Search Results (1,726)

With rapid population aging in China, the age-friendly upgrading of rural public spaces has become central to both rural revitalization and active aging. Existing evaluation frameworks are constrained by urban-oriented indicators, linear utility assumptions, and static assessments that overlook rural contextual needs. In response to these limitations, this study develops and validates a rural age-friendly public space evaluation system by coupling the Kano model with the Capability Maturity Model (CMM). Evaluation indicators were derived from in-depth interviews with rural older adults through three-level grounded-theory coding. The Kano model was then used to identify demand attributes and Better–Worse coefficients, while indicator weights were determined using an AHP–entropy method adjusted by Kano coefficients. Finally, a Kano–CMM correlation matrix was constructed to generate a five-level maturity evaluation model and applied to Xinan Village, Xiancun Town, Zengcheng District, Guangzhou. Results identify seven core dimensions: safety and protection; accessibility and mobility continuity; comfort and health friendliness; health and wellness support; social interaction and psychological belonging; environmental sanitation and quality; and maintenance, renewal, and durability. Rural older adults’ needs are dominated by must-be attributes, followed by attractive attributes, whereas one-dimensional attributes are comparatively less prominent. Safety- and accessibility-related indicators show the highest negative risk sensitivity, indicating that rural age-friendly design should prioritize risk reduction over experiential enhancement. The proposed framework moves beyond checklist-based assessment and provides an evidence-based, dynamic, and auditable tool for diagnosing and improving rural age-friendly public spaces. Full article

Drawing on social acceleration theory, this study examines how two perceived dimensions of acceleration in working life—technological acceleration and acceleration of social change—are associated with sense of agency and meaning in life among employed young adults in contemporary China. These two dimensions capture perceived increases in communication and information flow, as well as changing knowledge and skill demands in working life. Empirical evidence remains limited on how these perceived acceleration experiences are associated with agency and meaning in life, particularly across urban and rural contexts. Using data from the 2024–2025 Chinese Social Mentality Survey, we analyzed 5178 employed adults (aged 18–45). Structural equation modeling and multi-group analyses were used to examine the associations among technological acceleration, acceleration of social change, sense of agency, and meaning in life. The results showed that both measured acceleration dimensions were positively associated with presence of meaning and search for meaning, and these associations were partially statistically mediated by sense of agency. Notably, acceleration of social change shows stronger associations with sense of agency and search for meaning among rural participants, whereas sense of agency is more strongly associated with presence of meaning among urban participants. These findings suggest that the two measured dimensions of perceived acceleration in working life are not necessarily associated with lower meaning in life among employed young adults. Instead, they may be linked to meaning in life partly through sense of agency, highlighting the importance of considering urban–rural contexts. Full article

Urban residential outdoor spaces are increasingly affected by high temperatures, strong solar radiation, and uneven wind conditions, which influence residents’ outdoor activities and thermal comfort. This study proposes an evidence-based approach for the fine-grained design of residential outdoor activity spaces based on age-specific activity patterns and microclimatic conditions. Using 1096 valid questionnaires, field observations, and in situ microclimate measurements across four seasons, we quantified the activity patterns, temporal distributions, and spatial preferences of children, adolescents, adults, and older adults. Results reveal statistically significant age- and season-dependent differences in environmental preferences (Kruskal–Wallis H = 56.78, p < 0.001 for light priority; H = 26.81, p < 0.001 for thermal priority across age groups). Children and older adults exhibited sustained and widely distributed activities, whereas adolescents and adults showed more concentrated temporal patterns. In summer, activities shifted toward mornings and evenings to avoid heat, while in winter, activities peaked around midday and afternoon. Wind and light conditions were prioritized over thermal conditions across all seasons: in summer, 47.2% of respondents ranked wind first; in winter, 50.9% ranked light first. Tree shading consistently reduced air temperature, black globe temperature, and WBGT relative to open areas in every season, with the largest mean differences observed in spring (ΔT_g = 1.19 °C) and the largest instantaneous difference during summer early afternoon (ΔT_g = 1.51 °C at 13:00). Integrating these findings, this study proposes evidence-based design strategies, including optimized functional layouts, shading and ventilation features, sun-exposure management, and nighttime lighting, providing quantitative support for improving comfort, safety, and usability in residential outdoor spaces. Full article

