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SUMMARY OBJECTIVE: The aim of this methodological study was to translate, culturally adapt, and validate the Genital Self-Image Scale (GSIS-20) into Brazilian Portuguese. METHODS: The cross-cultural adaptation followed a standardized five-step process: (1) initial translation into Portuguese by two independent bilingual translators; (2) synthesis of the translations; (3) back-translation into English by two independent native speakers; (4) expert committee review to ensure semantic, idiomatic, experiential, and conceptual equivalence; and (5) pre-test with 15 women to evaluate comprehension and cultural relevance. Subsequently, the psychometric properties of the adapted instrument were assessed in 148 women divided into three groups: nulliparous (n=53), primiparous without pelvic organ prolapse (n=52), and women with stage III or IV pelvic organ prolapse (n=43). The Genital Self-Image Scale (GSIS-20) was applied at three time points to assess internal consistency (Cronbach's alpha), test–retest, and interobserver reliability (intraclass correlation coefficient), and discriminant validity. RESULTS: All subscales of the Genital Self-Image Scale (GSIS-20) showed statistically significant differences between groups. The instrument demonstrated excellent internal consistency (Cronbach's alpha=0.925) and reproducibility (intraclass correlation coefficient >0.75). CONCLUSION: The Genital Self-Image Scale (GSIS-20) was successfully translated and culturally adapted into Brazilian Portuguese, showing satisfactory psychometric properties for use in this population.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the relationship between sarcopenia and its components with fracture risk in people living with human immunodeficiency virus, and to assess the association with sociodemographic and clinical characteristics. METHODS: This cross-sectional study was conducted with people living with human immunodeficiency virus undergoing antiretroviral therapy in the state of Mato Grosso do Sul, Brazil. Sarcopenia was defined according to the European Working Group on Sarcopenia in Older People criteria, assessing muscle strength (handgrip strength), skeletal muscle mass (skeletal muscle mass index), and physical performance (gait speed). The 10-year risk of major osteoporotic and hip fracture was estimated using the Brazilian version of the Fracture Risk Assessment Tool (FRAX®). Statistical analyses included chi-square tests, analysis of variance, and Spearman correlation (p<0.05). RESULTS: Among 105 participants (44.6±13.5 years), the prevalence of confirmed or severe sarcopenia was 6.7%. No association was found between sarcopenia and the risk of major fracture (p=0.471) or hip fracture (p=0.254). However, handgrip strength was correlated with the risk of major fracture (ρ=-0.21; p=0.029) and hip fracture (ρ=-0.25; p=0.010). SMII showed moderate correlations with major fracture risk (ρ=-0.44; p<0.01) and hip fracture risk (ρ=-0.52; p<0.01). Gait speed was correlated only with hip fracture risk (ρ=-0.22; p=0.025). Older age (p<0.001) and lower body mass index (p=0.011) were significant risk factors. CONCLUSION: Sarcopenia as a categorical diagnosis was not associated with fracture risk, whereas lower handgrip strength and skeletal muscle mass index were associated with higher FRAX® estimates, and gait speed only with hip fracture risk. These findings support assessing sarcopenia-related parameters in people living with human immunodeficiency virus.

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SUMMARY OBJECTIVE: This study was conducted to determine women's awareness levels regarding gynecological cancers and their fatalistic perceptions regarding breast cancer. METHODS: This was a descriptive study conducted in a Family Health Centre District between October 2023 and August 2024. The study sample consisted of 333 women. A personal information form, Gynecological Cancer Awareness Scale, and breast cancer fatalism scale were used to collect data. RESULTS: The mean total score on the Gynecological Cancer Awareness Scale for the women participating in the study was 146.02±21.70, and the mean total score on the Breast Cancer Fatalism Scale was 7.40±2.61. Educational status, social security, obtaining information from healthcare professionals about gynecological cancers, and previous gynecological examination status of the participants explain 18.7% of the variance in the Gynecological Cancer Awareness Scale total score average. Additionally, age and educational status explain 13.6% of the variance in the Breast Cancer Fatalism Scale total score average. CONCLUSION: As a result, it can be said that women's awareness levels about gynecological cancers and their perception of breast cancer fatalism are above average. Therefore, education should be provided to increase awareness levels of gynecological cancers and reduce perceptions of breast cancer fatalism.

