REPRODUCTIVE HEALTH IN TRANS AND GENDER DIVERSE PATIENTS: Mind the gap: a nationwide audit of LGBTQ+ inclusion in fertility care providers in the United Kingdom.

In brief: We describe a first-of-its-kind audit of LGBTQ+ inclusivity in fertility care providers across the United Kingdom. Despite efforts being made to improve LGBTQ+ inclusion in fertility care, our results paint a picture of widespread gaps in clinical and cultural expertise alongside significant barriers to LGBTQ+ inclusion. Abstract: LGBTQ+ patients comprise one of the fastest-growing user demographics in fertility care, yet they remain under-represented in fertility research, practice, and discourse. Existing studies have revealed significant systemic barriers, including cisheteronormativity, discrimination, and gaps in clinical expertise. In this article, we present a checklist of measures that clinics can take to improve LGBTQ+ inclusion in fertility care, co-created with members of the LGBTQ+ community. This checklist focuses on three key areas: cultural competence, clinical considerations, and online presence. The cultural competence criteria encompass inclusive communication practices, a broad understanding of LGBTQ+ healthcare needs, and knowledge of treatment options suitable for LGBTQ+ individuals. Clinical considerations include awareness of alternative examination and gamete collection techniques for transgender and gender diverse patients, the existence of specific clinical pathways for LGBTQ+ patients, and sensitivity to the psychological aspects of fertility care unique to this demographic. The online presence criteria evaluate provider websites for the use of inclusive language and the availability of LGBTQ+-relevant information. The checklist was used as the foundation for an audit of fertility care providers across the UK in early 2024. Our audit identified a widespread lack of LGBTQ+ inclusion, particularly for transgender and gender diverse patients, highlighting deficiencies in clinical knowledge and cultural competence. Our work calls attention to the need for further efforts to understand the barriers to inclusive and competent LGBTQ+ fertility care from both healthcare provider and patient perspectives.

Seeking arrangements: cell contact as a cleavage-stage biomarker.

RESEARCH QUESTION: What can three-dimensional cell contact networks tell us about the developmental potential of cleavage-stage human embryos? DESIGN: This pilot study was a retrospective analysis of two Embryoscope imaging datasets from two clinics. An artificial intelligence system was used to reconstruct the three-dimensional structure of embryos from 11-plane focal stacks. Networks of cell contacts were extracted from the resulting embryo three-dimensional models and each embryo's mean contacts per cell was computed. Unpaired t-tests and receiver operating characteristic curve analysis were used to statistically analyse mean cell contact outcomes. Cell contact networks from different embryos were compared with identical embryos with similar cell arrangements. RESULTS: At t4, a higher mean number of contacts per cell was associated with greater rates of blastulation and blastocyst quality. No associations were found with biochemical pregnancy, live birth, miscarriage or ploidy. At t8, a higher mean number of contacts was associated with increased blastocyst quality, biochemical pregnancy and live birth. No associations were found with miscarriage or aneuploidy. Mean contacts at t4 weakly correlated with those at t8. Four-cell embryos fell into nine distinct cell arrangements; the five most common accounted for 97% of embryos. Eight-cell embryos, however, displayed a greater degree of variation with 59 distinct cell arrangements. CONCLUSIONS: Evidence is provided for the clinical relevance of cleavage-stage cell arrangement in the human preimplantation embryo beyond the four-cell stage, which may improve selection techniques for day-3 transfers. This pilot study provides a strong case for further investigation into spatial biomarkers and three-dimensional morphokinetics.

Trends in the prevalence of obesity, overweight, and thinness among schoolchildren aged 7-14 years from southern Brazil (2002-2019).

OBJECTIVE: To analyze the obesity, overweight, and thinness trends among Brazilian schoolchildren by sex, age group, and type of school according to World Health Organization (WHO) and International Obesity Task Force (IOTF) criteria. METHODS: We conducted four surveys between 2002 and 2018/19 involving schoolchildren aged 7-14 years from a state capital in southern Brazil. Weight status was classified using both WHO and IOTF criteria. RESULTS: In the total sample, obesity prevalence based on the IOTF and the WHO criteria were 72% and 44% higher in 2018/19 compared with 2002, respectively. Over the whole period, the obesity prevalence increased among children (WHO: 10.1% vs. 14.1%; IOTF: 5.0% vs. 8.3%), and those from public schools (WHO: 10.5% vs. 16.4%; IOTF: 5.6% vs. 10.1%). There was no significant reduction in thinness prevalence over the analyzed period. CONCLUSION: Obesity prevalence remains on an upward trend in a state capital in southern Brazil, especially among children from public schools. A higher prevalence of overweight and obesity was observed using the WHO criteria compared with IOTF criteria.

