No mandatory policies currently exist to address food environments in Belgium. Monitoring commitments and practices by food industry actors is essential for increasing accountability. The aim of this study was to evaluate and benchmark the transparency, specificity, and comprehensiveness of nutrition-related commitments and associated practices of leading food companies in Belgium, as well as changes over time. The Business Impact Assessment on Obesity and population-level nutrition (BIA-Obesity) was applied to assess commitments related to product formulation, labelling, promotion, accessibility, relationships with other organizations and corporate nutrition strategy among major packaged food and non-alcoholic beverage manufacturers (n = 21), supermarkets (n = 5), and quick-service restaurants (QSR) (n = 6) in Belgium. Publicly available data on commitments in 2023/2024 were collected and company representatives invited to verify and supplement the information. A standardized scoring framework comprising around 60 indicators was used to assess the commitments. Company product portfolios were evaluated using Nutri-Score, the NOVA classification, and the WHO Europe Nutrient Profile Model. In addition, supermarket shelf-space allocation, and QSR density near schools were assessed. Results were compared to the 2019 BIA-Obesity Belgium to evaluate progress. 63
Background:2025 European guidelines recommended transition from cytology to HPV-based cervical cancer screening. We compared both strategies in a pilot in Poland. Methods:Eligible, consenting women aged 30-59 years underwent centralized 1:1 randomization to HPV-testing or cytology (HPV or cytology arm, respectively) in 30-39, 40-49, and 50-59 years age strata in 27 clinics. Arm assignment was unblinded. HPV positive samples underwent liquid-based cytology (LBC) triage. If normal, another LBC was performed in six months. Abnormal LBC triggered colposcopy. If both LBCs were normal, p16/Ki-67 immunocytochemistry and FAM19A4/miR124-2 methylation tests were performed. Either positive triggered referral to colposcopy. In the cytology arm, abnormal results triggered another cytology after six months or colposcopy, according to routine protocols. Cervical intraepithelial neoplasia grade 2 or worse (CIN2+) detection rate in the population intended to treat was the main outcome. NCT04111835-Clinicaltrials.gov. Findings:Between 28 October 2019 and 31 December 2022, 16,795 and 16,707 women underwent primary HPV or cytological testing, respectively. 702/16,795 (4.2%; 95% CI: 3.9%-4.5%) and 499/16,707 women (3.0%; 95% CI: 2.7%-3.3%), were referred for colposcopy in the HPV and cytology arm, respectively (RR = 1.40; 95% CI: 1.25-1.57). CIN2+ was detected in 137 women (0.82%; 95% CI: 0.69-0.96%) and in 71 women (0.42%; 95% CI: 0.34-0.54%; OR = 1.93; 95% CI: 1.34-2.77), while CIN grade 3 or worse (CIN3+) was detected in 69 women (0.41%; 95% CI: 0.32%-0.52%) and in 35 women (0.21%; 95% CI: 0.15%-0.29%; OR = 1.99; 95% CI: 1.16-3.42) in the HPV and cytology arm, respectively. In HPV positive women with two normal LBCs immunocytochemistry and methylation detected 4/9 (44.4%) and 7/9 (77.8%) CIN2+ cases, respectively. Interpretation:HPV-based screening may almost double CIN2+ detection compared to cytology. It however yields more positive screening results and colposcopies. Smooth transition from cytology to HPV-based screening requires proper triage strategies and additional colposcopy services. Methylation seems to detect more CIN2+ than immunocytochemistry in HPV positive women with two normal LBCs. Funding:Polish Ministry of Health.