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SUMMARY OBJECTIVE: This study aims to investigate the clinical significance of serum soluble triggering receptor expressed on myeloid cells-1 levels in patients with polycystic ovary syndrome. METHODS: This case-control study included 40 women with polycystic ovary syndrome and 40 healthy control women. Serum soluble triggering receptor expressed on myeloid cells-1 and high-sensitive C-reactive protein levels were measured via commercially available enzyme-linked immunosorbent assay, according to the manufacturer's instructions. RESULTS: Soluble triggering receptor expressed on myeloid cells-1 levels were statistically significantly higher in women with polycystic ovary syndrome than controls (p<0.001). In the logistic regression analysis, an increase in serum soluble triggering receptor expressed on myeloid cells-1 level demonstrated a significant association with polycystic ovary syndrome diagnosis (p=0.011). In the receiver operating characteristic curve analysis, the area under the curve (AUC) for soluble triggering receptor expressed on myeloid cells-1 was found to be 0.800 (p<0.001). Setting the cut-off value at 45.22 pg/mL, soluble triggering receptor expressed on myeloid cells-1 demonstrated a sensitivity of 87.5% and a specificity of 65.0%. In the logistic regression analysis that incorporated homeostatic model assessment for insulin resistance, anti-müllerian hormone, and soluble triggering receptor expressed on myeloid cells-1, a 1 pg/mL rise in soluble triggering receptor expressed on myeloid cells-1 was associated with a 1.07-fold increase in the odds of polycystic ovary syndrome, a 3.10-fold increase in the odds due to a 1-point rise in homeostatic model assessment for insulin resistance, and a 3.24-fold increase in the odds for every 1 ng/mL rise in anti-müllerian hormone. The model incorporating anti-müllerian hormone, homeostatic model assessment for insulin resistance, and soluble triggering receptor expressed on myeloid cells-1 predicted polycystic ovary syndrome with 83.8% accuracy, 90.0% specificity, and 77.5% sensitivity. CONCLUSION: Soluble triggering receptor expressed on myeloid cells-1 may serve as an indicator of the chronic inflammatory process in polycystic ovary syndrome and could be a complementary marker rather than a diagnostic marker for polycystic ovary syndrome.

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SUMMARY OBJECTIVE: The aim of the study was to determine the association between plasma expression levels of microRNAs (miRNAs; MIR126-3p; and MIR375-3p) and pregnancy complications. METHODS: This prospective study included 39 pregnant women who admitted to Obstetrics and Gynecology Polyclinic of Tokat Gaziosmanpasa University, Faculty of Medicine. 28 of these pregnant women were healthy, while 11 had pregnancy complications (five hypertensive disorders of pregnancy and six gestational diabetes). Hypertensive disorders include preeclampsia, gestational hypertension, and chronic hypertension. The study included pregnant women older than 18 years of age with singleton pregnancies and no history of cancer. Quantitative real time-polymerase chain reaction was used to determine the expression patterns of MIR126-3p and MIR375-3p in maternal plasma. Fold change (2-ΔΔCt) analysis was used to examine the microRNA expression patterns. RESULTS: MIR375-3p expression levels demonstrated a statistically significant difference between two groups. It was significantly lower in women with pregnancy complications than healthy pregnant women. CONCLUSION: We found that MIR375-3p might be a useful indicator for non-invasive diagnosis and play a crucial part in predicting pregnancy complications. Given the limited patient cohort, more research using bigger samples is required to validate our findings.