Association between dietary patterns and biomarkers in connection with diabetes mellitus in adolescents: A systematic review.

AIMS: To perform a systematic review to investigate the association between adolescents' a posteriori dietary patterns with diabetes-related biomarkers (fasting blood glucose, fasting insulinemia, glycated hemoglobin and homeostatic model assessment insulin resistance index (HOMA-IR)). DATA SYNTHESIS: Review registered with PROSPERO under number CRD42020185369. Studies with adolescents aged 10-19 years that identified dietary patterns by a posteriori methods were included. The databases used included: PubMed, SCOPUS, Web of Science, Food Science and Technology Abstracts, CINAHL, SPORTDiscus, Lilacs/BVS, The Cochrane Central Register of Controlled Trials, ProQuest Dissertations&Theses Global and Capes Theses Bank and Brazilian Digital Library of Theses and Dissertations. Risk of bias was assessed via the Agency for Healthcare Research and Quality tool. Eight cross-sectional studies that evaluated 6438 adolescents (55.5% females) were included. For fasting blood glucose, the results were inconsistent and some studies found no association for the dietary patterns called traditional (57%), Western (42%) and healthy (28%). For the fasting insulinemia and HOMA-IR outcomes, the Western dietary pattern showed a positive association or higher means in 60% and 50% of the studies, respectively. No studies that evaluated glycated hemoglobin were found. CONCLUSION: Fasting insulinemia and HOMA-IR outcomes were positively associated with the Western dietary patterns. The studies reviewed did not present consistent evidence of an association with western, healthy and traditional dietary patterns with fasting blood glucose, as the results were conflicting or did not show statistical significance.

Body image and association with BMI, and purgative behaviours for weight control in adolescents aged 11-14 years.

We aimed to evaluate the association of overweight/obesity based in BMI and purgative behaviours with body image (BI). Methods: Cross-sectional study, with probabilistic sample of 976 adolescents, aged 11-14 years, from the city of Florianópolis, Brazil. Multivariate analyses were performed. Overweight (including obesity) and four variables related to purgative methods for body weight control or eating behaviour were evaluated as outcomes, while BI satisfaction was the primary independent variable in each model. Models were controlled for age, sex, type of school (public or private), intake of fruit and vegetables, number of daily meals, and physical activity scores levels. A total of 31·4 % of adolescents wanted to enlarge their silhouette and 45·6 % wanted to reduce it. Among overweight/obese adolescents, 9·6 % were satisfied with their bodies, while 89·8 % wanted to reduce it, while among the not overweight/obese adolescents, 45·4 % wanted to enlarge their silhouette (P < 0·001). Multivariate analysis showed that the odds for overweight/obesity is higher among adolescents who wanted to reduce their silhouette (OR = 11·20; 95 % CI = 5·55, 22·58). Adolescents who want to reduce their silhouette are more likely to use diuretics (OR = 3·08; CI = 1·78, 5·32) and to use laxatives (OR = 2·10; CI = 1·20, 3·68). A significant association was also found between dissatisfaction with BI and overeating (among those who want to enlarge their silhouette: OR = 1·78; CI = 1·12, 2·85 and among those who want to reduce their silhouette: OR = 1·81; CI = 1·03, 3·19). Conclusion: BI dissatisfaction was associated with overweight/obesity, as well with overeating, and the use of purgative methods.

Selenium intake is not associated with the metabolic syndrome in Brazilian adolescents: an analysis of the Study of Cardiovascular Risk Factors in Adolescents.