Background/Objectives: Herbal medicine is one of the most widely used forms of complementary medicine worldwide. Although traditionally associated with rural populations and older generations, its use among urban adolescents and young adults and the factors associated with its use remain insufficiently understood. This study aimed to evaluate herbal medicine knowledge, use, recommendation practices, and their associations with family-based recommendation, social media exposure, and previous experience using herbal medicine together with conventional medical treatment among urban adolescents and young adults in western Mexico. Methods: A cross-sectional study was conducted among 144 urban high school students in western Mexico. A structured questionnaire was used to assess sociodemographic characteristics, herbal medicine knowledge, use, recommendation practices, family-based recommendation, social media exposure, and self-reported concurrent use with conventional medical treatment. Bivariate and multivariable logistic regression analyses were performed to identify factors independently associated with herbal medicine use, recommendation, and self-reported knowledge. Results: Herbal medicine use was reported by 36.8% of participants, whereas 31.9% reported knowing what herbal medicine is. Family-based recommendation was independently associated with herbal medicine use (OR = 8.04; 95% CI: 2.99–21.61; p < 0.001), followed by self-reported herbal medicine knowledge (OR = 4.56; 95% CI: 1.97–10.58; p < 0.001). Recommendation behavior was independently associated with family-based recommendation (OR = 3.70; 95% CI: 1.45–9.44; p = 0.006) and previous herbal medicine use (OR = 4.16; 95% CI: 1.75–9.93; p = 0.001). Among herbal medicine users, all participants reported previous experience using herbal medicine together with conventional medical treatment, suggesting the coexistence of both therapeutic approaches within this study population. Social media exposure was associated with self-reported herbal medicine knowledge (OR = 2.97; 95% CI: 1.06–8.27; p = 0.038) but was not associated with herbal medicine use or recommendation. Conclusions: Among this study population, herbal medicine was commonly reported and appeared to be part of complementary healthcare practices among urban adolescents and young adults. Family-based recommendation was independently associated with herbal medicine use and recommendation, whereas social media exposure was associated primarily with self-reported knowledge rather than behavioral outcomes. These findings highlight the importance of considering herbal medicine use during clinical communication and adolescent health education while recognizing the coexistence of herbal and conventional healthcare practices. Full article

Background: Staphylococcus aureus bloodstream infection remains a major clinical challenge because of its association with invasive disease, antimicrobial resistance, biofilm formation, and substantial mortality. Local susceptibility surveillance is essential for guiding empirical therapy and antimicrobial stewardship. This study evaluated the epidemiology, resistance patterns, turnaround time, and clinical correlates of S. aureus bacteremia in a Romanian tertiary-care hospital. Methods: We conducted a retrospective, single-center observational study including all consecutive adults with positive blood cultures for S. aureus admitted to Sibiu County Clinical Emergency Hospital between 1 January 2024 and 31 December 2025. Demographic, clinical, microbiological, antimicrobial susceptibility, and outcome data were extracted from electronic medical records. MRSA was defined phenotypically, while MDR and XDR phenotypes were classified according to standard resistance definitions. Between-year comparisons and regression analyses were performed to explore factors associated with mortality, MRSA, and MDR status. Results: During the study period, 11,578 blood culture sets were processed, of which 2472 (21.3%) were positive; S. aureus accounted for 314 isolates (12.7% of positive cultures). After one isolate per patient was retained, the final analysis included 142 patients with S. aureus bacteremia. Median age was 70 years, 55.6% were male, and 67.6% lived in urban areas. Overall mortality was 33.1% (47/142). MRSA was identified in 39.4% of cases and MDR in 49.3%, while no XDR isolates were detected. The most frequent resistances were observed for penicillin (75.9%), erythromycin (66.2%), clindamycin (46.5%), tetracycline (45.1%), and oxacillin (38.0%). Full susceptibility was preserved for vancomycin, linezolid, ceftaroline, daptomycin, and mupirocin. Turnaround time significantly improved in 2025 compared with 2024 (median 71.4 h vs. 66.3 h; p = 0.004). In adjusted analysis, acute or chronic kidney disease was independently associated with mortality, whereas MRSA and MDR status were not independent predictors of death. Conclusions: In this single-center cohort, S. aureus bacteremia was associated with high mortality and a substantial burden of MRSA and MDR phenotypes, although preserved activity of key anti-staphylococcal agents was observed. These findings support the need for continuous local resistance surveillance, rapid microbiological diagnosis, and stewardship-guided treatment strategies. Full article