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SUMMARY OBJECTIVE: The aim of this study was to compare functional shoulder performance and fatigue among young adults with forward head posture, forward head posture with scapular dyskinesis (forward head posture+scapular dyskinesia), and healthy controls. METHODS: This cross-sectional study included 85 young adults aged 18–25 years, allocated to three groups: forward head posture+scapular dyskinesia (n=25), forward head posture (n=30), and control (n=30). Forward head posture was assessed using the craniovertebral angle, scapular dyskinesia with the Lateral Scapular Slide Test, functional shoulder performance with Timed Functional Arm and Shoulder Test, and fatigue with the Chalder Fatigue Scale. RESULTS: Significant between-group differences were found for dominant-side, non-dominant-side, and total Timed Functional Arm and Shoulder Test scores (p<0.001). The forward head posture+scapular dyskinesia group had lower dominant-side and total Timed Functional Arm and Shoulder Test scores than the both forward head posture and control groups (p=0.040, p<0.001, and p=0.031, p<0.001, respectively), while both postural disorder groups had lower non-dominant-side Timed Functional Arm and Shoulder Test scores than controls (forward head posture+scapular dyskinesia: p<0.001; forward head posture: p=0.003). Total and physical fatigue scores were higher in both the forward head posture+scapular dyskinesia and forward head posture groups than in controls (total fatigue: p=0.010 and p=0.011; physical fatigue: both p=0.019), whereas mental fatigue did not differ significantly among the groups (p=0.163). CONCLUSION: Functional shoulder performance was lower in the forward head posture and forward head posture+scapular dyskinesia groups than in the controls, with the lowest scores in the forward head posture+scapular dyskinesia group. Total and physical fatigue were higher in both postural disorder groups, whereas mental fatigue did not differ between groups.

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SUMMARY OBJECTIVE: The aim of this study was to analyze the association of thyroid stimulating hormone and free-thyroxin with anemia as well as the role of several sociodemographic variables in these associations. METHODS: This is a cross-sectional analysis of the Brazilian Longitudinal Study of Adult Health study (2008–2010), a prospective cohort study of civil servants in six locations in Brazil. Inclusion criteria: to be an active or retired civil servant of one of the institutions and 35–74 years at enrollment. Exclusion criteria: pregnancy less than 4 months before entering the study for women, intention to quit the institution soon, live outside the metropolitan region where the investigation center is located or communication problems. Anemia was defined as hemoglobin <12 g% in women and <13 g% in men. After exclusions, 13,247 participants were included in the analysis. Models were presented without adjustment and adjusted for sociodemographic and clinical risk factors. The study was approved by the Ethic Committee. RESULTS: Median age was 51.9 (51–53 years), 54% of women There was an association of less presence of anemia with higher free-thyroxin levels considering the entire sample: OR 0.80 (95%CI 0.65–0.98) for the second quintile; OR 0.55 (95%CI 0.43–0.70) for third quintile; OR 0.49 (95%CI 0.38–0.63) for fourth quintile; and OR 0.52 (95%CI 0.40–0.66) for fifth quintile for free-thyroxin levels. This association was also present when analyzing the sample by sex. CONCLUSION: Higher levels of free-thyroxin are associated with lower odds of anemia. No associations were found between thyroid stimulating hormone levels and anemia. In analysis, according to sex, No differences were found between men and women.

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SUMMARY OBJECTIVE: The aim of this study was to examine general self-efficacy in relation to perceived social support, self-esteem, and employment status among individuals with remitted bipolar disorder. METHODS: This cross-sectional study included 67 patients with bipolar disorder in remission for at least eight weeks. Sociodemographic data were collected with a semi-structured form, and participants completed the Rosenberg Self-Esteem Scale, Multidimensional Scale of Perceived Social Support, and General Self-Efficacy Scale. Correlation analyses, group comparisons, and an exploratory multiple linear regression analysis were conducted. RESULTS: Self-esteem was positively correlated with perceived social support (r=0.390, p<0.01) and general self-efficacy (r=0.604, p<0.001). Employed participants had higher perceived social support, self-esteem, and general self-efficacy than unemployed participants (all p<0.05). In an exploratory multiple linear regression model, self-esteem and employment status remained associated with general self-efficacy after adjustment for perceived social support, age, and gender. CONCLUSION: Self-esteem and employment status were associated with general self-efficacy in patients with remitted bipolar disorder. These preliminary findings highlight the potential relevance of psychosocial and vocational factors, although longitudinal studies are needed to clarify the directionality of these relationships.

