A survey-based assessment of rates and covariates of mpox diagnosis and vaccination provides evidence to refine eligibility criteria for mpox vaccination among gay, bisexual and other men who have sex with men in the Netherlands

Background: The 2022 multicountry mpox outbreaks predominantly affected gay, bisexual and other men who have sex with men (GBMSM) in non-endemic countries, including in the Netherlands. We conducted a survey-based assessment of the alignment between the risk factors associated with mpox diagnosis among GBMSM in the Netherlands and the eligibility criteria used in 2022 for vaccinating this group, with the aim to refine these criteria. Methods: An online self-report survey was conducted among adult GBMSM in the Netherlands between 29 July and 30 August 2022, corresponding to the first month of the Dutch mpox vaccination campaign. GBMSM were recruited via advertisements on social media and gay dating apps. Participants reported on their sexual behaviour, mpox diagnosis, and/or (initial) mpox vaccination since the start of the outbreak. Covariables of mpox diagnosis and vaccination were assessed using logistic regression analyses. Results: Of the 2,460 participants, 73 (3.0%, 95% CI 2.3–3.6%) were diagnosed with mpox and 485 (19.7%, 95% CI 18.1–21.3%) had received (initial) mpox vaccination. Using sample weighting, we estimated that, of the GBMSM population aged 18–80 years in the Netherlands, 1.1% (95% CI 0.7–1.6%) had been diagnosed with mpox and 7.8% (95% CI 6.8–8.9%) had received (initial) vaccination. HIV-PrEP use, living with HIV, reporting ≥20 sex partners in the past 12 months, and sex in sex venues/parties in the past 2 months were independent risk factors for mpox diagnosis. Except for sex in sex venues/parties, these variables were also independently associated with mpox vaccination. Conclusion: This study provides novel evidence regarding the degree to which the 2022 eligibility criteria for mpox vaccination align with the risk factors for mpox among GBMSM in the Netherlands. The findings contribute to a refinement of the eligibility criteria for mpox vaccination, to which sex in sex venues/parties should be added

Topical or oral antibiotics for children with acute otitis media presenting with ear discharge: study protocol of a randomised controlled non-inferiority trial

BACKGROUND: Around 15%-20% of children with acute otitis media present with ear discharge due to a spontaneous tear or perforation of the eardrum (AOMd). Current guidance recommends clinicians to consider oral antibiotics as first-line treatment in this condition. The opening in the eardrum however should allow topical antibiotics to enter the middle ear directly. Local administration of antibiotics does not expose children to systemic side effects and may put less selective resistance pressure on bacteria. Evidence on the effectiveness of this approach in children with AOMd is lacking. METHODS AND ANALYSIS: A primary care-based, open, individually randomised, controlled, non-inferiority trial. The trial aims to recruit 350 children aged 6 months to 12 years with AOMd and ear pain and/or fever. Participants will be randomised to 7 days of hydrocortisone-bacitracin-colistin eardrops five drops three times daily or amoxicillin oral suspension 50 mg/kg body weight per day, divided over three doses. Parents will keep a daily diary of AOM symptoms, adverse events and complications for 2 weeks. In addition, they will record AOM recurrences, healthcare utilisation and societal costs for 3 months. The primary outcome is the proportion of children without ear pain and fever at day 3. Secondary outcomes include ear pain and fever intensity/severity; days with ear discharge; eardrum perforation at 2 weeks; adverse events during first 2 weeks; costs; and cost effectiveness at 2 weeks and 3 months. The primary analyses will be intention-to-treat and per-protocol analyses will be conducted as well. ETHICS AND DISSEMINATION: The medical research ethics committee Utrecht, The Netherlands has given ethical approval (17-400/G-M). Parents/guardians of participants will provide written informed consent. Study results will be submitted for publication in peer-reviewed medical journals and presented at relevant (inter)national scientific meetings. TRIAL REGISTRATION NUMBER: The Netherlands National Trial Register; NTR6723. Date of registration: 27 November 2017

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI 2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity. Funding UK Medical Research Council, UK Research and Innovation (Research England), UK Research and Innovation (Innovate UK), and European Union

General and abdominal adiposity and hypertension in eight world regions: a pooled analysis of 837 population-based studies with 7·5 million participants