Background: Acne is a common inflammatory dermatosis with well-documented epidemiology in urban populations; however, data from rural sub-Saharan African settings remain limited. Objective: To characterize the demographic profile, clinical subtypes, severity spectrum, complications, and comorbidities of acne among patients attending a rural tertiary dermatology centre in the Eastern Cape, South Africa. Methods: A quantitative, retrospective cross-sectional study was conducted using census sampling of dermatologist-confirmed acne cases diagnosed between 2022 and 2025. Demographic and clinical variables were extracted from medical records and analysed using descriptive and inferential statistics (p < 0.05). Results: A total of 166 patients were included, all of African ethnicity. Females predominated (89.2%), yielding a female-to-male ratio of 8.2:1. Adult-onset acne was most common (85.5%), with a median onset age of 26 years. Acne vulgaris represented the predominant subtype (83.1%). Papules and comedones were the most frequent lesions, and facial involvement was nearly universal (94.8%). Moderate disease (Grade 2) was most prevalent. Post-acne complications were highly frequent (92.8%), with post-inflammatory hyperpigmentation being the most frequent of these (87.0%). Comorbidities were observed in 52.4% of patients, most commonly eczema and pigmentary disorders. Conclusions: Acne in this rural cohort demonstrated a predominance of adult-onset disease, marked female susceptibility, moderate severity, and a high burden of pigmentary sequelae. These findings highlight the need for context-specific diagnostic and management strategies in underserved rural populations. Full article

Background/Objectives: Iron deficiency anemia (IDA) remains the most prevalent nutritional deficiency worldwide and a leading cause of years lived with disability, particularly in low-income countries. In Egypt, the burden is substantial and compounded by regional socioeconomic, nutritional, and parasitic factors. Despite this, the predictors of diagnostic delay within the Egyptian healthcare system remain poorly characterized. This study aimed to quantify the extent of diagnostic delay among Egyptian patients with IDA and to identify the sociodemographic and clinical risk factors independently associated with prolonged time to diagnostic confirmation. Methods: A single-center retrospective cohort study was conducted at Al-Minia University Hospital, Egypt, between March and April 2026, enrolling 350 adults with confirmed IDA diagnosed between 2015 and 2025. “Diagnostic delay” was defined as the interval in days from the index date (the first documented abnormal complete blood count) to laboratory confirmation of iron deficiency by serum ferritin and/or transferrin saturation. Secondary outcomes included patient delay, system/testing delay, and etiology work-up delay. Time-to-event analysis was performed using Kaplan–Meier curves and Cox proportional hazards regression. All analyses were conducted in R version 4.4.0. Results: The cohort comprised 213 females (60.9%) and 137 males (39.1%), with a median age of 39 and 36 years, respectively. The median primary diagnostic delay was 76.0 days (IQR: 38.0, 182.8), with patient delay accounting for a median of 26.5 days and system/testing delay for 21.0 days. Overall, 155 patients (44.3%) experienced a diagnostic delay of more than 90 days. In the multivariable Cox model, urban residence (aHR = 0.69, 95% CI [0.53, 0.99], p = 0.045) was independently associated with a slower rate of diagnostic confirmation. Conclusions: Diagnostic delay in IDA is substantial in Egypt, driven by both patient-level symptom normalization and counterintuitive systemic bottlenecks. Urban residence was independently associated with prolonged time to diagnostic confirmation; ordering of iron studies at the first visit was associated with delay in bivariate analysis only and was not an independent predictor after multivariable adjustment. Targeted public health education, restructured primary care pathways, and improved laboratory turnaround times are essential to reduce this burden. Full article