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SUMMARY OBJECTIVE: The objective of this study was to describe the demographic, clinical, cognitive, and functional characteristics of acquired brain injury patients, analyze complications, and evaluate inpatient rehabilitation outcomes. METHODS: Retrospective review of 50 acquired brain injury patients undergoing multidisciplinary inpatient rehabilitation (2019–2024). Glasgow Coma Scale, post-traumatic amnesia, cognitive scales (Mini-Mental State Examination, Montreal Cognitive Assessment, Rancho Los Amigos), Functional Ambulation Scale, and complications were assessed. RESULTS: Traumatic etiology comprised 76% of cases; 72% were severe (Glasgow Coma Scale 3–8). Prolonged post-traumatic amnesia (>24 h) was significantly associated with severe injury (p<0.001). Spasticity (64%), contractures (42%), speech disorders (42%), and dysphagia (34%) were most prevalent. Functional Ambulation Scale score 0 decreased from 58 to 42% post-rehabilitation; Functional Ambulation Scale 3–5 increased from 24 to 46% (Wilcoxon signed-rank test, p<0.001). CONCLUSION: Structured multidisciplinary rehabilitation was associated with measurable functional gains in acquired brain injury patients despite severe deficits and frequent complications; however, the absence of a control group precludes causal conclusions.

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SUMMARY OBJECTIVE: In emergency departments, accurate and timely triage plays a critical role in prioritizing patient care. Traditional triage often suffers from subjectivity and inconsistency, especially under time pressure and overcrowded conditions. The aim of this study was to evaluate the predictive potential of multiple supervised machine learning models for three-class emergency department triage classification and compare their performance using routinely available triage variables. METHODS: We conducted a comparative analysis of eight supervised machine learning models using a retrospective dataset comprising 510 patient records from the emergency department triage. The dataset included demographic features, vital signs, and chief complaints. A 10-fold cross-validation strategy was employed to evaluate performance in a three-class triage outcome scenario based on urgency levels using accuracy, precision, recall, and F1-score. RESULTS: Among the evaluated models, logistic regression, random forest, support vector machine, and majority voting achieved the highest predictive performance, with overall accuracies exceeding 89%. The confusion matrix analysis revealed that low-urgency cases were consistently classified with the highest accuracy across all models, while misclassifications occurred primarily between high-urgency and medium-urgency cases. CONCLUSION: The results show that machine learning models appear well-suited to support the emergency departments triage decision-making process. Integrating such models into emergency departments workflows can improve patient prioritization, streamline clinical operations, and ultimately contribute to better quality of care.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate postural balance in patients with rheumatoid arthritis and identify factors associated with balance impairment. METHODS: This cross-sectional case–control study included 101 patients with rheumatoid arthritis and 94 healthy controls recruited at a single tertiary referral center between March 2024 and April 2025. Epidemiological and clinical data, including disease activity, current treatments, and the number of falls during the previous year, were obtained through medical record review and direct patient interviews. Balance was assessed using the Berg Balance Scale, and handgrip strength was measured with a Jamar® dynamometer. RESULTS: Patients with rheumatoid arthritis had significantly lower Berg Balance Scale scores (p<0.0001) and a markedly higher likelihood of experiencing falls than controls (OR 6.2; 95%CI 1.48–28.2). In univariate analysis, age (p<0.0001), handgrip strength (p=0.002), hypertension (p=0.02), tobacco exposure (p=0.0008), antimalarial use (p=0.02), and methotrexate use (p=0.007) were significantly associated with Berg Balance Scale scores. However, after multivariable adjustment, only antimalarial use (β=-2.75;95%CI -5.12 to -0.38; p=0.02), handgrip strength (β=0.09; 95%CI 0.01–0.17; p=0.01), and tobacco exposure (β=-1.90; 95%CI -3.20 to -0.62; p=0.004) remained independently associated with balance performance. CONCLUSION: Postural imbalance appears to be an important and potentially modifiable feature of rheumatoid arthritis. Routine balance assessment, together with interventions targeting muscle strength and smoking cessation, may help reduce fall risk and improve functional outcomes. Further studies are needed to clarify the relationship between antimalarial use and balance impairment.