Background Adiposity can be measured using BMI (which is based on weight and height) as well as indices of abdominal adiposity. We examined the association between BMI and waist-to-height ratio (WHtR) within and across populations of different world regions and quantified how well these two metrics discriminate between people with and without hypertension. Methods We used data from studies carried out from 1990 to 2023 on BMI, WHtR and hypertension in people aged 20–64 years in representative samples of the general population in eight world regions. We graphically compared the regional distributions of BMI and WHtR, and calculated Pearson’s correlation coefficients between BMI and WHtR within each region. We used mixed-effects linear regression to estimate the extent to which WHtR varies across regions at the same BMI. We graphically examined the prevalence of hypertension and the distribution of people who have hypertension both in relation to BMI and WHtR, and we assessed how closely BMI and WHtR discriminate between participants with and without hypertension using C-statistic and net reclassification improvement (NRI). Findings The correlation between BMI and WHtR ranged from 0·76 to 0·89 within different regions. After adjusting for age and BMI, mean WHtR was highest in south Asia for both sexes, followed by Latin America and the Caribbean and the region of central Asia, Middle East and north Africa. Mean WHtR was lowest in central and eastern Europe for both sexes, in the high-income western region for women, and in Oceania for men. Conversely, to achieve an equivalent WHtR, the BMI of the population of south Asia would need to be, on average, 2·79 kg/m² (95% CI 2·31–3·28) lower for women and 1·28 kg/m² (1·02–1·54) lower for men than in the high-income western region. In every region, hypertension prevalence increased with both BMI and WHtR. Models with either of these two adiposity metrics had virtually identical C-statistics and NRIs for every region and sex, with C-statistics ranging from 0·72 to 0·81 and NRIs ranging from 0·34 to 0·57 in different region and sex combinations. When both BMI and WHtR were used, performance improved only slightly compared with using either adiposity measure alone. Interpretation BMI can distinguish young and middle-aged adults with higher versus lower amounts of abdominal adiposity with moderate-to-high accuracy, and both BMI and WHtR distinguish people with or without hypertension. However, at the same BMI level, people in south Asia, Latin America and the Caribbean, and the region of central Asia, Middle East and north Africa, have higher WHtR than in the other regions

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI 2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining https://researchonline.ljmu.ac.uk/images/research_banner_face_lab_290.jpgunderweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity

Diminishing benefits of urban living for children and adolescents’ growth and development

AbstractOptimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was &lt;1.1 kg m–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.</jats:p

Archeologische begeleiding van de plaatsing van ondergrondse containers in de wijk Selwerd te Groningen, gemeente Groningen (GR)

Op de twee onderzoekslocaties worden afvalcontainers geplaatst. De omvang van de ontgravingen voor het plaatsen van deze containers bedraagt 2 bij 2 m; de diepte van de ontgravingen reikt tot 3 m-mv. Het doel van een archeologische begeleiding, protocol opgraven is het documenteren van gegevens en het veiligstellen van materiaal van vindplaatsen om daarmee informatie te behouden die van belang is voor de kennisvorming over het verleden. Door de relatief hoge ligging van het onderzoekgebied in het landschap kunnen er resten verwacht worden vanaf de steentijd tot aan de nieuwe tijd. Uit de reeds uitgevoerde onderzoeken nabij de te plaatsen afvalcontainers valt deze verwachting echter te specificeren. In de omgeving zijn namelijk met name archeologische resten uit de ijzertijd aangetroffen en deze resten zijn mogelijk ook binnen de huidige onderzoekslocaties aanwezig. Over het gebruik van de onderzoekslocaties en het omringende gebied in de Romeinse tijd en de vroege middeleeuwen is weinig bekend. Het gebruik van de flank van de Hondsrug voor zowel bewoning als transport gaat in elk geval terug tot in de late middeleeuwen. Voorafgaand aan de verstedelijking zullen ook bewoning en landbouwactiviteiten binnen het gebied plaatsgevonden hebben. Op beide onderzoekslocaties is de natuurlijke bodemopbouw hetzelfde. Onder het moderne cunetzand bevinden zich verschillende kleilagen, die naar beneden toe iets zandiger worden. Op een diepte van 0,8 m-mv is in de kleilagen een vegetatiehorizont aanwezig. Het betreft de onderste van de twee vegetatiehorizonten die op meerdere locaties rond de stad Groningen voorkomen. Deze horizont kan worden gedateerd in de middenijzertijd. In de horizont zijn geen archeologische vondsten of sporen aangetroffen. Mogelijk is de bodemopbouw op beide locaties deels afgetopt. Uit onderzoeken uit de nabije omgeving (Bessemoerpark, Pleiadenlaan, Grote Beerstraat) die globaal eenzelfde bodemopbouw als op de huidige locaties laten zien, blijkt dat zich hier onder het moderne cunet- of bouwzand een vrij dik ophoogpakket bevindt, dat kan worden gerelateerd aan het bouwrijp maken van het gebied voor de aanleg van de woonwijk in de jaren ’60 van de vorige eeuw, met hieronder de oude bouwvoor. Dit ophoogpakket en de oude bouwvoor ontbreken op beide onderzoekslocaties volledig. Bij het bouwrijpmaken van het gebied voor de aanleg van de woonwijk is hier vermoedelijk een deel van het natuurlijke bodemprofiel afgeschoven. In de ontgraving in de Hazelaarstraat is een nieuwetijdse sloot aangetroffen. Deze sloot is zichtbaar op de topografische kaart van 1900-1916 en op een luchtfoto uit 1932. De sloot zal vermoedelijk zijn gedempt bij de aanleg van de woonwijk Selwerd in de jaren ’60 van de vorige eeuw.

