populated initially by a small group of Arawak people, the first European settlement of the island occurred in by a small group of shipwrecked Englishmen Figure 3 Hartog, This was followed shortly by Dutch settlement in Unable to support a large population due to its thin soil and steep terrain, the island had at its peak only people.

Travel between villages was precarious and travel to the island from other islands was limited. This, and the frequent out-migrations for work that occurred over the past years especially for men may have resulted in population bottlenecks over the years.

Our analysis of vital records covering over individuals born on Saba since indicate that more than of them belong to one, large, extended pedigree. Previous accounts of the health of the people on Saba include a book written by a physician on the island Mol, and a study on diet diversity in relation to hypertension Miller et al. Mol cited hypertension, skin tumors and Type II diabetes mellitus as the primary medical conditions. He also described the demographic characteristics of the island and detailed his work with the residents.

Miller et al attempted to link the high prevalence of hypertension in the population with a lack of diet diversity among the islanders, specifically a lack of legumes. This theory has not been corroborated elsewhere. While hypertension was reportedly prevalent, no studies have yet ascertained if there is a relationship between modernization of the island and high rates of hypertension.

Through a survey of hypertension and obesity on the island and examination of lifestyle factors, this study aims to examine the interrelationship between hypertension and economic modernization. The most current census in estimated a population of 1, indigenous residents i. Of these, approximately were adults over 18 years of age. The population lives in two large villages The Bottom and Windwardside and two smaller villages St. John's and Hell's Gate. A sample of Saban adults was targeted for this study.

The subjects were recruited through open houses at the local community centers and through house-to-house and workplace visits. Out of approximately households, we knocked on the doors of Someone eligible for the study answered at approximately of those houses and someone agreed to participate at approximately houses.

A total of adults participated in the first phase of the study. These participants completed brief demographic age, sex, ethnicity, employment and medical questionnaires personal and familial history of hypertension and obesity along with questions on personal use of anti-hypertensives and oral contraceptives. For the second phase of the study, we contacted th4e original participants to determine whether they would be interested in continuing with the study.

The continuation consisted of a longer questionnaire and an interview focused on lifestyle and activity habits, income and educational level. Out of the original participants, agreed to participate in a follow-up interview. No other traits gender, ethnicity, employment differed between those who participated in Phase 2 and those who did not. For the first phase of the study, height was measured, in bare feet, on a flat surface with a standard anthropometer.

Weight was measured with a Tanita BF scale with subjects wearing light, tropical clothing. Triceps skinfolds were measured with Lange skinfold calipers. Resting, seated systolic and diastolic blood pressures were measured with a Welch Allyn sphygmomanometer, using the appropriate cuff size. Ethnicity was coded as Afro-Caribbean, Caucasian, or other. Questions in the second phase were grouped into the following categories: The most common travel off island was to St.

Eustatius Statia , the US and the Netherlands. This was done to reflect the greater value historically placed on off-island education. These last two categories were scored backwards so that the more social and family contacts an individual had, the lower the modernization score. Independent t tests were used to test sex differences.

Multivariate linear and logistic regression models were constructed to test body composition and lifestyle factors related to the level of systolic and diastolic blood pressure and risk of hypertension. Initially, each variable was entered singly, and those that were statistically significant were sequentially added into larger models containing other significant variables.

Lifestyle incongruity was measured using a model published previously Bindon et al. Hypertension status was examined as the dependent variable and age, triceps skinfold, activity level, sex, aggregate socioeconomic rank defined as: Table 1 shows the descriptive statistics for the original sample population.

Expected sex differences in body composition and blood pressure were observed. There was no difference between treated and untreated groups based on age, gender, ethnicity or village of residence and thus these groups were combined into one group hypertensives for further analysis.

In addition there were 10 individuals who reported that they had been told they were hypertensive once, or only when pregnant, and were not on anti-hypertensive medication.