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SUMMARY OBJECTIVE: Cancer is a major global cause of mortality and holds particular importance in forensic cases regarding diagnosis, treatment processes, and determination of cause of death. METHODS: This retrospective study analyzed 163 cancer-related death cases referred for forensic evaluation to the First Specialized Board of the Council of Forensic Medicine of Türkiye between 2019 and 2023. Demographic, clinical, pathological, and forensic data were evaluated comprehensively. RESULTS: Most cases were male (79.1%), with a mean age of 57.3±18.5 years. The most common primary cancer was lung (30.7%). Diagnosis relied mainly on medical records (84%), while 12.3% were diagnosed solely by autopsy. Comorbidities were frequent (74.2%), the metastasis rate was high (46.0%), and deaths mostly occurred in hospitals (78.5%). Malpractice claims were present in 36.8%, particularly higher in interventional treatments. CONCLUSION: Autopsy and histopathological examinations remain essential for diagnostic accuracy in forensic cancer-related deaths. Malpractice allegations were more frequent among cases undergoing surgery and chemotherapy/radiotherapy, although these findings reflect allegations rather than confirmed malpractice. A multidisciplinary approach integrating clinical, pathological, and forensic data is crucial for medicolegal evaluation.

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SUMMARY OBJECTIVE: This study aimed to assess the reasons for admission, demographic and clinical characteristics, diagnostic procedures, hospitalization rates, and repeat visits among infants aged 0–12 months transported to the pediatric emergency department by 112 Emergency Medical Services ambulances in 2023, with a focus on. The study further evaluated the urgency of visits and sought to identify potentially preventable hospital admissions, while also examining the clinical decision-making processes involved. METHODS: This retrospective investigation involved infants brought to the Pediatric Emergency Department of Batman Training and Research Hospital from January 1 to December 31, 2023. Hospital records were examined for demographic reasons for admission, laboratory and imaging evaluations, hospitalization or referral outcomes, and repeat visits. Patients were grouped as neonates (0–28 days) or post-neonatal infants (29 days–12 months). Statistical analyses were conducted using Statistical Package for the Social Sciences 26. RESULTS: Of 3,950 ambulance transports, 957 (24.2%) involved infants aged 0–12 months; 55.6% were male. The leading causes for admission were respiratory distress (38.8%), jaundice (21.8%), and fever (8.3%). Hospitalization was needed in 60.6% of cases, and 20.0% were admitted to neonatal intensive care. Approximately 37.2% were discharged after clinical examination and limited diagnostic workup. Repeat presentations were seen in 11.3% of patients. Most admissions occurred on weekends and during off-hours periods. CONCLUSION: Many ambulance transports of infants involved non-urgent conditions, yet hospitalization rates remained high, especially among neonates. Improving parental education, scheduled follow-up for high-risk infants, and primary care access could reduce unnecessary visits.

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SUMMARY OBJECTIVE: The aim of this study was to investigate the clinical, imaging, and hematological parameters predicting the necessity of surgical intervention in pregnant women presenting with symptomatic gestational hydronephrosis. METHODS: We retrospectively evaluated 192 pregnant women diagnosed with symptomatic hydronephrosis between January 2015 and September 2024. Patients were divided into Group 1 (conservative management, n=138) and Group 2 (surgical intervention via double-J stent or percutaneous nephrostomy, n=54). Demographic data, clinical findings, degree of hydronephrosis, urinalysis, and complete blood count parameters—including C-reactive protein, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune-inflammation index—were compared. Logistic regression analysis was performed to identify predictors for surgery. RESULTS: A history of urolithiasis, prolonged pain, fever, severe hydronephrosis, pyuria, and elevated creatinine were significantly higher in Group 2 (p<0.05). White blood cell, neutrophil-to-lymphocyte ratio, and C-reactive protein levels did not differ significantly between the groups. However, platelet counts (p=0.020), platelet-to-lymphocyte ratio (p=0.038), and systemic immune-inflammation index (p=0.015) were significantly elevated in the surgical cohort. Univariate logistic regression analysis revealed that an elevated platelet count (p=0.039) and a higher systemic immune-inflammation index (p=0.004) were significant predictors. In the multivariate analysis, the systemic immune-inflammation index remained an independent predictor (p=0.009), whereas platelet count did not. CONCLUSION: While clinical presentation and the severity of hydronephrosis primarily indicate the need for surgical intervention, the systemic immune-inflammation index serves as a valuable, cost-effective auxiliary predictor among the hematological parameters.