Se reduces cellular inflammation and lipid peroxides; therefore, its association with CVD and the metabolic syndrome (MetS) has been studied. We aimed to investigate the association between Se intake and the MetS and its parameters (high waist circumference, hyperglycaemia, high blood pressure, high TAG and low HDL-cholesterol) in Brazilian adolescents between 12 and 17 years old. This research is part of the Study of Cardiovascular Risks in Adolescents (ERICA), a Brazilian nationwide school-based study with regional and national relevance. We assessed: (1) socio-demographic data (sex, age, type of school and maternal education) using a self-administered questionnaire; (2) dietary intake using a 24-h recall applied for the whole sample and a second one applied to a subsample to allow within-person variability adjustment; (3) anthropometric data (weight, height, waist circumference) and blood pressure using standardised procedures; and (4) biochemical analyses (fasting glucose, TAG and HDL-cholesterol). Logistic regression was applied, basing the analysis on a theoretical model. Median Se intake was 98·3 µg/d. Hypertension and hyperglycaemia were more prevalent among boys, while a high waist circumference was more frequent in girls, and low HDL-cholesterol levels were higher among private school students. The prevalence of the MetS was 2·6 %. No association between the MetS and its parameters and Se intake was found. This lack of association could be due to an adequate Se intake in the studied population.

Scientific evidence of the association between oral intake of OMEGA-3 and OMEGA-6 fatty acids and the metabolic syndrome in adolescents: A systematic review.

AIMS: To conduct a systematic review of the literature on the scientific evidence of the oral intake of omega-3 and omega-6 FAs and metabolic syndrome (MS) in adolescents. DATA SYNTHESIS: The study was registered in PROSPERO (number 42020185370). Studies were carried out with adolescents aged 10-19 years, who presented as intervention/exposure the oral intake of omega-3 and/or omega-6 fatty acids (FAs), in the databases PubMed, Scopus, Web of Science, LILACS, CENTRAL, and PQDT Global e BDTD. The tools used to assess the risk of bias were RoB 2.0, Agency for Healthcare Research and Quality (AHRQ), and Newcastle-Ottawa Scale. Fifteen papers retrieved published from 2010 to 2019 were included (n = 3534); nine were randomized studies and controlled clinical trials, four were cross-sectional studies, one was a retrospective cohort study, and one case-control study. No studies have evaluated the effect or association of omega-3 and/or of omega-6 FAs with actual MS, only with its components. The randomized clinical trials identified the effects of omega-3 FA on the decrease in blood pressure (n = 1 out of six), glycemia (n = 2 out of seven), and triglycerides (n = 5 out of eight), and the increase in HDL-c (n = 2 out of eight) considering the comparison between the group that received omega-3 FA and the control group. CONCLUSIONS: Scientific evidence is controversial on the association between oral intake of omega-3 FAs and MS in adolescents, due to the heterogeneity between studies and the divergence of results for the same MS component.

Assessment of the median ages at sexual maturation stages of Brazilian schoolchildren according to overweight status and type of school over a 5-year period: 2007-2012/2013.

OBJECTIVES: A secular trend of earlier puberty has been observed in girls, and, although more uncertain in boys, is associated with an increasing trend in the prevalence of overweight and obesity. We aimed to compare the median ages of sexual maturation stages in schoolchildren from a city in southern Brazil over a 5-year period, according to weight status and type of school. METHODS: Two cross-sectional studies were performed in 2007 and 2012/2013, including 2215 and 1614 schoolchildren, respectively. Body mass index z-scores were calculated and categorized as either nonoverweight or overweight (including obesity). The type of school was categorized as either public or private. Sexual maturation was self-assessed according to the Tanner stages. Mann-Whitney and Kruskal-Wallis tests were performed to compare the median ages of sexual maturation stages. RESULTS: The median age decreased for almost all stages over the 5-year period in both sexes. In boys, the decrease ranged from 0.3 to 1.0 years (stages 2, 3, 4, and 5 for genitalia, and stages 2 and 4 for pubic hair), and from 0.3 to 0.7 years (stages 2, 3, and 4 for breast, and stages 3, 4, and 5 for pubic hair). In 2012, overweight students had lower median ages for most stages compared to those in 2007, especially in girls. Differences by type of school were balanced across years. CONCLUSIONS: The median age of Tanner's stages after 5 years was reduced in both sexes. In overweight girls, the reduction was more pronounced. The results by type of school were inconsistent.