During adolescence, exposure to community violence (ECV) can negatively impact multiple facets of health and future achievement. Existing research mainly focuses on the risk factors that increase ECV, although multiple promotive factors are associated with lower levels of ECV. However, research has not examined the unique and combined effects of these promotive factors on ECV. The current study investigates promotive factors at the individual, peer, and supportive adult relationship levels for their unique and combined associations with ECV to determine which factors are associated with the lowest levels of ECV. 2725 adolescents from three urban middle schools (M_age = 13.22; 48% male; 90% Black, 18% Hispanic or Latino) reported measures of ECV, positive outlook, self-efficacy for nonviolence, peers’ prosocial behavior, friends’ support for nonviolence, presence of a caring adult, and parental support for nonviolence. Regression analyses showed that a combination of multiple promotive factors better explained the variance in ECV than any single promotive factor alone, indicating that promotive factors have compounding effects. Positive outlook, self-efficacy for nonviolence, friends’ support for nonviolence, and the presence of a caring adult were all uniquely associated with lower levels of exposure to community violence across all steps of the hierarchical regression. In alignment with positive youth development theory, these results demonstrate that an adolescent’s ECV risk is lower if they have more promotive factors. These findings emphasize the importance of relational promotive factors as future targets for strengths-based interventions. Full article

Background/Objectives: Dengue is an emerging arboviral disease in temperate South America, where urban expansion, climate variability, and social vulnerability favor transmission. In Argentina, the endemic circulation of dengue was established in the late 1990s and outbreaks are reported every three or four years. Methods: This cross-sectional study assessed dengue virus (DENV) seropositivity and associated sociodemographic, environmental, and knowledge-attitudes-practices (KAPs) factors in three socioeconomically vulnerable peripheral neighborhoods of Santa Fe, Argentina, between December 2019 and March 2020. Results: A total of 188 adults were surveyed and tested for anti-DENV IgG using ELISA. KAPs questionnaires and direct peridomiciliary observations were used to characterize exposure contexts. Apparent seropositivity was 16.5%, with an adjusted estimate of 10.7% after accounting for test performance, indicating substantial unrecognized DENV circulation. Most seropositive individuals had no previous dengue diagnosis, highlighting underdetection likely related to asymptomatic infections, limited healthcare access, or surveillance gaps. Although dengue awareness was high (98.4%), knowledge was often incomplete and was weakly correlated with preventive practices, suggesting that awareness alone does not translate into effective risk reduction under structural constraints. In multivariate analysis, living farther from vacant lots was associated with higher odds of seropositivity, consistent with transmission concentrated in denser urban settings. Conclusions: Integrating serology with KAPs surveys provides critical insights into hidden transmission and supports targeted surveillance and public health interventions in vulnerable urban settings. Full article

Background: Inappropriate antibiotic use contributes significantly to antibiotic resistance (ABR), particularly in low- and middle-income countries. Understanding community-level knowledge, attitudes, and practices is essential for designing effective interventions. This study assessed Knowledge, Attitudes and Practices (KAP) related to antibiotic use, with consideration of awareness of antibiotic resistance, in Montserrado County, Liberia. Methods: A community-based cross-sectional survey was conducted among 1160 adults in Montserrado County, Liberia, using a structured questionnaire to assess knowledge, attitudes, and practices (KAP) related to antibiotic use and antibiotic resistance. Composite KAP scores were calculated from Likert-scale items and subsequently categorized into ordered levels (poor, moderate, and good) based on percentile thresholds. Ordinal logistic regression was used to examine associations between sociodemographic characteristics and KAP outcomes. Results are presented as crude and adjusted odds ratios (COR, AOR) with 95% confidence intervals (CI), and statistical significance was set at p < 0.05. Results: Participants demonstrated moderate knowledge, with correct identification of antibiotic use for bacterial infections (skin infections: 78.8%; ear infections: 76.8%), but widespread misconceptions were observed, including use for colds and flu (73.6%) and diarrhea (80.7%). Attitudes were mixed, with many recognizing inappropriate use, yet expectation-driven demand remained common (62.7% dissatisfied when antibiotics were not prescribed; 80.9% willing to suggest antibiotics to clinicians). Practices were inconsistent, with both appropriate and inappropriate behaviors reported. While 46.2% of participants always completed antibiotic courses, inappropriate practices were frequent, including antibiotic use for common symptoms (38.6%), preventive use (37.2%), and self-medication without prescription (20.1% always). In multivariable analysis, older age was associated with higher knowledge (AOR = 3.82, 95% CI: 1.26–11.1), while lower education predicted poorer knowledge and practices (e.g., AOR = 0.25, 95% CI: 0.07–1.00). Urban residence was associated with poorer practices (AOR = 0.42, 95% CI: 0.29–0.61). Conclusions: While overall knowledge of antibiotic use in Montserrado County is moderate, critical misconceptions remain, and appropriate practices are inconsistent. Weak relationships between knowledge, attitudes, and practices highlight the limitations of knowledge-based interventions alone. Efforts to improve antibiotic use should address structural drivers, including access to antibiotics, healthcare-seeking behavior, and regulatory enforcement, through targeted and context-specific strategies. Full article

