National Public Health Organization

Health systems today face overlapping pressures-from demographic shifts, workforce shortages, climate change, and geopolitical and economic instability. This strains their ability to deliver effective and equitable care and erodes public trust. Traditional approaches to quality of care, often focused on service volumes or process compliance, are proving insufficient to address these system-wide challenges. In response, this paper proposes a transformational vision for quality of care that moves beyond traditional models. This vision is rooted in two interconnected pillars. First, a focus on outcomes that truly matter to people and populations, prioritizing health and well-being over service volume. The second pillar is a whole-systems perspective that embeds quality across all levels of governance, policy, and financing. This transformation is made possible through three key enablers. First, an empowered workforce and accountable leadership are needed to drive change. Second, data must be used transparently to build trust and guide results-focused work. Finally, innovative solutions and tools must enhance quality and be aligned with equity. Drawing on practical implementation examples, this paper outlines a roadmap for system-wide alignment of health systems-to rebuild trust, improve resource use, and advance health equity. This makes quality a lasting foundation for resilient, sustainable, and equitable healthcare.

The interactions between human viruses and human stem cells may differ from those with differentiated cells. These differences may arise through heterogeneous intercellular mechanisms and responses to specific infectious agents, resulting in different phenotypes that affect human pathophysiology. Understanding and exploiting such differences could have clinical and translational potential. Here, we discuss the various mechanistic interactions between stem cells and viruses related to entry mechanisms, replication dynamics, and immunomodulation. In doing so, we critically assess proposed models and hypotheses about how viruses manipulate stem cell biology, while also providing new paradigms for stem cell biology and therapeutic interventions. We highlight recent discoveries on the dual role of viruses in oncogenesis and oncolysis. In parallel, we explore similarities between stem cells and complex viruses-such as giant viruses and jumbo phages-to propose novel perspectives on viral adaptability and pathogenesis. We examine both established mechanisms and emerging viral phenomena to encourage further research and debate on the clinical implications of viral interactions with stem cells.

Hypersaline solar saltworks represent unique ecological niches that harbor extremophilic microalgae with considerable biotechnological potential. Within these environments, members of the genus Dunaliella are particularly noteworthy due to their remarkable metabolic plasticity and ability to accumulate high-value biomolecules. In the present study, we investigated the biodiversity of Dunaliella in hypersaline saltworks by isolating and identifying autochthonous strains and assessing their growth kinetics and biomass biochemical composition in the context of potential biotechnological applications. Specifically, sixteen strains of Dunaliella were isolated from evaporation and crystallizer ponds of the Kalloni saltworks in Lesvos, Greece, and subjected to an integrative characterization combining morphological observations, molecular phylogenetics, growth kinetics, and biochemical profiling. Phylogenetic analyses based on four genetic markers (18S, ITS, rbcL, tufA) consistently resolved the isolates into three distinct clades: one corresponding to Dunaliella salina/D. minutissima, one to D. parva, and a third representing a clearly divergent lineage. Growth assays revealed marked variability in cell density, biomass productivity and specific growth rate, with certain strains exhibiting enhanced proliferation under controlled conditions. Biochemical analyses demonstrated distinct allocation patterns, with evaporation pond isolates comparatively enriched in proteins (up to 60.8% DW), whereas crystallizer pond isolates accumulated higher levels of carbohydrates (up to 19.0% DW), carotenoids (up to 7.34% mg g-1 DW) and phenolic compounds (up to 8.68% mg GAE g-1 DW). Antioxidant assays (FRAP, TEAC) further indicated significantly elevated reducing and radical scavenging activities among crystallizer isolates. These findings expand current knowledge on the biodiversity of autochthonous Dunaliella strains and support their potential as sustainable sources of bioactive compounds for applications in the agri-food, nutraceutical, pharmaceutical, and cosmeutical sectors.