Dimensionless squared jerk: An objective differential to assess experienced and novice probe movement in obstetric ultrasound.

OBJECTIVE: Widely accepted, validated and objective measures of ultrasound competency have not been established for clinical practice. Outcomes of training curricula are often based on arbitrary thresholds, such as the number of clinical cases completed. We aimed to define metrics against which competency could be measured. METHOD: We undertook a prospective, observational study of obstetric sonographers at a UK University Teaching Hospital. Participants were either experienced in fetal ultrasound (n = 10, >200 ultrasound examinations) or novice operators (n = 10, <25 ultrasound examinations). We recorded probe motion data during the performance of biometry on a commercially available mid-trimester phantom. RESULTS: We report that Dimensionless squared jerk, an assessment of deliberate hand movements, independent of movement duration, extent, spurious peaks and dimension differed significantly different between groups, 19.26 (SD 3.02) for experienced and 22.08 (SD 1.05, p = 0.01) for novice operators, respectively. Experienced operator performance, was associated with a shorter time to task completion of 176.46 s (SD 47.31) compared to 666.94 s (SD 490.36, p = 0.0004) for novice operators. Probe travel was also shorter for experienced operators 521.23 mm (SD 27.41) versus 2234.82 mm (SD 188.50, p = 0.007) when compared to novice operators. CONCLUSION: Our results represent progress toward an objective assessment of technical skill in obstetric ultrasound. Repeating this methodology in a clinical environment may develop insight into the generalisability of these findings into ultrasound education.

Body phenotypes and sexual maturation in Brazilian and US adolescents: evidence for a change in BMI category.

OBJECTIVE: Our study aimed to describe body phenotypes (BP) estimated by multivariate analysis and their association with body mass. DESIGN: BP were defined based on demographic variables, anthropometric data (body mass, height, skinfolds and circumferences), body composition (phase angle measured by bioelectrical impedance analysis), biochemical parameters (TAG, glucose, total cholesterol ratio/LDL, Hb and sexual maturation (pubic hair and breasts or gonads). ANOVA was performed to verify the differences between skin colour and the stages of pubertal development, BP, body composition, anthropometric and biochemical variables. SETTING: Cities of São Paulo-SP, Piracicaba-SP and Florianópolis-SC from Brazil and the United States. PARTICIPANTS: 9269 adolescents aged between 10 and 15 years old. RESULTS: The composition of BP was similar in all surveys, which are: BP1 was composed by skinfolds, body mass and circumferences variables; BP2 by pubic hair, breast in girls or gonad in boys, height and age; BP3 by cholesterol, TAG and glucose; and BP4 by phase angle, Hb and glucose (negative loading). There was a strong correlation (r = 0·9, P < 0·001) between BP1 and BMI. CONCLUSION: We highlighted independence observed between biochemical parameters, anthropometry, body composition and sexual maturation. BP may support the calculation of scores for diagnosis of obesity based on anthropometric variables and overcome ambiguity in the isolated use of BMI.

Association between pubertal development stages and body adiposity in children and adolescents.

BACKGROUND: The study aimed to analyze the association between pubertal development stages and adiposity in children and adolescents. METHODS: Cross-sectional study conducted in 2007 in Florianópolis, Brazil, with 2339 schoolchildren 32 aged 8 to 14 years old (1107 males). The outcome (adiposity) was evaluated using Z score and 33 percentilee values > = 85 of four skinfolds (triceps, subscapular, suprailiac and calf) and waist 34 circumference. Total body adiposity (Z score of the sum of skinfolds), central adiposity (Z score 35 of waist circumference) and peripheral adiposity (Z scores of triceps and calf skinfolds) were 36 estimated. Pubertal development stages was self-assessed according to Tanner stages of development. Thirty-seven Children and adolescents were classified according to tertiles of age for each pubertal development stages 38 stage - early, normal and late. Statistical analysis was performed using univariate and 39 multivariate Poisson regression models. RESULTS: Children and adolescent from both sexes with early pubertal development stages presented higher prevalence of central adiposity (waist circumference), with adjusted prevalence ratio (CI 95%) of 2.21 (1.12; 4.35) for males and 2.18 (1.04; 4.57) for females (reference group: normal pubertal development stages). Among females, there was a reduction in the prevalence of excess adiposity with decreased occurrence of early pubertal development stages. There was a strong relationship between adiposity and pubertal development stages. CONCLUSIONS: Excess adiposity was higher in both sexes for those with early pubertal development stages.