Pedestrian Spatial Experience PSE in urban spaces is a multi-faceted topic that requires the thematization of assessment methods due to their fragmentation across studies. Accordingly, this systematic review followed an inductive approach to define a framework of PSE assessment themes reflecting their evaluation in public and university campus spaces. This systematic review included open-access, accessible, peer-reviewed sources based on assessment-focused English research that followed defined frameworks on the effects of urban environments on adult PSE. Studies were excluded if they focused on non-pedestrians or vulnerable user groups, examined non-pedestrian-scale contexts, explored pedestrian experience in virtual environments, assessed interior spaces, lacked a structured attribute-based assessment framework, were review articles, did not specify how urban environments shape pedestrian experience, investigated non-urban or rural areas, or examined urban settings without clearly defined street or square infrastructure. The review relied on querying PSE-related bibliography from the Scopus and Web of Science databases on 12 October 2025; results were processed through a screening procedure according to the inclusion and exclusion criteria. The final sets of sources reviewed included 83 and 24 sources related to PSE assessment in public and university campus spaces, respectively. Risk of Bias (RoB) tools included the Joanna Briggs Institute (JBI) tool for cross-sectional studies, tailored for urban spatial studies, and the Prediction model Risk Of Bias Assessment Tool (PROBAST+AI), tailored for ABM studies. Using a data extraction sheet and codebook to identify the prominent codes in the included sources, in addition to reviewing frequent words and the methods of the included sources, clarified the main conceptual framework of PSE assessment themes. The thematic categorization of PSE studies was followed by analyses of the frequencies of the themes, the prevalence of themes across countries and cities, and the theoretical explorations within the themes over the years in both reviewed contexts. Subsequently, synthesizing both sets clarified the interrelations between themes, methods, and tools as an attempt to address gaps in PSE assessment methods. The main results of this review are the 11 themes of PSE assessment that were identified from the reviewed sources. Data analyses and syntheses indicated a high prevalence of quantitative methods relying on visual aspects, signifying the dominance of the Cognitive and Navigational Experience theme due to its frequent assessment by numerous and diverse sets of methods in both reviewed sets. Nevertheless, the Temporal Experience theme emerged as the least considered. The key limitations of this systematic review include its reliance on accessible articles from bibliographic databases, as well as its focus on adult populations as the common users of public and university campus spaces. This review decodes PSE in terms of its assessment themes through the methods followed and the applied tools within real environments. As an application of the introduced conceptual framework, this systematic review clarifies the comparison of the themes examined between public and university campus spaces. The findings of this systematic review provide a foundation for a comprehensive understanding of PSE, thereby informing the design of more user-centered environments. Full article