Univariate analysis of systolic blood pressure showed significant statistical associations between sex, age, BMI, occupation and ethnicity, with those being male, older, heavier, those having no employment, or being of Afro-Caribbean ancestry having higher systolic blood pressures than women, younger, leaner individuals and those holding office employment or being of non-Caucasian or non-Afro-Caribbean ancestry Table 2.

The relationships with diastolic blood pressure were similar data not shown. When occupation and ethnicity were adjusted for age, sex and BMI, however, their effects on systolic blood pressure levels were diminished. Afro-Caribbean subjects also had higher risk of hypertension, but this was no longer statistically significant after adjustment for age and BMI.

For the models from the Phase 2 survey of socioeconomic factors and exposure to modernizing influences, residential history was statistically significant, with adults who had lived only on Saba or nearby Statia island having 7 mm Hg higher systolic blood pressure and higher risk of hypertension than those who had lived in the larger, more affluent St. Maarten or outside the Caribbean region Table 3. However, when residential history and social contact were adjusted for age and BMI, their effects on systolic blood pressure and the risk of hypertension were no longer statistically significant.

Again, diastolic blood pressure showed similar trends as systolic blood pressure and so were not shown. Although our study was not powered or designed to simultaneously examine age versus birth cohort effects, we attempted to explore this by stratifying the sample on year of birth before and after , the median birth year , and comparing the risk of hypertension associated with residence history, social contact and occupation in the two cohorts.

We found a stronger relationship between off-island residence history and hypertension in the older cohort, but no difference in the effects of social contact and occupation. This was true even when age was controlled for in the model. Relationship between lifestyle incongruity and risk of hypertension, logistic regression model. Chronic hypertension was first recognized as a problem in the Caribbean in the 's Halberstein, In the US, hypertension is seen more in people of African-American descent than in Caucasians Dressler and Bindon ; Collins and Winkleby, , and this ethnic disparity was also evident in the current study.

One of the aims of this study was to examine economic modernization and lifestyle influences on blood pressure and hypertension in Saba. Hypertension and obesity have been implicated in several studies as a result of rapid modernization Shapiro, ; Chiang et al. With the introduction and increased accessibility of processed food and other modern conveniences, the relative rates of both hypertension and obesity tend to increase.

Counter to our expectations, we found that a history of extended residency outside the Caribbean region e. None of the other individual measures of affluence or exposure to Western cultural influences were associated with risk of hypertension. One possible explanation is that individuals who were younger and leaner had higher scores on affluence and Western style of life, yet lower risks of hypertension.

We suspect that the apparent protection of affluence and exposure to Western influences may be due to the negative correlation of age and those factors. When age and BMI were accounted for, occupation, residence history and extent of social contact were no longer statistically significant. Although the cross-sectional nature of the data does not allow us to clearly distinguish cohort and age effects from one another, we explored differences in the relationship of lifestyle factors on blood pressure and hypertension between those born before and those born after median split.

These results suggest that while the association between hypertension and residence history may differ between the earlier cohort and the most recent cohort, other variables such as occupation and social contacts did not differ.

This may be because of the more recent changes in occupation and social contacts compared to those changes in residence history among people on the island, where there has been a large amount of migration on and off the island since the 's. This is important because there has been a substantial shift in affluence, access to different types of food and cars since the 's.

These factors became more widespread in the 's and the younger cohort has been exposed to much more of these factors than previous cohorts. This finding is in line with that of Dressler, who found that status inconsistency that is, having differing scores on categories of modernization using scales of social factors , led to an increase in blood pressure Dressler, Specifically, owning more things than one could afford led to an increase in blood pressure.

However, more social contact was found to be protective, which was not found here. It is possible that the extensive government welfare support on Saba is creating a picture of hypertension that more greatly resembles that of a developed nation, in which chronic disease risk is concentrated in the lower socioeconomic strata.