Time trends in the prevalence of breastfeeding among schoolchildren from public and private schools in Florianópolis, Southern Brazil: From 2002 to 2013.

OBJECTIVE: To describe breastfeeding trends from 2002 to 2012/2013, and to investigate whether breastfeeding practices differ between mothers of children in public and private schools. METHODS: Data were obtained from three school-based cross-sectional studies conducted with 7 to 10 years old children. The total sample was 7264 individuals. Data related to breastfeeding were analyzed descriptively and compared using the chi-square test for heterogeneity or trend. RESULTS: In the 10-year period was observed a decrease in the total percentage of schoolchildren who were not breastfed (12.9%-10.5%) and an increase in the percentage of schoolchildren breastfed for >12 months (23.9%-36.7%). In public schools, the increase of breastfeeding for >12 months was independent of maternal age and years of schooling. In private schools, the increase was observed for schoolchildren born to older mothers and to more educated mothers, although the highest percentage was observed for schoolchildren born to less educated mothers. CONCLUSIONS: The results confirm the complexity of determining breastfeeding behaviors, and understanding these dynamics is fundamental to develop and improve programs and actions aimed at encouraging, supporting, and protecting breastfeeding. However, strategies developed in Brazil during the first decade of the 21st century should explain the increase of proportion of breastfed children for more than 12 months, and the concomitant decrease of never breastfeed children in the city of Florianopolis (Southern Brazil).

Refractive Two-View Reconstruction for Underwater 3D Vision.

Recovering 3D geometry from cameras in underwater applications involves the Refractive Structure-from-Motion problem where the non-linear distortion of light induced by a change of medium density invalidates the single viewpoint assumption. The pinhole-plus-distortion camera projection model suffers from a systematic geometric bias since refractive distortion depends on object distance. This leads to inaccurate camera pose and 3D shape estimation. To account for refraction, it is possible to use the axial camera model or to explicitly consider one or multiple parallel refractive interfaces whose orientations and positions with respect to the camera can be calibrated. Although it has been demonstrated that the refractive camera model is well-suited for underwater imaging, Refractive Structure-from-Motion remains particularly difficult to use in practice when considering the seldom studied case of a camera with a flat refractive interface. Our method applies to the case of underwater imaging systems whose entrance lens is in direct contact with the external medium. By adopting the refractive camera model, we provide a succinct derivation and expression for the refractive fundamental matrix and use this as the basis for a novel two-view reconstruction method for underwater imaging. For validation we use synthetic data to show the numerical properties of our method and we provide results on real data to demonstrate its practical application within laboratory settings and for medical applications in fluid-immersed endoscopy. We demonstrate our approach outperforms classic two-view Structure-from-Motion method relying on the pinhole-plus-distortion camera model.

Bottom-up and top-down effects of browning and warming on shallow lake food webs.

Productivity and trophic structure of aquatic ecosystems result from a complex interplay of bottom-up and top-down forces that operate across benthic and pelagic food web compartments. Projected global changes urge the question how this interplay will be affected by browning (increasing input of terrestrial dissolved organic matter), nutrient enrichment and warming. We explored this with a process-based model of a shallow lake food web consisting of benthic and pelagic components (abiotic resources, primary producers, grazers, carnivores), and compared model expectations with the results of a browning and warming experiment in nutrient-poor ponds harboring a boreal lake community. Under low nutrient conditions, the model makes three major predictions. (a) Browning reduces light and increases nutrient supply; this decreases benthic and increases pelagic production, gradually shifting productivity from the benthic to the pelagic habitat. (b) Because of active habitat choice, fish exert top-down control on grazers and benefit primary producers primarily in the more productive of the two habitats. (c) Warming relaxes top-down control of grazers by fish and decreases primary producer biomass, but effects of warming are generally small compared to effects of browning and nutrient supply. Experimental results were consistent with most model predictions for browning: light penetration, benthic algal production, and zoobenthos biomass decreased, and pelagic nutrients and pelagic algal production increased with browning. Also consistent with expectations, warming had negative effects on benthic and pelagic algal biomass and weak effects on algal production and zoobenthos and zooplankton biomass. Inconsistent with expectations, browning had no effect on zooplankton and warming effects on fish depended on browning. The model is applicable also to nutrient-rich systems, and we propose that it is a useful tool for the exploration of the consequences of different climate change scenarios for productivity and food web dynamics in shallow lakes, the worldwide most common lake type.