Archeologische begeleiding Bloemenbuurt Groningen, gemeente Groningen (GR)

Het onderzoeksgebied betreft de Hortensialaan en de Begoniastraat te Groningen en is in gebruik als straat. De totale lengte van het onderzoeksgebied is circa 350 m per straat. Binnen het onderzoeksgebied is in een eerder stadium een inventariserend veldonderzoek door middel van verkennende boringen uitgevoerd. Uit dit onderzoek blijkt dat het plangebied in het dal van de Hunze ligt. De bodem in het plangebied is grotendeels onverstoord, er bevindt zich hier een dik sedimentatiepakket van klei met zandlagen (soms zand met kleilagen) dat wijst op een kwelderlandschap waarin mogelijk ook beeksedimenten zijn afgezet. De voormalige bouwvoor is grotendeels intact en hieronder bevindt zich een vegetatielaag, te dateren in de ijzertijd of Romeinse tijd, die soms in de bouwvoor is opgenomen maar meestal intact is gebleven. Zowel de voormalige bouwvoor als de vegetatielaag kunnen als archeologisch kansrijke laag worden beschouwd. Gezien het voorkomen van deze lagen over het gehele plangebied is geconcludeerd dat het gehele plangebied kansrijk is op het aantreffen van archeologische waarden. Uit de archeologische begeleiding in de Begoniastraat blijkt dat de bodemopbouw binnen het onderzoeksgebied inderdaad intact is en geen afwijkingen kent ten opzichte van de resultaten van het vooronderzoek. Ondanks de intacte bodemopbouw zijn er binnen het onderzoeksgebied geen relevante archeologische vondsten gedaan. De sporen die zijn aangetroffen, betreffen perceelsloten, die dateren uit de periode voordat het gebied een woonbestemming kreeg en de wijk Oosterpark werd gebouwd. De sloten zijn alle zichtbaar op de historische kaarten uit de 19e en het begin van de 20e eeuw. Ook de oude bouwvoor die in de profielen duidelijk te zien is, kan aan deze periode en aan de perceelsloten worden gekoppeld. Het vondstmateriaal dat is geborgen, is nieuwetijds en uitsluitend afkomstig uit de sloten en de oude bouwvoor en zal met bemesting hierin terechtgekomen zijn. Op basis van de resultaten van het onderzoek in de Begoniastraat is, conform het PvE en in overleg met de gemeentelijk archeoloog, besloten de rioolwerkzaamheden in de Hortensialaan (dat eveneens deel uitmaakt van het plangebied) zonder archeologische begeleiding uit te voeren. De archeologische verwachting voor de Hortsensialaan is laag op basis van de resultaten in de Begoniastraat