BACKGROUND:Marketing of nutrient-poor foods is a recognized driver of unhealthy dietary behaviors and childhood obesity. In Senegal, the triple burden of malnutrition persists, while regulations restricting unhealthy food marketing to children remain limited. OBJECTIVE:To assess the extent and nature of food advertising around schools and on television in Senegal and to explore children's and parents' perceptions of food marketing. METHODS:A cross-sectional mixed-methods study was conducted across four regions in Senegal (Dakar, Kaolack, Saint-Louis, Ziguinchor). Food advertising was mapped within a 250-m radius of 40 selected urban/peri-urban schools, and inventoried on four national television channels. Advertised foods were evaluated using the WHO-NPM AFRO and Nutri-Score systems and classified as 'permitted' or 'non-permitted' foods. Focus group discussions with children and in-depth interviews with parents were conducted to explore food marketing perceptions. Quantitative data were analyzed using descriptive and inferential statistical analysis, and qualitative data were analyzed using thematic analysis. RESULTS:Overall, 79% (n = 438) of food advertisements around schools and 75% (n = 366) on television were for 'non-permitted' foods. Non-permitted food advertisements were more frequent during peak viewing times and used persuasive marketing techniques. Children demonstrated brand recall and reported requesting advertised products following exposure. Parents expressed concerns about poor nutritional quality of foods advertised to children and supported stricter regulatory measures. CONCLUSIONS:Children were exposed to 'non-permitted' food advertising across physical and virtual environments in Senegal. The predominance of nutrient-poor food promotion underscores the urgent need for mandatory policies to restrict unhealthy food marketing to children.
Meta-analyses show comparable clinical accuracy of PCR-based human papillomavirus (HPV) assays on self- compared with clinician-collected specimens. We extended these meta-analyses by comparing HPV testing on both samples with cytology from clinician-collected specimens. Studies published in PubMed, Embase, and Cochrane Library up to September 2024 were reviewed for inclusion. Studies had to report paired HPV self-collection, clinician-collected HPV testing, and cytology. Performance measures included sensitivity and specificity of atypical squamous cells of undetermined significance or worse and high-risk HPV positivity in self- and clinician-collected samples for cervical intraepithelial neoplasia 2 or worse. Accuracy data were pooled using the bivariate normal model for logit transforms of sensitivity and specificity. Sixteen full-text articles met inclusion criteria. Studies were heterogeneous and included referral populations, which may overestimate cytology sensitivity. Cytology was less sensitive in detecting cervical intraepithelial neoplasia 2 or worse (pooled sensitivity 87%; 95% confidence interval, 76-93) compared with HPV testing on self- (90%) and clinician-collected samples (93%) when restricting to PCR-based HPV assays. Overall, HPV self-collection sensitivity surpassed clinician-collected cytology testing, demonstrating that 3-year screening intervals, which are recommended for negative cytology results, are safe to use for negative HPV results from self-collected specimens. Longitudinal data of HPV testing on self- versus clinician-collected samples are lacking.
Background Cervical carcinogenesis is mediated by the HPV-E6 and E7 oncoproteins, considered as biomarkers usable in managing screen-positive women. Methods We conducted a systematic review and meta-analysis assessing the accuracy of HPV-E6/E7-oncoprotein tests to detect underlying cervical-precancer and cancer. We included studies reporting data on oncoprotein test accuracy detecting cervical intraepithelial neoplasia grade 3 or worse. Random effects logistic regression models were applied for pooling absolute and relative accuracy. Results Twenty-two studies were included. Sensitivity and specificity estimates ranged from 54.2% (95%CI: 45.2–63.0) to 69.5% (95%CI:60.8–76.9) and from 82.8% (95%CI: 50.4–95.8) to 99.1 (95%CI: 98.8–99.3), respectively in the population irrespective of HPV status. Higher sensitivity estimates ranging from 60.8% (95%CI: 49.6–70.9) to 75.5% (95%CI: 71.7–78.9) but lower specificity estimates ranging from 83.7% (95%CI: 76.1–89.3) to 92.1% (95%CI: 88.5–94.6) were observed in studies enrolling high-risk-HPV-positive women. Studies recruiting only HIV-positive women showed a pooled sensitivity of 46.9% (95%CI: 30.6–63.9) with a specificity of 98.0% (95%CI: 96.8–98.7). Conclusions The high specificity of oncoprotein tests supports its use for triaging HPV-positive women. However, oncoprotein-negative women would not be recommended to undertake routine screening, requiring further follow-up. Large-scale and longitudinal studies are needed to further investigate the role of E6/E7-oncoprotein detection in predicting the risk of developing cervical pre-cancer and cancer.
