PubMed Health⌕ Search

Biomedical subjects

P Kunstadter

Publications and source records attributed to P Kunstadter.

12 recordsLinked to original sources
PubMed2002

The prevalence of viral hepatitis among the Hmong people of northern Thailand.

Sera from 269 Hmong people (102 males and 167 females, with mean age 35.4 years, range 16-63 years) were examined in order to determine the seroprevalence of hepatitis virus infection. The seroprevalence rates for HAV (hepatitis A virus), HBV (hepatitis B virus), HCV (hepatitis C virus), HDV (hepatitis D virus), HEV (hepatitis E virus), HGV (hepatitis G virus) and TTV (TT virus) infection were 87.8% (n=140), 76.0% (n=150), 2.0% (n=150), 0.7% (n=150), 6.5% (n=139), 5.3% (n=94) and 25.6% (n=121) respectively. The rate for carriers of HBV (HBsAg) was 13.8% (20.5% in males and 9.6% females) with a peak prevalence in the 21-40 year age group. A high rate of HAV seropositivity was found among the younger subjects. The rate of HEV seroprevalence was low. The prevalence of TTV-DNA was high with no difference between the sexes. HGV-RNA prevalence was low and seen primarily in males. This study indicates that the Hmong people are endemically infected with HAV and HBV infection and should be considered for targeted vaccination. The role of TTV and HGV in producing illness and hepatic disease has yet to be determined in this population.

Adolescent↗
PubMed1993

Demographic variables in fetal and child mortality: Hmong in Thailand.

Conventional theories would not predict the 60% decline of infant mortality which has occurred among the Hmong population of Thailand, from 123/1000 in the mid-1960s to 48 in the mid-1980s. The Hmong population in northern Thailand has sustained high fertility and low use of modern health services. Most Hmong live in relatively remote rural villages and earn their living by self-employed farming. They have low levels of education, especially for women. They live in multi-generational patrilineal-patrilocal extended family households. Women's status is low. These characteristics contrast strongly with the majority ethnic Thai population, among whom a comparable mortality decline has been accompanied by widespread use of family planning, rapidly declining fertility, widespread use of modern health facilities, rapidly increasing levels of education for both sexes, rapid economic development, and a predominance of nuclear-based family households. Distributions of Hmong pregnancies by birth order and maternal age have remained relatively constant while fetal and young child death rates have declined for each level of parity and all maternal ages in recent cohorts. As predicted by conventional theories, infant mortality rates are highest among higher order births and for births to mothers of the highest ages, however there is relatively little effect on risk of infant mortality of first order pregnancies, or births to very young (10-14 year old) women. Fetal and infant mortality have declined steadily in recent cohorts at each parity level and all maternal ages. Modern medical care and decline in a surplus of female deaths associated with low status of women might explain the declines in fetal and child deaths regardless of parity or maternal age. Use of modern medical care for delivery is recent and accounts for less than 10% of all recent Hmong births, but survival rates are not consistently or significantly higher for children born with a modern birth attendant. Sex-specific mortality rates calculated from reproductive histories show no surplus of female deaths in the past, but females have benefitted more from recent mortality declines than males. Ethnographic evidence suggests that Hmong have customs which act to protect the health of mother and child ('chicken soup theory'), and that they are predisposed to accept innovations (including use of modern medicine) which they see as beneficial. This may allow them to respond especially quickly to small opportunities for improving their children's survival, as compared with other ethnic groups.

Birth Order↗
PubMed1992

Pregnancy among the Hmong: birthweight, age, and parity.

OBJECTIVES: The influx of Southeast Asians into the United States allows for the study of this special population and contributes to a broader understanding of reproductive health. METHODS: We used information on birth certificates to identify 1937 Hmong children born 1985 through 1988 in California, and we compared birthweight and reproductive factors as related to these children with the same factors as related to 3776 White, non-Hispanic children born in the same period. RESULTS: Mean birthweight among Hmong children (3311 g) was significantly lower (P less than .05) than among White children (3452 g), but the proportion of births under 1500 g was higher for Whites. Hmong women were of much higher parity and were more likely to deliver at both a young (less than 18 years) and an old (greater than 40 years) maternal age. At every age and every parity, however, Hmong women had cesarean sections at one-half to one-tenth the rate of White women. CONCLUSIONS: Despite a high proportion of births at high parity and advanced maternal age, Hmong women gave birth to very low-birthweight babies at essentially the same rates as White women. Their lower cesarean section rates, however, deserve further attention.

Adolescent↗
PubMed1992

Maternal practices and risk factors for dehydration from diarrhoea in young children: a case-control study in central Thailand slums.

To determine factors related to dehydration from diarrhoea, we conducted a hospital-based, case-control study in children aged 24 months or younger who had acute watery diarrhoea and attended Chonburi Regional Hospital in central Thailand during November 1988 through May 1989. The study compared 48 cases who had moderate or severe dehydration with 48 controls who had no dehydration. Both cases and controls belonged to low socioeconomic families and were living in urban slum areas. They had adequate health care facilities and access to ORS packets. Overall, 56% of the mothers used ORS solution at home. None of the mothers knew how to administer ORS, i.e. the fluid was not given at the onset of diarrhoea to prevent dehydration, and they gave no more than 60 ml over a 24-hour period to their dehydrated children. They also did not use home fluids. Multivariate analysis of data showed two factors significantly associated with dehydration: children's dirty fingernails that indicated inadequate maternal hygiene-related behaviour (Odds Ratio 6.4; 95% Confidence Intervals 1.5-27.6, p < 0.01), and frequency of vomiting in the 24 hours before rehydration (Odds Ratio 1.3; 95% Confidence Intervals 1.1-1.6, p < 0.001). Cases and controls had similar aetiologic agents and nutritional status. Providing proper education to mothers about oral rehydration therapy with special emphasis on the volume of ORS to be given, along with guidance to improve their personal hygiene should be considered important interventions in reducing the risk of dehydration and deaths from diarrhoea in these children.

