An important element of sustainability is food security, related to ensuring access to suitable food. Despite having an intensive agricultural economy and a developed food industry, European Union (EU) countries import some products. Within the Rapid Alert System for Food and Feed (RASFF), so-called border rejections are reported, which accounted for 38.7% of all notifications submitted in 2008–2023. The purpose of this study was to analyse border rejections reported in the RASFF in 2008–2023, considering hazards, hazard categories, product categories, notifying country, and country of origin. The data were pre-processed in Microsoft Excel and then subjected to two-way joining cluster analysis in Statistica 13.3. Taking into account the quantity of imports and the hazards, the greatest attention should be paid to fruits and vegetables from Turkey (presence of ochratoxin A, pesticides, and sulphites), nuts from Turkey (aflatoxins), poultry and spices from Brazil (Salmonella spp.), fish from China and Morocco (poor temperature control), and feed and fruits and vegetables from Ukraine (moulds). Through border rejections, the common European market is protected from hazards in food from outside the EU, which contributes to sustainability. However, ensuring safety in this regard requires close cooperation between border posts of all member countries.

Patient-centered care is considered to be one of the essential pillars of a modern healthcare system. Thus, quality assessment based on patients’ perceptions, views and experiences in their journey through the healthcare system is recognized as one of the key principles for quality improvement initiatives. Measuring patient satisfaction can be confounded by expectations and prior experiences, which can be at least partly overcome by evaluating patient-perceived healthcare quality (PPHQ). Understanding the principal constituents of PPHQ may aid healthcare professionals and decision makers in the healthcare management process and help in creating instruments to meaningfully measure patient feedback. Herein, we aimed to analyze the primary determinants of PPHQ and their interactions, with a focus on patient experiences and healthcare accessibility, using the example of Lithuanian primary healthcare. For this purpose, we conducted a cross-sectional representative telephone survey that included a total of 1033 respondents (48% male) who had encountered primary healthcare during last 3 years. Survey questions consisted of sociodemographic characteristics, patient perceptions of healthcare service provision, patient experiences, self-reported health status and overall PPHQ ranked with a 5-point Likert scale as the primary outcome. The classification-regression tree (CRT) technique was used to analyze the relationship between different explanatory variables and PPHQ, as well as their relative importance and interactions. The majority of respondents (89%) evaluated PPHQ as acceptable or good. CRT analysis identified staff behavior, organizational accessibility and financial accessibility as the most important factors affecting PPHQ. Importantly, the latter factors surpassed the effect of other known PPHQ determinants, such as sociodemographic characteristics or health status. Further analysis has revealed that the relative importance of staff behavior, including understanding, attention and empathy, increased when more problems with organizational accessibility were encountered. In conclusion, our study suggests that PPHQ in primary healthcare may primarily be determined by organizational and financial accessibility and staff behavior, which may also act as an important mediating factor.

In Lithuania, the year 2024 has been identified as a pivotal moment for healthcare reform, which encompasses two primary objectives: implementing a proactive public health policy and enhancing the accessibility, quality, and efficiency of healthcare through the restructuring of the service delivery network. This reform is essential for remote regions, where demographic shifts have modified service requirements. Certain services, such as midwifery, have diminished, while others, including elderly nursing care, require reestablishment. Adapting to these reforms has disrupted competencies, underscoring their importance as a critical area for regional development, particularly in enhancing new resources. By analysing the public health reform in Lithuania through the lens of remote regions, it becomes possible to identify specific strategies and practices that can be applied both nationally and internationally. The study aims to highlight shifts in the emerging needs of healthcare personnel's competencies in remote regional areas, particularly during the national healthcare system's structural transformations, and their capacity to achieve the reform goal of delivering top-quality health services based on transformative competencies. The study uses qualitative interviews to identify the competencies health professionals lack following the establishment of new Primary Health Care Centres. The study revealed that while clinical and professional competencies related to legal and clinical responsibilities are easier to adopt from a technical standpoint, competencies like leadership, collaboration, and patient involvement pose greater challenges, leading to community stress. The acquisition of these competencies requires long-term investment in staff development, emotional support, and clear change management. Moreover, the new structure of health centers and newly introduced work processes may increase employees’ emotional exhaustion, stress, or even the risk of burnout if adequate support or training is not provided.