Many of the lifestyle and modernization factors hypothesized to be associated with elevated blood pressure e. Salt or mineral intake through the water catchment system and diet may also be to blame for the unusually high blood pressures seen on the island, although sodium chloride as a factor has been far from conclusive in other studies James et al.

Continuing work focuses on estimating the heritability of blood pressure and obesity on Saba, and the interaction of genetic predisposition and lifestyle factors on hypertension risk.

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Blood Pressure and Lifestyle on Saba, Netherlands Antilles

Lucia Dressler, among others. The island of Saba, Netherlands Antilles, is an example of a natural experimental model area, being of small size 5. Until the 's, Saba was relatively isolated due to lack of air service and little tourism or other sources of revenue. Following a population boom in the late 19 th century, Saba subsequently experienced rapid depopulation, as men predominantly left the island for work MacQueen, Because of the high prevalence of hypertension that has been reported on the island Miller et al.

Reprinted with permission from MacQueen Map of The Caribbean with Saba position noted. Of particular importance in the epidemiology of hypertension, Saba has proceeded through a period of rapid economic modernization over the past years. Populated initially by a small group of Arawak people, the first European settlement of the island occurred in by a small group of shipwrecked Englishmen Figure 3 Hartog, This was followed shortly by Dutch settlement in Unable to support a large population due to its thin soil and steep terrain, the island had at its peak only people.

Travel between villages was precarious and travel to the island from other islands was limited. This, and the frequent out-migrations for work that occurred over the past years especially for men may have resulted in population bottlenecks over the years. Our analysis of vital records covering over individuals born on Saba since indicate that more than of them belong to one, large, extended pedigree.

Previous accounts of the health of the people on Saba include a book written by a physician on the island Mol, and a study on diet diversity in relation to hypertension Miller et al.

Mol cited hypertension, skin tumors and Type II diabetes mellitus as the primary medical conditions. He also described the demographic characteristics of the island and detailed his work with the residents. Miller et al attempted to link the high prevalence of hypertension in the population with a lack of diet diversity among the islanders, specifically a lack of legumes.

This theory has not been corroborated elsewhere. While hypertension was reportedly prevalent, no studies have yet ascertained if there is a relationship between modernization of the island and high rates of hypertension.

Through a survey of hypertension and obesity on the island and examination of lifestyle factors, this study aims to examine the interrelationship between hypertension and economic modernization. The most current census in estimated a population of 1, indigenous residents i. Of these, approximately were adults over 18 years of age.

The population lives in two large villages The Bottom and Windwardside and two smaller villages St. John's and Hell's Gate. A sample of Saban adults was targeted for this study. The subjects were recruited through open houses at the local community centers and through house-to-house and workplace visits.

Out of approximately households, we knocked on the doors of Someone eligible for the study answered at approximately of those houses and someone agreed to participate at approximately houses. A total of adults participated in the first phase of the study. These participants completed brief demographic age, sex, ethnicity, employment and medical questionnaires personal and familial history of hypertension and obesity along with questions on personal use of anti-hypertensives and oral contraceptives.

For the second phase of the study, we contacted th4e original participants to determine whether they would be interested in continuing with the study. The continuation consisted of a longer questionnaire and an interview focused on lifestyle and activity habits, income and educational level.

Out of the original participants, agreed to participate in a follow-up interview. No other traits gender, ethnicity, employment differed between those who participated in Phase 2 and those who did not. For the first phase of the study, height was measured, in bare feet, on a flat surface with a standard anthropometer. Weight was measured with a Tanita BF scale with subjects wearing light, tropical clothing.

Triceps skinfolds were measured with Lange skinfold calipers. Resting, seated systolic and diastolic blood pressures were measured with a Welch Allyn sphygmomanometer, using the appropriate cuff size. Ethnicity was coded as Afro-Caribbean, Caucasian, or other. Questions in the second phase were grouped into the following categories: The most common travel off island was to St. Eustatius Statia , the US and the Netherlands. This was done to reflect the greater value historically placed on off-island education.