Case-Control Studies↗
PubMed1992

Causes and consequences of increase in child survival rates: ethnoepidemiology among the Hmong of Thailand.

The Hmong "hill tribe" minority in Thailand has much higher exposure to factors usually associated with risk of child mortality (high fertility, low status of women, low education, less use of modern medical care for births, exposure to warfare, economic and physical disruption, and poor hygienic conditions) than the rural ethnic Thai population. Nonetheless, infant mortality has declined from over 120 per 1000 to under 50 per 1000 live births among both these populations in the past 30 years. The reason for the rapid increase in child survival among the Hmong appears to be better access to and more use of modern curative and preventive medical care associated with road construction rather than major changes in social or hygienic conditions. Conventional wisdom suggests that high fertility is both a cause and a consequence of high infant and child mortality and that parents will not reduce fertility until they see that mortality has declined. Most Hmong parents recognize the decline in child mortality and attribute it to better access to modern medical care. Most Hmong parents also say that, if they were starting to have children now, they would want to have fewer children. Fear of child death is infrequently mentioned as a motive for having more children, and the perceived decline in child mortality is rarely mentioned as a reason for reduced fertility. Most Hmong parents explain their desired family size in terms of economic conditions rather than perceived risk of child mortality. Results of this study suggest that fertility and child mortality can vary independently of one another and that major reductions in child mortality can be accomplished without waiting for major social changes (e.g., improved education or status of women) or major reductions in fertility.

Child Health Services↗
PubMed1985

Health of Hmong in Thailand: risk factors, morbidity and mortality in comparison with other ethnic groups.

Demographic and health conditions among Hmong in Thailand were examined in comparison with other ethnic groups which closely resemble the ethnic origins of Southeast Asian refugees in the U.S. Thailand Hmong have very large extended family households, very high birth rates, low use of contraception, very young age at first marriage, and, compared with other highland minorities, relatively low infant and crude mortality rates. Hmong use of tobacco and alcohol and other stimulants is lower than other ethnic groups, and is much more frequent among men than among women. Opium was used by 15% of the men in the surveyed village, lower than among another highland group, but higher than in surveyed lowland villages. Fewer illnesses were reported by Hmong in the 7 days prior to survey than in other rural groups. Relatively low Hmong morbidity and mortality as compared with other highland ethnic groups may be associated with low use of tobacco and alcohol, and with the sharing of child care responsibilities within the large Hmong extended family households.

Adolescent↗
PubMedDate not supplied

Social and behavioral factors in transmission and response to shigellosis.

Biomedical approaches to shigellosis tend to emphasize unique etiologic and clinical features of the disease, e.g., those related to the development of vaccines or case management. The biologic characteristics of the organism and sociocultural responses to it imply that it is unlikely that a purely technologic solution (vaccine) to shigellosis will be found soon. Infrastructural development (protected water supply and sanitary disposal of feces) may be too expensive to be feasible due to the economic, environmental, and demographic conditions in developing countries. Behavioral change to reduce the risk of transmission may be a more effective preventive strategy. Case management in developing countries will require prompt, appropriate action when symptoms of shigellosis occur. A general model of health-seeking behavior suggests patients' parents or guardians (anyone responsible for care of the child and for overseeing the child's health, e.g., older siblings or grandparents) will take no action if the symptoms are not recognized or are perceived as normal or if the condition is not evaluated as serious or treatable. It is not necessary for patients' parents or guardians to learn about etiologic models from medical practitioners to behave in ways that will reduce the risk of infection or to seek effective treatment. For example, hand washing may be promoted on the basis of symbolism. Agreement between potential patients or their guardians and health care providers on signs of potentially severe disease may be enough to bring them into effective contact.

Dysentery, Bacillary↗
PubMedDate not supplied

Pesticide exposures among Hmong farmers in Thailand.

Highland Hmong farmers in Thailand have abandoned shifting cultivation of subsistence crops and turned to chemical-intensive cultivation of non-narcotic permanent field cash crops. Three highland communities and Hmong in urban Chiang Mai were studied. Most rural study participants applied chemicals, primarily to control insects, weeds, and fungus, by backpack and machine sprays and by hand. Hmong women have less Thai language skill than men and less information concerning hazards of exposure or use of protective clothing. Most Hmong know of the health hazards, but many fail to use adequate protective clothing to prevent exposure. Screening showed 20-69% of 582 Hmong adults with risky or unsafe levels of cholinesterase inhibition, an indicator of exposure to organophosphate and carbamate pesticides. Exposure rates are as high among those who do not actually apply pesticides as among those who do, suggesting exposure by routes in addition to direct contact associated with application.

Adolescent↗