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SUMMARY OBJECTIVE: This study considers institutional and contextual characteristics in an analysis of factors associated with unsatisfactory ratings among medical courses in the 2025 Brazilian National Medical Education Assessment Exam. METHODS: We analyzed secondary data from participating medical courses, with an interest in unsatisfactory ratings (1 or 2 out of 5). To measure associations of unsatisfactory ratings with course characteristics (i.e., institution type, location, existence duration, applicant-vacancy ratio, student-faculty ratio), logistic regression models estimated crude and adjusted odds ratios, with 95%CIs. RESULTS: Of 350 courses (119 public, 231 private), one third (n=107) underperformed. More public (95.8%) than private (55.8%) courses performed satisfactorily. In the multivariate model, courses in the 2nd and 3rd quartiles of the applicant-vacancy ratio had lower odds of receiving an unsatisfactory rating (aOR 0.47; 95%CI 0.23–0.93 and aOR 0.32; 95%CI 0.15–0.67). Courses with less than 10 years of existence had higher odds of an unsatisfactory rating (aOR 2.13; 95%CI 1.01–4.47). Higher odds were observed in the North (aOR 5.41; 95%CI 1.70–17.18), whereas lower odds were found in the South (aOR 0.39; 95%CI 0.15–0.98), compared with the Southeast. Private courses had higher odds of an unsatisfactory rating (aOR 10.93; 95%CI 2.68–44.53). CONCLUSION: Results showed inequalities in medical course ratings by institution type, existence duration, applicant-vacancy ratio, and geographical location, indicating the need to improve regulatory policies and processes for evaluating medical education in Brazil.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the predictive value of systemic inflammation markers for abnormal cervical screening results and high-grade cervical lesions in women participating in a human papillomavirus- and cytology-based screening program, thereby determining colposcopy indications more accurately to reduce unnecessary colposcopy requests and prevent overtreatment. METHODS: A total of 2,758 women who underwent cervical cancer screening between 2020 and 2025 were included in this retrospective cross-sectional study. Abnormal screening results were defined as abnormal cytology (≥Atypical squamous cells of undetermined significance [ASC-US]) and/or high-risk human papillomavirus positivity. Hematological parameters measured within 1 month prior to screening were used to calculate neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune-inflammation index. Continuous variables were evaluated using nonparametric tests, and the independent predictors of abnormal screening results and high-grade lesions were identified using logistic regression models. RESULTS: Neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune-inflammation index values were significantly higher in the abnormal smear groups and in human papillomavirus -positive patients (all p<0.001). Neutrophil-to-lymphocyte ratio displayed the highest diagnostic performance for high-grade lesions (area under the curve=0.871; cutoff value >4.41, sensitivity 66.7%, specificity 99.2%), followed by systemic immune-inflammation index (area under the curve=0.847), while platelet-to-lymphocyte ratio showed lower specificity (area under the curve=0.741). CONCLUSION: In conclusion, our findings suggest that inflammatory markers are associated with abnormal cervical screening results. To determine the significance and clinical utility of serum inflammatory markers, multicenter clinical trials involving larger patient cohorts are needed.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the experiences and confidence levels of acne patients using artificial intelligence tools. This study investigates whether patients view artificial intelligence as a standalone resource or a facilitator of physician collaboration to support the ethical implementation of healthcare technologies. METHODS: This cross-sectional, descriptive study included acne patients aged ≥18 years with internet access. Alongside physician-led clinical evaluations, a structured questionnaire was administered. RESULTS: Among 123 patients (81.3% female), 45.5% utilized artificial intelligence tools for general health purposes before consulting a physician, with acne-specific artificial intelligence usage being significantly driven by the perception of rapid access (r=0.490, p<0.001). Despite this interest, 67.5% insisted on professional validation for artificial intelligence advice, and notably, no significant correlation was found between clinical acne score and artificial intelligence utilization for acne management. Additionally, 55.3% of participants expressed concern about the risk of artificial intelligence making incorrect diagnoses, and 48.8% stated that they were reluctant to share personal data, such as photos, with these systems. Of those who prefer artificial intelligence, 53.7% use it for “rapid and easy access,” while 52% stated that they “would never use it without consulting a doctor.” CONCLUSION: The integration of artificial intelligence in dermatology necessitates a physician-led, transparent approach that prioritizes digital health literacy and ensures these tools serve as supervised supplements rather than a replacement for human-centered care.