Background/Objectives: Large language models have created new pathways for patients to access health information, yet little is known about how the general population uses these conversational artificial intelligence (AI) tools for oral health concerns. This study investigated patterns of AI use as a source of oral health information, the nature of data shared with these systems, users’ perceptions, and the impact on dental care-seeking behavior. Methods: A cross-sectional study was conducted among adults from Bihor County, Romania, using a structured 16-item online questionnaire distributed via social media, with eligibility restricted to individuals who had previously used conversational AI for oral health information. The final sample comprised 393 valid responses from this self-selected group of users. Fisher’s exact test and Z-tests with Bonferroni correction were applied (α = 0.05). Results: Most participants were female (68.2%), university-educated (52.9%), and lived in an urban setting (88.3%). Significant differences in patterns of AI use for oral health information were identified according to age, sex, and living environment (p < 0.001). Younger participants used AI more frequently, while older individuals perceived the information as less clear. The vast majority used AI for informational or preliminary guidance purposes, with very few treating it as a substitute for professional opinion. A relevant subset shared visual data (intraoral photographs or radiographs) with AI systems, raising data privacy concerns. Rural participants more frequently delayed dental visits and less often discussed AI-derived information with their dentist compared to urban participants. Conclusions: When used by the public as a source of oral health information, AI is increasingly adopted, with adoption shaped by age, sex, and socioeconomic context. These findings concern only this informational use and do not extend to other applications of AI in dentistry, such as diagnostic support, image analysis, or clinical decision-making. Dental professionals should proactively engage patients about their use of AI for oral health information to ensure that digitally obtained content is appropriately contextualized. Full article

Objectives: To identify factors influencing influenza vaccination willingness and uptake among adults aged ≥60 years in Henan Province and to evaluate the effect of a brief educational intervention on vaccination willingness and behavior. Methods: In September 2024, a cross-sectional survey based on the Behavioral and Social Drivers (BeSD) framework was conducted among adults aged ≥60 years across five counties in Henan. For participants without baseline willingness, a 3 min one-on-one educational intervention was delivered. In May 2025, following the end of the 2024–2025 influenza vaccination season (which runs from 1 October to 31 March in Henan Province), we retrieved vaccination records for all participants from the Henan Provincial Immunization Information System. This system captures all influenza vaccinations administered at designated vaccination clinics across the province. To ensure completeness for doses administered outside the provincial system (e.g., in other provinces or at private healthcare facilities), we conducted telephone follow-up interviews with all participants whose baseline vaccination intention was inconsistent with their actual vaccination behavior (i.e., willing but unvaccinated or unwilling but vaccinated). During these interviews, for those who reported receiving the vaccine outside Henan Province or at private facilities, we inquired about the specific date and location of vaccination to supplement the registry data. We also explored the reasons behind the intention–behavior discrepancy. For these participants, we requested vaccination certificates or other supporting documentation to confirm their vaccination status. Results: Baseline vaccination willingness was 68.20% (1630/2390), whereas the actual vaccination rate was only 6.95% (166/2390), yielding a willingness-to-behavior conversion rate of 9.51% (155/1630) among those with baseline willingness. Of the 760 participants without baseline willingness, 543 (71.45%) completed the 3 min one-on-one instant educational intervention and the follow-up assessment; the remaining 217 were excluded due to refusal or loss to follow-up. Among these 543 completers, 46 (8.47%) became willing to vaccinate, and eight (1.47%) were subsequently vaccinated. Multivariate analysis identified the social processes dimension as the strongest correlate of both willingness (OR = 1.38 per 1-point increase, 95% CI: 1.33–1.44) and uptake (OR = 1.12, 95% CI: 1.03–1.22). Urban residence was associated with higher willingness (OR = 1.41, 95% CI: 1.12–1.78) and higher uptake (OR = 1.64, 95% CI: 1.11–2.42). Current smokers had a significantly lower uptake than never smokers (OR = 0.43, 95% CI: 0.22–0.85). Among the 11 participants without baseline willingness who were eventually vaccinated (eight from the intervention group and three from the non-intervention group), family/friend influence (63.64%, 7/11) and physician recommendation (36.36%, 4/11) were the primary drivers. For those with willingness but no action (n = 1475), the main barriers were perceived good health (33.29%), high vaccine cost (27.12%), and lack of time (26.31%). Conclusions: Influenza vaccination among older adults in Henan exhibits a “high willingness, low conversion” pattern, with social processes as the strongest driver bridging the intention–behavior gap. A brief educational intervention improved willingness but failed to translate into meaningful uptake, underscoring that knowledge transfer alone is insufficient. We recommend a multi-component strategy that (1) mobilizes family members and community doctors as trusted vaccine advocates; (2) leverages family and village doctor networks to reduce urban–rural disparities; (3) counters the “perceived good health” barrier with age-specific risk communication; and (4) integrates vaccine recommendations into routine care for high-risk groups, particularly frequent outpatient attendees and smokers. Full article