These last two categories were scored backwards so that the more social and family contacts an individual had, the lower the modernization score. Independent t tests were used to test sex differences. Multivariate linear and logistic regression models were constructed to test body composition and lifestyle factors related to the level of systolic and diastolic blood pressure and risk of hypertension. Initially, each variable was entered singly, and those that were statistically significant were sequentially added into larger models containing other significant variables.

Lifestyle incongruity was measured using a model published previously Bindon et al. Hypertension status was examined as the dependent variable and age, triceps skinfold, activity level, sex, aggregate socioeconomic rank defined as: Table 1 shows the descriptive statistics for the original sample population. Expected sex differences in body composition and blood pressure were observed.

There was no difference between treated and untreated groups based on age, gender, ethnicity or village of residence and thus these groups were combined into one group hypertensives for further analysis.

In addition there were 10 individuals who reported that they had been told they were hypertensive once, or only when pregnant, and were not on anti-hypertensive medication.

Univariate analysis of systolic blood pressure showed significant statistical associations between sex, age, BMI, occupation and ethnicity, with those being male, older, heavier, those having no employment, or being of Afro-Caribbean ancestry having higher systolic blood pressures than women, younger, leaner individuals and those holding office employment or being of non-Caucasian or non-Afro-Caribbean ancestry Table 2.

The relationships with diastolic blood pressure were similar data not shown. When occupation and ethnicity were adjusted for age, sex and BMI, however, their effects on systolic blood pressure levels were diminished. Afro-Caribbean subjects also had higher risk of hypertension, but this was no longer statistically significant after adjustment for age and BMI. For the models from the Phase 2 survey of socioeconomic factors and exposure to modernizing influences, residential history was statistically significant, with adults who had lived only on Saba or nearby Statia island having 7 mm Hg higher systolic blood pressure and higher risk of hypertension than those who had lived in the larger, more affluent St.

Maarten or outside the Caribbean region Table 3. However, when residential history and social contact were adjusted for age and BMI, their effects on systolic blood pressure and the risk of hypertension were no longer statistically significant.

Again, diastolic blood pressure showed similar trends as systolic blood pressure and so were not shown. Although our study was not powered or designed to simultaneously examine age versus birth cohort effects, we attempted to explore this by stratifying the sample on year of birth before and after , the median birth year , and comparing the risk of hypertension associated with residence history, social contact and occupation in the two cohorts.

We found a stronger relationship between off-island residence history and hypertension in the older cohort, but no difference in the effects of social contact and occupation. This was true even when age was controlled for in the model. Relationship between lifestyle incongruity and risk of hypertension, logistic regression model. Chronic hypertension was first recognized as a problem in the Caribbean in the 's Halberstein, In the US, hypertension is seen more in people of African-American descent than in Caucasians Dressler and Bindon ; Collins and Winkleby, , and this ethnic disparity was also evident in the current study.

One of the aims of this study was to examine economic modernization and lifestyle influences on blood pressure and hypertension in Saba. Hypertension and obesity have been implicated in several studies as a result of rapid modernization Shapiro, ; Chiang et al. With the introduction and increased accessibility of processed food and other modern conveniences, the relative rates of both hypertension and obesity tend to increase.

Counter to our expectations, we found that a history of extended residency outside the Caribbean region e. None of the other individual measures of affluence or exposure to Western cultural influences were associated with risk of hypertension. One possible explanation is that individuals who were younger and leaner had higher scores on affluence and Western style of life, yet lower risks of hypertension. We suspect that the apparent protection of affluence and exposure to Western influences may be due to the negative correlation of age and those factors.

When age and BMI were accounted for, occupation, residence history and extent of social contact were no longer statistically significant. Although the cross-sectional nature of the data does not allow us to clearly distinguish cohort and age effects from one another, we explored differences in the relationship of lifestyle factors on blood pressure and hypertension between those born before and those born after median split.