Association between food, physical activity, and social assistance environments and the body mass index of schoolchildren from different socioeconomic strata.

The aim of this article was to evaluate associations between body mass index (BMI) and use of and distance from subjects homes of elements of the food and physical activity environments and use of social assistance environment, in schoolchildren from 7 to 14 years living in Florianópolis (South Brazil), stratified by monthly family income. A cross-sectional study was conducted with a probabilistic sample of 2152 schoolchildren. Univariate and multivariate linear regression analyses were conducted to test for associations between BMI and the use of and distance from supermarkets, bakeries and farmers' markets; use of and distance from parks/playgrounds and football pitches; and use of health centers, Reference Centers for Social Assistance, instructional facilities, residents associations, religious groups and a Brazilian program for cash transfer. Overweight and obesity rates were 21.5 and 12.7%, respectively. Among schoolchildren from low-income families, living more than 11 min' walk from parks/playgrounds was associated with higher BMI (ß = 0.53; 95% CI = 0.33-0.73). In the high-income strata, a longer distance from home to football pitches was associated with lower BMI (ß = -0.49; 95% CI = -0.69; -0.29). Neither food nor social assistance environments were associated with BMI of schoolchildren, even when analyzed by income strata.

Utilization and environmental availability of food outlets and overweight/obesity among schoolchildren in a city in the south of Brazil.

Among the causes of obesity, environmental factors have also been studied, in addition to genetic, social, psychological, and hormonal factors. The distribution of food outlets, facilitating or hindering food acquisition, can promote body weight control by encouraging healthier food habits. The objective of this study was to investigate associations between environmental availability and utilization of food outlets and overweight/obesity in 7 to 14-year-old schoolchildren in Florianópolis, in the South of Brazil. A logistic regression analysis identified a positive association between overweight/obesity in 2195 schoolchildren and the presence of restaurants in the vicinity of their homes (buffer = 400 meters). Being a member of a family that utilizes public markets/greengrocers was also positively associated with overweight/obesity in the sample investigated. Identifying the distribution of these establishments in the vicinity of the homes of schoolchildren in middle-income countries is an important element in understanding the role played by the food environment in weight gain in a variety of different settings.

Asymmetrical competition between aquatic primary producers in a warmer and browner world.

In shallow lakes, pelagic and benthic producers engage in spatially asymmetrical resource competition. Pelagic producers intercept the flux of light to the benthic habitat and benthic producers intercept the flux of sediment-derived nutrients to the pelagic habitat. In boreal and subarctic regions, climate change is affecting this interaction both directly through warming and indirectly through increased loading with colored dissolved organic matter (cDOM) from the catchment ("brownification"). We use a dynamical ecosystem model to explore the consequences of these changing environmental conditions for lake primary production and compare model predictions with the results of an experiment in which we manipulated water temperature and cDOM supply in a 2 × 2 factorial design. The experiment was performed in field mesocosms large enough to harbor reproducing fish populations and was run over an entire growing season. In agreement with model predictions, benthic algal production and biomass declined and pelagic algal production and biomass increased with browning. Pelagic nutrient concentrations diverged over time between low and high cDOM treatments, suggesting that browning alleviated pelagic algal nutrient limitation by shading benthic competitors and preventing them from intercepting the release of nutrients from the sediment. Warming considerably reduced benthic and pelagic algal production as well as pelagic algal biomass and total phosphorus. The warming results are only in partial accordance with model expectations, but can be explained by an indirectly inferred, positive response of macrophyte production (which was not included in the model) to warming. Our study suggests that lake ecosystem responses to climate change are mediated by cross-habitat feedbacks between benthic and pelagic producers.

The Study of Cardiovascular Risk in Adolescents--ERICA: rationale, design and sample characteristics of a national survey examining cardiovascular risk factor profile in Brazilian adolescents.