Snacking has become a routine part of how people eat today, with real potential to shape overall diet quality, food choices, and daily nutrient intake. This cross-sectional study aimed to investigate snack purchasing and consumption habits among Greek adults, examine consumers’ perceptions of the nutritional value of snacks, and assess their attitudes toward nutrition labelling, nutrition claims, and innovative snack products. A structured questionnaire was sent out electronically to 1039 Greek adults. Participants provided information on their sociodemographic background, health and lifestyle habits, snack consumption and purchasing behavior, perceptions of snack products, nutrition labelling, and interest in innovative and functional snacks. The data were analyzed using descriptive statistics and Chi-square tests of independence. The most common packaged snack for the average person in the study was a cereal bar, while the least popular non-packaged snack was a bakery cheese pie. Consumers viewed the appearance of the product’s packaging as a secondary consideration at the point of purchase, and the most prominent label elements that attracted consumer attention were nutrition, calories, and fat. The claims that consumers found most appealing were “no preservatives” and “sugar-free/no added sugars.” A clear preference was shown for snack products that relied mainly on naturally occurring nutrients rather than fortified ingredients, as well as a greater willingness to try new savory snack options that used familiar/demonstrable Greek ingredients, such as certain olives, nuts, and fruit. Statistically significant relationships have been identified between certain snacking behaviors, attitudes, and labelling preferences, with respect to age, gender, education level, employment status, Body Mass Index (BMI), health status, physical activity, and place of residence. Within this relatively highly educated and predominantly urban sample, sociodemographic, education level and lifestyle all have an influence on how Greek adult consumers view and use snacks. Interest in nutrition information varies widely between different types of consumers. These findings may be useful in guiding the future development of snacks that meet the nutritional requirements of the Mediterranean diet, as well as in creating more targeted nutrition information and consumer education programs. Full article

Predicted cardiovascular age (heart age) translates the risk-factor profile into an equivalent age, which may facilitate interpretation of estimated cardiovascular risk. Excess cardiovascular age describes, in years, the integrated burden of modifiable risk factors and its distribution in the population. This study aimed to quantify socioeconomic and geographic inequalities in predicted excess cardiovascular age among Peruvian adults using standardized inequality measures, and to describe its temporal variation from 2014 to 2024. We analyzed ENDES Peru 2014–2024 data for adults aged 30–74 years. Cardiovascular age was estimated using the body mass index (BMI)–based non-laboratory Framingham equation, and excess was defined as the difference between cardiovascular age and chronological age. Weighted means and 95% confidence intervals were estimated accounting for the complex survey design. Socioeconomic inequalities were assessed using absolute and relative gaps between extreme wealth quintiles (Q5–Q1), the Slope Index of Inequality (SII), the Relative Index of Inequality (RII), and the concentration index/curve. Among 163,889 participants, mean excess cardiovascular age was 9.64 years (95% CI: 9.48–9.80), with similar estimates in women (9.73; 95% CI: 9.52–9.94) and men (9.54; 95% CI: 9.33–9.75). Temporal variation was observed, peaking in 2021 (10.91; 95% CI: 10.57–11.25). Excess increased with wealth (Q1: 7.14 vs. Q5: 11.25 years), with an SII of 5.04 years (95% CI: 4.71–5.37) and a concentration index of 0.087. The gradient was steeper in men (SII 6.14) than in women (SII 3.90). Geographically, Metropolitan Lima had higher excess than the Highlands (11.17 vs. 7.45 years), and urban areas exceeded rural areas (10.28 vs. 7.25 years). In Peru, adults aged 30–74 years had a mean predicted excess cardiovascular age of about 10 years, with a consistent pro-rich and urban/coastal concentration pattern, more pronounced among men. Because this metric is derived from a risk prediction equation, these findings should be interpreted as surveillance-oriented evidence of inequalities in estimated risk-factor burden, not as evidence of observed cardiovascular disease, subclinical cardiovascular damage, causal mechanisms, or tested intervention effects. Full article