These results suggest that while the association between hypertension and residence history may differ between the earlier cohort and the most recent cohort, other variables such as occupation and social contacts did not differ.

This may be because of the more recent changes in occupation and social contacts compared to those changes in residence history among people on the island, where there has been a large amount of migration on and off the island since the 's. This is important because there has been a substantial shift in affluence, access to different types of food and cars since the 's. These factors became more widespread in the 's and the younger cohort has been exposed to much more of these factors than previous cohorts.

This finding is in line with that of Dressler, who found that status inconsistency that is, having differing scores on categories of modernization using scales of social factors , led to an increase in blood pressure Dressler, Specifically, owning more things than one could afford led to an increase in blood pressure. However, more social contact was found to be protective, which was not found here. It is possible that the extensive government welfare support on Saba is creating a picture of hypertension that more greatly resembles that of a developed nation, in which chronic disease risk is concentrated in the lower socioeconomic strata.

Many of the lifestyle and modernization factors hypothesized to be associated with elevated blood pressure e. Salt or mineral intake through the water catchment system and diet may also be to blame for the unusually high blood pressures seen on the island, although sodium chloride as a factor has been far from conclusive in other studies James et al. The special commission finished its work in and concluded that civil marriage should be extended to include same-sex couples.

After the election of , the Government promised to tackle the issue. In September , the final legislation draft was debated in the Dutch Parliament. The marriage bill passed the House of Representatives by votes to 33 on 12 September The Senate approved the bill on 19 December by 49 to 26 votes. Although the Christian Democratic Appeal would form the next Government, they did not indicate any intention to repeal the law. The main article of the law changed article 1: The law came into effect on 1 April , and on that day four same-sex couples were married by the Mayor of Amsterdam , Job Cohen , [12] [13] who became a registrar specifically to officiate at the weddings.

A few months earlier, Mayor Cohen had been junior Minister of Justice of the Netherlands and was responsible for putting the new marriage and adoption laws through Parliament. Dutch law requires either partner must have Dutch nationality or have residency in the Netherlands.

The marriageable age in the Netherlands is 18, or below 18 with parental consent. The law is only valid in the European territory of the Netherlands and on the Caribbean Islands of Bonaire , Sint Eustatius and Saba , but does not apply to the other constituent countries of the Kingdom of the Netherlands. The single legal difference between same-sex marriages and heterosexual marriages was that, in the former case, parentage by both partners was not automatic.

The legal mother of a child is its biological mother article 1: Moreover, the father must be a man article 1: The other partner could thus become a legal mother only through adoption. Only in the case when a biological father did not become a parent e. In December , the Dutch Parliament changed this and allowed automatic parenthood for lesbian couples.

The new law, which came into effect on 1 April , allows the co-mother who is married to — or has a registered partnership with — the mother can only be automatically recognized as the legal mother if the sperm donor was initially anonymous.

In the case of a known donor, the biological mother decides whether the donor or the co-mother is the child's second legal parent. On 6 April , Minister of Foreign Affairs Bert Koenders and Minister of Security and Justice Ard van der Steur confirmed the Dutch position that like other couples same-sex couples who are not Dutch residents or nationals cannot marry in the country.

They said it will lead to practical and legal problems and could even be dangerous to some participants. The move came after the Liberal Democratic Party had asked the ministers to look into allowing non-resident foreigners to take advantage of the Netherlands' same-sex marriage law. Since the mids, religious solemnizations of same-sex relationships have taken place in some Dutch churches. All territories of the Kingdom of the Netherlands register same-sex marriages performed in the Netherlands proper as a result of a Dutch Supreme Court ruling.

The Supreme Court ruled that all vital records recorded in the Kingdom of the Netherlands were valid throughout the Kingdom; this was based on its interpretation of the Charter for the Kingdom of the Netherlands.