BACKGROUND: The Study of Cardiovascular Risk in Adolescents (Portuguese acronym, "ERICA") is a multicenter, school-based country-wide cross-sectional study funded by the Brazilian Ministry of Health, which aims at estimating the prevalence of cardiovascular risk factors, including those included in the definition of the metabolic syndrome, in a random sample of adolescents aged 12 to 17 years in Brazilian cities with more than 100,000 inhabitants. Approximately 85,000 students were assessed in public and private schools. Brazil is a continental country with a heterogeneous population of 190 million living in its five main geographic regions (North, Northeast, Midwest, South and Southeast). ERICA is a pioneering study that will assess the prevalence rates of cardiovascular risk factors in Brazilian adolescents using a sample with national and regional representativeness. This paper describes the rationale, design and procedures of ERICA. METHODS/DESIGN: Participants answered a self-administered questionnaire using an electronic device, in order to obtain information on demographic and lifestyle characteristics, including physical activity, smoking, alcohol intake, sleeping hours, common mental disorders and reproductive and oral health. Dietary intake was assessed using a 24-hour dietary recall. Anthropometric measures (weight, height and waist circumference) and blood pressure were also be measured. Blood was collected from a subsample of approximately 44,000 adolescents for measurements of fasting glucose, total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, glycated hemoglobin and fasting insulin. DISCUSSION: The study findings will be instrumental to the development of public policies aiming at the prevention of obesity, atherosclerotic diseases and diabetes in an adolescent population.

Association of sexual maturation with excess body weight and height in children and adolescents.

BACKGROUND: Studies addressing the influence of early sexual maturation on the excess of body weight and height of children and adolescents are scarce. The aim of the study was to analyze the association of sexual maturation with excess body weight and height in children and adolescents. METHODS: This was a cross-sectional study performed in Florianópolis city, Brazil, in 2007, with 2339 school children, aged 8-14 years (1107 males). Selection was based on a probabilistic, cluster-stratified sampling technique. School children were classified according to the presence of excess body weight, using sex- and age-specific body mass index (BMI) cutoff points. Z-scores were calculated from height and BMI data. Sexual maturation was self-assessed according to Tanner stages of development. Subjects were ranked based on tertiles of sexual maturation (early, normal and late) for each stage of development. Poisson and linear regression models were used. RESULTS: Compared to the reference group (normal sexual maturation), early maturing females had higher prevalence of excess weight (adjusted prevalence ratio: 1.70; 95% CI: 1.24 to 2.33) and increased height-for-age (adjusted ß: 0.37; 95% CI: 0.14 to 0.59), while late maturing females had lower prevalence of excess weight (adjusted prevalence ratio: 0.57; 95% CI: 0.37 to 0.87) and decreased height-for-age (adjusted ß: -0.38; 95% CI: -0.56 to -0.20). In males, early and late sexual maturation were associated with increased (adjusted ß: 0.37; 95% CI: 0.14 to 0.59) and decreased (adjusted ß: -0.38; 95% CI: -0.56 to -0.20) height-for-age, respectively. CONCLUSION: Early sexual maturation is associated with excess body weight in females and with greater height-for-age in both sexes.

Ultrasound Plane Pose Regression: Assessing Generalized Pose Coordinates in the Fetal Brain.

In obstetric ultrasound (US) scanning, the learner's ability to mentally build a three-dimensional (3D) map of the fetus from a two-dimensional (2D) US image represents a significant challenge in skill acquisition. We aim to build a US plane localization system for 3D visualization, training, and guidance without integrating additional sensors. This work builds on top of our previous work, which predicts the six-dimensional (6D) pose of arbitrarily oriented US planes slicing the fetal brain with respect to a normalized reference frame using a convolutional neural network (CNN) regression network. Here, we analyze in detail the assumptions of the normalized fetal brain reference frame and quantify its accuracy with respect to the acquisition of transventricular (TV) standard plane (SP) for fetal biometry. We investigate the impact of registration quality in the training and testing data and its subsequent effect on trained models. Finally, we introduce data augmentations and larger training sets that improve the results of our previous work, achieving median errors of 2.97 mm and 6.63° for translation and rotation, respectively.