BackgroundNutritional rickets is a growing global public health concern despite existing prevention programmes and health policies. We aimed to compare infant and childhood vitamin D supplementation policies, implementation strategies and practices across Europe and explore factors influencing adherence.MethodsEuropean Society for Paediatric Endocrinology Bone and Growth Plate Working Group members and other specialists completed a questionnaire on country-specific vitamin D supplementation policy and child health care programmes, socioeconomic factors, policy implementation strategies and adherence. Factors influencing adherence were assessed using Kendall’s tau-b correlation coefficient.ResultsResponses were received from 29 of 30 European countries (97%). Ninety-six per cent had national policies for infant vitamin D supplementation. Supplements are commenced on day 1–5 in 48% (14/29) of countries, day 6–21 in 48% (14/29); only the UK (1/29) starts supplements at 6 months. Duration of supplementation varied widely (6 months to lifelong in at-risk populations). Good (≥80% of infants), moderate (50–79%) and low adherence (<50%) to supplements was reported by 59% (17/29), 31% (9/29) and 10% (3/29) of countries, respectively. UK reported lowest adherence (5–20%). Factors significantly associated with good adherence were universal supplementation independent of feeding mode (P = 0.007), providing information at neonatal unit (NNU) discharge (P = 0.02), financial family support (P = 0.005); monitoring adherence at surveillance visits (P = 0.001) and the total number of factors adopted (P < 0.001).ConclusionsGood adherence to supplementation is a multi-task operation that works best when parents are informed at birth, all babies are supplemented, and adherence monitoring is incorporated into child health surveillance visits. Implementation strategies matter for delivering efficient prevention policies.

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Migration has become a very topical political and economic concern over the past few years, with particular reference to human migration from developing countries to more developed countries. Health workforce migration from the countries in Western Balkans, especially from Albania to more developed countries is increasing during the past few years according to official statement of medical associations. So, last three years 400 doctors have asked for certificate of “Good standing” in order to apply for a job abroad. Thus, the migration of healthcare personnel in Albania is becoming a phenomenon that might risk the stability of the healthcare system with its upgrading intensity. It also contributes to lowering the quality of services rendered and at the same time reduces the necessary transfer of knowledge to the younger generations. Quantitative research performed during 2014, outlines and frames the problems and causes for the migration in five basic categories: economic, professional, political, personal and social factors for migration, including questions concerning the index of satisfaction for the profession. In order to respond to the objective of the study, doctors were invited by email to fill online the questionnaire in Survey Monkey webpage. The aim of this paper is to understand the “push” factors which affect the mobility of Albanian healthcare personnel. The needs for higher income, living and working conditions are the main causes of the expansive trend of migration of healthcare workers from Albania in the past several years. Still, the reasons behind migration of health workforce are multifold, ranging from economic and professional, to political and personal factors. The lack of job satisfaction and possibilities for further education and career development, poor working conditions, political pressure, the exposure to verbal and physical violence, are also the factors that stimulate the migration.

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