Publications by authors named "Heeren T"

Objectives: Sudden unexpected infant death (SUID) occurs disproportionately among opioid exposed newborns (OENs) compared to those unexposed. The extent that primary caregivers of OENs adhere to SUID-reducing infant care practices is unknown. We examined rates of SUID-reducing practices (smoking cessation, breastfeeding, and safe sleep [supine sleep, room-sharing not bed-sharing, nonuse of soft bedding or objects]) in a pilot sample of caregivers of OENs.

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Importance: Caries is the most common chronic childhood disease, with substantial health disparities.

Objective: To test whether parent-targeted oral health text (OHT) messages outperform child wellness text (CWT) messages on pediatric caries increment and oral health behaviors among underserved children attending pediatric well-child visits.

Design, Setting, And Participants: The parallel randomized clinical trial, Interactive Parent-Targeted Text Messaging in Pediatric Clinics to Reduce Caries Among Urban Children (iSmile), included participants who were recruited during pediatric medical clinic visits at 4 sites in Boston, Massachusetts, that serve low-income and racially and ethnically diverse (herein, underserved) populations.

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  • Approximately 28.2% of mothers reported falling asleep while feeding their infants, with most cases being unplanned.
  • The study found no significant differences in FAF based on sociodemographic factors, but feeding location played a role—mothers feeding in a chair were less likely to FAF compared to those feeding in bed.
  • Mothers who received education on safe sleep practices reported notably lower rates of FAF, suggesting the importance of providing guidance to new parents on safe infant feeding practices.
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Introduction: Older adults living in long-term care facilities (LTCFs) often have poor oral health and difficulty accessing dental services. The aim was to implement a virtual dental home (VDH) program for residents in two LTCFs utilizing asynchronous teledentistry techniques and mobile dental equipment.

Methods: This pilot project was a 6-month longitudinal cohort study in two LTCFs.

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Background: Unhealthy alcohol use is prevalent among people living with HIV/AIDS (PLWH) and contributes to impaired functioning, diminished quality of life, and poorer HIV outcomes. Common cooccurring conditions such as chronic pain may be associated with negative outcomes both directly and through its influence on unhealthy drinking itself. However, there is relatively little known about how pain influences unhealthy drinking among PLWH over time.

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Background: Unhealthy alcohol use represents a significant risk for morbidity and mortality among people living with HIV (PLWH), in part through its impact on HIV management. Chronic pain, a common comorbidity, exacerbates suboptimal engagement in the HIV care continuum and has reciprocal detrimental effects on alcohol outcomes. There are no integrated, accessible approaches that address these comorbid conditions among PLWH to date.

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Objective: The chronic impact of acetylcholinesterase inhibitors and other toxicants on Gulf War (GW) veterans' health symptoms is unclear.

Methods: Building on reports of adverse neuropsychological outcomes in GW pesticide applicators exposed to pesticides and pyridostigmine bromide, we now report on health symptoms in this group.

Results: In adjusted analyses, applicators with high exposures/impact to pesticides reported significantly more symptoms (18/34 symptoms) than applicators with lower exposures/impact and were more likely to meet modified Kansas and CDC Gulf War Illness criteria.

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  • - The study aimed to compare the risks of preterm birth (PTB) and small for gestational age (SGA) in pregnant women with HIV versus those without, while also looking at maternal immune activation and the timing of antiretroviral therapy (cART).
  • - Conducted in Lusaka, Zambia, the study enrolled 1481 women with singleton pregnancies and found that HIV infection increased the risk of PTB (adjusted odds ratio of 1.60) and SGA (1.29); cART started after conception was linked to even greater risks.
  • - The findings suggest that maternal HIV is a significant factor for PTB, with women starting cART during pregnancy facing the highest risks, indicating
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Objectives: The aim of this study was to examine the association between Medicaid dental benefits for pregnant people and dental care use among very young children in Medicaid. We hypothesized that children living in states with more generous dental benefits for Medicaid-enrolled pregnant people would be more likely to have a recent dental visit.

Methods: This national cross-sectional study used pooled 2017-2019 data from the National Survey of Children's Health, as well as state Medicaid policy data.

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Introduction: There have been few empirical studies for diagnostic test accuracy of syphilis using a sequence of rapid tests in populations with low prevalence of syphilis such as pregnant women. This analysis describes syphilis test positivity frequency among pregnant women at an antenatal clinic in Zambia using a reverse-sequence testing algorithm for antenatal syphilis screening.

Methods: Between August 2019 and May 2023, we recruited 1510 pregnant women from a peri-urban hospital in Lusaka, Zambia.

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: Gulf War Illness (GWI) is a debilitating multisymptom condition that affects nearly a third of 1990-91 Gulf War (GW) veterans. Symptoms include pain, fatigue, gastrointestinal issues, and cognitive decrements. Our work has shown that GWI rates and potential causes for symptoms vary between men and women veterans.