Important questions remain regarding differences in geographical and age-specific mortality patterns as the COVID-19 pandemic evolved in consecutive waves, and how COVID-19 mortality compares to seasonal influenza. In a pandemic situation, excess all-cause mortality provides a more complete and robust measure than cause-specific mortality. Data submitted by 26 countries participating in the European Mortality Monitoring (EuroMOMO) network between 2020 and 2023 was analysed to quantify excess all-cause mortality during the COVID-19 pandemic. Excess mortality from this period was compared to previous influenza seasons from 2014 to 2019. Pooled estimates of excess mortality showed four main waves during the COVID-19 pandemic period, most markedly in people aged 65 years and above, with timing and magnitude that varied between countries. Here we show that prior to implementation of control measures and COVID-19 vaccination, excess mortality greatly exceeded typical seasonal influenza mortality, but later during the pandemic was at levels comparable to influenza.

<ns3:p>Introduction: Investment in human capital is a strategic imperative in a highly competitive work environment, such as that of a hospital. Job satisfaction and retention in the profession largely depend on staff motivation.Purpose: This review study focuses on Herzberg's motivation-hygiene theory and its application in the nursing profession to improve job satisfaction and performance.Materials and methods: A literature review was conducted using articles and research studies from the last decade, retrieved from the electronic databases PubMed and Google Scholar.Results. Nursing is one of the most demanding and psychologically draining professional fields. Hospital management is required to find ways to enhance the working culture of nurses. In this context, Herzberg's motivation-hygiene theory can be applied to the nursing profession to improve job satisfaction and performance.Conclusions: Nurse motivation is linked to moral satisfaction, recognition, and career development. Herzberg's theory can serve as a foundation for designing policies that promote a respectful environment with growth opportunities.</ns3:p>

This literature review explores the role of intergenerational learning as a pedagogical strategy within Environmental Education and Education for Sustainable Development. A systematic analysis of 34 empirical studies published between 2016 and 2025 examines the interactions between children and parents regarding the transmission of environmental knowledge and the development of attitudes and behaviours. Findings indicate that intergenerational learning is not a unidirectional flow of knowledge from adults to children but a reciprocal process, where children can significantly influence their parents (reverse socialization), especially when emotionally engaged or actively involved in educational initiatives. Key moderating factors identified include the quality of the parent-child relationship, intra-family communication, the structure of interventions, and the broader sociocultural context. The review enhances understanding of intergenerational learning as a mechanism for strengthening family bonds and promoting sustainable values. It also highlights challenges related to reverse socialization, as children’s influence on adults does not always lead to long-term behavioral change. These findings underscore the need for multi-level, participatory interventions that engage both children and parents within and beyond the school environment to foster sustainable transformation.

HighlightsWhat are the main findings?Non-communicable diseases (NCDs) impact 2.1 billion children worldwide and cause nearly 1 million deaths annually, with poor nutritional status further in-creasing mortality and treatment-related complications.Integrating nutrition care into childhood NCD management improves survival, reduces treatment-related complications, influences disease progression, and lowers healthcare costs.What is the implication of the main finding?Nutrition services should be embedded as a standard component of NCD care for children, yet underfunding, workforce shortages, inadequate training, and limited access to nutrition products continue to hinder progress.Multi-sectoral collaboration is essential to expand the nutrition workforce, strengthen training and professional standards, establish effective monitoring frameworks, and leverage technology to deliver sustainable solutions.Non-communicable diseases (NCDs) affect over 2.1 billion children globally, accounting for 15.9% of deaths in children under 20 and contributing 174 million years lived with disability. Integrating nutrition care into NCD management within health systems can save lives, reduce costs, and improve quality of life. Nutrition interventions have been found to improve survival rates in children with cancer by 30%. Incorporating early nutrition interventions in hospitals is associated with a 36% reduction in per-patient costs. Despite these clear benefits, nutrition care is often not readily accessible as part of NCD management in children. Access to trained nutrition professionals is limited, and nutrition training for healthcare workers is often inadequate. There are cost-effective and scalable models for delivering high-quality nutrition care, but scaling these models will require commitment to capacity building, training, technological innovation, and monitoring frameworks. Coordinated, multisectoral responses are needed urgently to incorporate nutrition sustainably into healthcare systems to confront the growing burden of childhood NCDs.