However, subsequent rulings have established that same-sex marriages are not automatically entitled to the same privileges e. Aruba legalised registered partnerships for both same-sex and opposite-sex couples in October In Bonaire , Sint Eustatius and Saba , marriage is open to same-sex and opposite-sex couples [26] following the entry into force of a law enabling same-sex couples to marry there on 10 October Burgerlijk wetboek BES was proposed by Dutch House of Representatives [28] rather than the Government itself which preferred to negotiate the change with the islands first.

The first same-sex marriage was performed on Saba on 4 December between a Dutch and a Venezuelan man, both residing in Aruba. Same-sex marriages and registered partnership performed elsewhere have been legally recognised on the islands since To ensure that same-sex couples enjoy similar rights, the provisions of the Dutch Civil Code rather than the Civil Code for the Caribbean Netherlands applies for marriages performed outside the islands since 1 January After the Dutch Parliament legalized same-sex marriage, the Protestant Church in the Netherlands permitted individual congregations to decide whether or not to bless such relationships as a union of love and faith before God , and in practice many churches now conduct such ceremonies.

Local governments are obliged to perform civil same-sex marriages, and they can require their personnel to conduct marriages for same-sex couples. However, if their existing contract did not state this requirement, they cannot be fired over a refusal. Some local councils choose not to require registrars who object to same-sex marriage to perform ceremonies. In , controversy arose when the new Government Fourth Balkenende cabinet announced in its policy statement that officials who object to same-sex marriage on principle may refuse to marry such couples.

The Balkenende Government claimed that this issue lay solely within the remit of the central Government. In practice, municipalities decide whether or not to hire registrars who object to marrying same-sex couples.

According to provisional figures from Statistics Netherlands , for the first six months, same-sex marriages made up 3. In March , Statistics Netherlands released estimates on the number of same-sex marriages performed in each year: From to , 14, same-sex marriages were performed, 7, between two women and 7, between two men. In the same period, there were , heterosexual marriages.

There were also 1, same-sex divorces. From to , approximately 21, same-sex couples wed in the Netherlands. Of these, 11, were female couples and 10, were male couples. On 1 January , registered partnerships Dutch: The partnerships were meant for same-sex couples as an alternative to marriage , though they can also be entered into by opposite-sex couples, and in fact about one third of the registered partnerships between and were of opposite-sex couples.

In law, registered partnerships and marriage convey the same rights and duties, especially after some laws were changed to remedy inequalities with respect to inheritance and some other issues. Unregistered partnerships or informal cohabitation is when same-sex or opposite-sex couples live together as a couple but they choose to keep the legal status of their relationship unregistered or informal.

This means all worldwide assets that belong to a single party remain the sole property of the party with no legal entitlement by the other party, whether owned before or acquired during the relationship. This legal status of unregistered partnership is respected by Dutch courts. From Wikipedia, the free encyclopedia. Israel Mexico 5 Netherlands: Same-sex union legislation Same-sex union court cases Timeline of same-sex marriage Recognition of same-sex unions in Africa Recognition of same-sex unions in Asia Recognition of same-sex unions in Europe Recognition of same-sex unions in the Americas Recognition of same-sex unions in Oceania Marriage privatization Divorce of same-sex couples Domestic partnership Military policy Adoption Listings by country.

Constitution limits marriage to opposite-sex couples. Other type of partnership. Same-sex sexual activity illegal but no longer enforced.

art-stroj.com - the best free porn videos on internet, % free. Herrick has a nice offering of Netherlands Antilles stamps on our website. Strong in topicals, and until recent years low in face value, Netherland Antilles stamps have been popular with Dutch and American stamp collectors for decades. Antilles Post Tracking Details TrackingMore is a third party parcel tracking tool (also known as multi-carrier tracking tool) which supports online parcel tracking of worldwide express and postal couriers/10(2).