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  • The study investigates how maternal responsiveness and self-regulation mediate the link between a mother's education level and her child's self-regulation skills.
  • It involved 189 mother-child pairs and used various scales to assess maternal emotional regulation, responsiveness, and child self-regulation.
  • Results showed that higher maternal education correlated with better child self-regulation, largely due to increased maternal responsiveness, which accounted for 29% of the effect.
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Purpose: Although diabetes is highly prevalent in patients with MacTel, progression to severe non-proliferative (NPDR) and proliferative diabetic retinopathy (PDR) is rarely reported. We report multimodal imaging features of sight-threatening diabetic retinopathy (STDR) in eyes with macular telangiectasia type 2 (MacTel).

Methods: Retrospective case series of seven participants of the MacTel Study at the Moorfields Eye Hospital NHS Foundation Trust study site and one patient from the Institute of Retina and Vitreous of Londrina, Brazil.

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Background: Breastfeeding has long-lasting effects on children's cognition, behavioral, mental and physical health. Previous research shows parental characteristics (e.g.

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  • * It was found that heavy drinking significantly worsened viral suppression only for participants experiencing moderate to severe pain, highlighting a negative interaction between these two factors.
  • * The findings suggest the importance of healthcare providers addressing both heavy drinking and pain in order to enhance HIV treatment outcomes and overall quality of life for PLWH.
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  • The study investigates the relationship between alcohol and drug use and the occurrence of falls among people living with HIV (PLWH), focusing on whether frailty affects this association.
  • Researchers analyzed data from a cohort of 251 PLWH, finding that 35% reported heavy alcohol use and significant percentages reported illicit drug use; one-third experienced falls.
  • Heavy alcohol consumption, especially among frail individuals, significantly increased the risk of falls and related emergencies, emphasizing the need for targeted prevention strategies for this population.
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  • There is a lack of research on self-medication for pain using alcohol and drugs among people living with HIV, highlighting the need for further study in this area.
  • In a study involving 248 participants with HIV, about half reported self-medicating, with varying use of alcohol and other substances, and those who self-medicated tended to be younger, less employed, and have poorer health outcomes.
  • Factors like depression, anxiety, and substance dependence were linked to higher rates of self-medication, suggesting that healthcare providers should address these issues in their care for patients with HIV who use substances.
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Background: During deployment, veterans of the 1991 Gulf War (GW) were exposed to multiple war-related toxicants. Roughly a third of these veterans continue to exhibit neurotoxicant induced symptoms of Gulf War Illness (GWI), a multi-faceted condition that includes fatigue, pain and cognitive decrements. When studied empirically, both deployed veterans with exposures and those who meet the criteria for GWI are more likely to show deficits in the area of neuropsychological functioning.

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Purpose: Deep learning (DL) models have achieved state-of-the-art medical diagnosis classification accuracy. Current models are limited by discrete diagnosis labels, but could yield more information with diagnosis in a continuous scale. We developed a novel continuous severity scaling system for macular telangiectasia (MacTel) type 2 by combining a DL classification model with uniform manifold approximation and projection (UMAP).

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Background: Food insecurity (FI) prevalence was consistently >10% over the past 20 years, indicating chronic economic hardship. Recession periods exacerbate already high prevalence of FI, reflecting acute economic hardship. To monitor FI and respond quickly to changes in prevalence, an abbreviated food security scale measuring presence and severity of household FI in adults and children is needed.

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Objectives: To provide a metric to differentiate between hyperopic and myopic ablation of a prior LASIK treatment based on the corneal pachymetry profile after laser vision correction (LVC).

Methods: Pachymetry data were retrospectively recovered from patients who had previous LASIK for refractive purposes between 2019 and 2020. Patients with any corneal disorder were excluded.

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Objective: Oral health self-efficacy is a modifiable determinant of early childhood caries, which is one of the most prevalent childhood diseases. Yet, two common measures of self-efficacy (i.e.

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Cannabis is often used by people with HIV (PWH) for pain, yet study results are inconsistent regarding whether and how it affects pain. This study examines whether greater cannabis use frequency is associated with lower pain interference and whether cannabis use modifies the association of pain severity and pain interference among 134 PWH with substance dependence or a lifetime history of injection drug use. Multi-variable linear regression models examined the association between past 30-day cannabis use frequency and pain interference.

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Importance: Even brief periods of hardship during early childhood may have lifelong consequences. Prior cross-sectional research limited to respondents with English proficiency and internet access during the COVID-19 crisis documented families with young children that struggled to afford basic needs like food and rent. Few studies have examined experiences of families with young children by race and ethnicity and maternal nativity.

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