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SUMMARY OBJECTIVE: The aim of this study was to determine the prevalence of night eating syndrome among women with gestational diabetes mellitus compared with healthy pregnant controls, and to evaluate its associations with sleep quality, healthy lifestyle behaviors, fatigue severity, physical activity, perceived social support, and neonatal outcomes. METHODS: This single-center, comparative cross-sectional study enrolled 615 pregnant women at a tertiary hospital. Night eating syndrome was identified using the Night Eating Questionnaire ≥25. Sleep quality, lifestyle behaviors, fatigue, physical activity, and perceived social support were assessed with the Pittsburgh Sleep Quality Index, Healthy Lifestyle Behaviors Scale, Fatigue Severity Scale, International Physical Activity Questionnaire, and Multidimensional Scale of Perceived Social Support. Group comparisons, and multivariable logistic regression with Benjamini-Hochberg correction were performed. RESULTS: Night eating syndrome prevalence was higher in women with gestational diabetes mellitus than in controls (p<0.001). The gestational diabetes mellitus group exhibited worse sleep (Pittsburgh Sleep Quality Index 17.2±4.0 vs. 8.3±5.7), lower Healthy Lifestyle Behaviors Scale scores, greater fatigue, and reduced social support (all p<0.001). Higher Healthy Lifestyle Behaviors Scale and physical activity were protective against night eating syndrome. Night eating syndrome was independently associated with a nearly fourfold increase in neonatal intensive care unit admission (adjusted odds ratio 3.82; 95%CI 1.68–8.71; p=0.001) after adjustment for gestational diabetes mellitus, body mass index, sleep, fatigue, lifestyle, gestational age at birth, and maternal age. CONCLUSION: Night eating syndrome is highly prevalent among women with gestational diabetes mellitus, clustering with poor sleep, severe fatigue, sedentariness, and reduced social support, and independently associated with adverse neonatal outcomes.

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SUMMARY OBJECTIVE: The aim of this study was to investigate whether changes in body composition over 6 months of Mediterranean diet follow-up were associated with corresponding changes in device-derived metabolic age after adjustment for weight change. METHODS: This retrospective observational study analyzed body composition records of 414 adults who completed routine 6-month follow-up after Mediterranean diet counseling between June 2024 and June 2025. Metabolic age and body composition parameters were assessed using the Tanita MC-580 body composition analyzer at baseline and after 6 months. Hierarchical multiple linear regression analysis was used to evaluate the associations between changes in body composition parameters and metabolic age change after adjustment for weight change, age, sex, and baseline metabolic age. RESULTS: Tanita-derived metabolic age decreased by 0.94 years (p<0.001). Changes in muscle–fat ratio (β=-0.585), visceral fat (β=-0.556), and protein mass (β=-0.339) were significantly associated with metabolic age change after adjustment, whereas weight-adjusted waist index was not significantly associated with metabolic age change in the adjusted model. Inclusion of body composition variables increased the explained variance of the model from 20.4 to 45.7% (adjusted R2 from 0.196 to 0.446). CONCLUSION: Favorable changes in Tanita-derived metabolic age were observed during follow-up. The associated body composition changes may partly reflect shared components of the device algorithm because metabolic age is a composite surrogate rather than a direct measure of biological aging. Given the retrospective uncontrolled design, causal effects of the Mediterranean diet cannot be established.