Polysubstance Use in Pregnancy: Surveillance, Interventions, and Next Steps.

Substance use during pregnancy increases risk for a wide range of adverse maternal and neonatal health outcomes. Polysubstance use is common among people who use substances during pregnancy; however, the risks of combined substance exposures during pregnancy are poorly understood. In this report, we provide an overview of the activities of the Centers for Disease Control and Prevention (CDC) and partners and identified gaps related to (1) surveillance, (2) routine screening, and (3) prevention of polysubstance use during pregnancy. Efforts by CDC and other partners to reduce polysubstance use during pregnancy can improve the health of pregnant people and their infants and children.

Parental confidence in making overweight-related behavior changes.

BACKGROUND: Confidence is an important construct for behavioral change; higher levels of confidence, or self-efficacy, increase the likelihood that a person will change a health behavior even when faced with obstacles. OBJECTIVE: To identify parent, child, and clinician characteristics associated with higher parental confidence in their ability to make overweight-related behavior changes for their family. METHODS: We interviewed 446 parents of children, aged 2 to 12 years, with a BMI of >or=85th percentile and surveyed their pediatric clinicians (N = 75). The main outcome was parental confidence in their ability to make overweight-related behavior changes. We derived a continuous parental confidence score from 6 questions (Cronbach's alpha = 0.72) regarding parental confidence in limiting television viewing, removing televisions from children's bedrooms, reducing fast-food intake, reducing sugar-sweetened beverage intake, increasing physical activity, and improving overall eating patterns for their family. We used multiple linear regression to predict the effects of parent, child, and clinician characteristics on the parents' confidence scores. RESULTS: The mean (SD) score on the parental confidence scale was 13.0 (3.5), and the range was 0.0 to 24.0. In multivariable analyses, parents who said their clinicians assessed their confidence (41%; beta = 0.73 [95% confidence interval: 0.04-1.42]) or who said that their clinicians assessed their readiness to change (35%; beta =0.80 [95% confidence interval: 0.10-1.49]) reported higher levels of confidence compared with parents whose clinicians did not assess confidence or readiness to change. CONCLUSIONS: Clinician assessment of parental confidence and readiness to change was associated with higher parent confidence in making changes to keep their child from being overweight.

Escherichia coli expressing recombinant antigen and listeriolysin O stimulate class I-restricted CD8+ T cells following uptake by human APC.

Vaccination against cancer or intracellular pathogens requires stimulation of class I-restricted CD8(+) T cells. It is therefore important to develop Ag delivery vectors that will promote cross-presentation by APCs and stimulate appropriate inflammatory responses. Toward this goal, we tested the potential of Escherichia coli as an Ag delivery vector in in vitro human culture. Bacteria expressing enhanced green fluorescent protein were internalized efficiently by dendritic cells, as shown by flow cytometry and fluorescence microscopy. Phenotypic changes in DC were observed, including up-regulation of costimulatory molecules and IL-12p40 production. We tested whether bacteria expressing recombinant Ags could stimulate human T cells using the influenza matrix protein as a model Ag. Specific responses against an immunodominant epitope were seen using IFN-gamma ELISPOT assays when the matrix protein was coexpressed with listeriolysin O, but not when expressed alone. THP-1 macrophages were also capable of stimulating T cells after uptake of bacteria, but showed slower kinetics and lower overall levels of T cell stimulation than dendritic cells. Increased phagocytosis of bacteria induced by differentiation of THP-1 increased their ability to stimulate T cells, as did opsonization. Presentation was blocked by proteasome inhibitors, but not by lysosomal protease inhibitors leupeptin and E64. These results demonstrate that recombinant E. coli can be engineered to direct Ags to the cytosol of human phagocytic APCs, and suggest possible vaccine strategies for generating CD8(+) T cell responses against pathogens or tumors.