Adolescent Services Research Articles

Contraceptive use and determinants among sexually active unmarried adolescents and young women (aged 15-24 years) in East Africa: insights from Demographic and Health Survey data.

Low contraception usage among adolescents is a significant public health issue, leading to a rise in unintended pregnancies and adolescent childbearing in sub-Saharan Africa. Despite global efforts to improve access to contraception, sexually active adolescents and young women in East Africa are often overlooked, exposing them to substantial health risks. This study explored the factors influencing contraceptive use among unmarried and sexually active adolescents and young women in East African countries. National representative data from the 2016 Demographic and Health Survey for eight East African countries were used in the analysis. Data processing and analysis were performed using STATA 17 software. A multilevel mixed-effect logistic regression was used to identify determinants of contraceptive use at p<0.05. A total of 7813 sexually active unmarried adolescents and young women were considered for the final analysis. Among these young women, 24.9% were using a contraceptive method. Age, place of residence, knowledge of contraceptive methods, employment status and educational attainment were identified as significant determining factors of contraceptive use among sexually active unmarried adolescents and young women (aged 15-24 y) in East Africa. Contraceptive utilization among sexually active unmarried adolescents and young women was relatively low in East African countries. Addressing the existing inequalities in access to contraceptive services for rural adolescents and young women in East African countries is crucial. Prioritizing policies that implement comprehensive sexual education is essential to enhance their knowledge of contraceptives and empower them to make informed decisions.

Examining functional sexual and reproductive health and right-based friendly services: perspectives from exit adolescents, caregivers, and health workers at health services delivery points in Tanzania

BackgroundThe lack of adequate access to and use of sexual and reproductive health care by youth and adolescent, n low- and middle-income countries persists despite international accords on their rights, which exposes them to violence against children; early and unintended pregnancies; and sexually transmitted infections. This study examined functional sexual and reproductive health and right-based friendly services as perceived by exit male and female adolescents, caregivers, and health workers at the Tanzanian health services delivery points as they were the ones who would share their opinions to establish a diversified and representative reality about the matter based on sex.MethodsThis was a multicentric study among 205 randomly selected participants in eleven selected health facilities within the three regions of Tanzania including Dar es Salaam, Dodoma, and Kigoma regions using a one-time descriptive cross-sectional design with a quantitative research approach from 01 to 30 November 2022. Triangulation technique of data collection activities using structured questionnaires and observation checklist adopted from the Tanzanian Ministry of Health was used to collect data. IBM Statistical Package for Social Sciences version 26 data entry templates (Sa PSS – 26) were used to analyze data descriptively to establish frequencies and percentages.ResultsResults indicated that 205 participants were assessed in this study with a response rate of 100%. Exit adolescents (46%); health workers in dispensaries (60%), and community members (42%) were more likely to confirm the availability of functional SRH right-based adolescent and youth-friendly services at the health services delivery points. The SRH displays (50%); adolescent rights (6%) and confidentiality (5%) were the least reported functional SRH aspects by the study participants. It was noted that the 11 health services delivery points in their totality did not fully implement the National standards in providing the services to adolescents and youth of which standards III (54.0%) and VIII (46.1%) scored the lowest.ConclusionThe results of this study have uncovered that there is disperities in the availability and accessibility of functional SRH right-based adolescent and youth-friendly services across the levels of health facilities; among adolescents and community members. Hospitals were more likely to confirm the availability of Functional Right Based Youth Friendly Services than at health centers and dispensaries with female adolescents, youth, and community members being disadvantaged. There is a need to address issues of differentials in equity to the accessibility of services among adolescents, youth, and community members by improving functional sexual and reproductive health and right-based friendly services provision infrastructures, health care workers capacity building, and mechanisms or approaches to increase adolescents’ access and uptake to SRHR services.

Service Providers' Perceptions of Psychological, Emotional, and Behavioral Issues Among Children and Adolescents During COVID‐19 in South Korea

ABSTRACTVarious emotional and psychological support services for children and adolescents were implemented in South Korea during the COVID‐19 era. However, little is known about the limitations and future directions of current support services from the perspective of service providers. The purpose of this study was to explore service providers' perspectives on emotional and psychological support services for children and adolescents. The present study purposively recruited 11 clinical practitioners providing support services for children and adolescents to conduct semistructured focus group interviews. Thematic analysis identified four major themes: (a) a noticeable increase in problematic behaviors among children and adolescents (e.g., intrinsic and extrinsic problem behaviors); (b) changes in service use patterns (e.g., increased non‐face‐to‐face services); (c) frustrations with inadequate support systems (e.g., the absence of qualified professionals); and (d) identifying future directions (e.g., improving awareness of support services). The findings highlight the necessity of enhancing awareness of how to access services by reducing stigma. The findings also emphasize the need for improved cooperation between public and private facilities, as well as a greater number of skilled professionals to provide high‐quality programs. The practical and political implications are discussed based on the findings.

Knowledge on adolescent and reproductive health among secondary school students in Khulna City, Bangladesh

The main objective of this study was to investigate the depth and breadth of knowledge and ideas about adolescent health among secondary-level students. A concurrent mixed method approach, both quantitative and qualitative methods, was followed to carry out the study. Students enrolled in tenth grade under the Directorate of Secondary and Higher Education (DSHE) in Khulna City, Bangladesh, were chosen as the respondents of the study. Kotwali and Khanjahan Ali Thana of Khulna City were rationally chosen as the areas of the study. A total of 40 schools were randomly chosen, and 400 surveys, 10 surveys from each school, ideally 05 boys and 05 girls, were carried out, including 10 in-depth case studies. Findings indicated that, on average, more than half of the adolescents have knowledge gaps about adolescents and reproductive health, for example, misconceptions about the adolescent period and age range of puberty, vague understanding of the first sign(s) of physical appearances, and face critical emotional and social challenges. Both qualitative and quantitative data further showed that they hardly get sufficient cooperation and support from family and social environments in dealing with their challenges, display risky health behaviour, and make major decisions based on their self-discretionary assumptions to deal with crises. The findings of this study would provide important guidelines to parents and guardians, local and district and regional and national level GOs and NGOs health professionals who work with adolescent and reproductive health services, policymakers, academics, and researchers to create an adolescent-friendly environment.

Exploring perceptions of maternity services for pregnant adolescents in Indonesia: a qualitative study

Background/Aims Adolescent pregnancies are prevalent in Indonesia. This study aimed to explore perceptions from healthcare workers and pregnant adolescents of maternity services for pregnant adolescents. Methods This qualitative exploratory study involved two policymakers, 10 midwives, five doctors, and 10 pregnant adolescents. Data were collected through structured interviews in public health centre consultation rooms. The data were analysed thematically to explore factors that promoted or hindered use of maternity services for pregnant adolescents. Results The identified barriers included a lack of tailored directives, challenges in engaging adolescents, insufficient numbers of skilled healthcare professionals, adolescents' fears and compromised confidentiality. Opportunities for improvement included enhancing service quality through strategic planning and specialised training for midwives and psychologists. Conclusions The study underscores the need to improve maternity services offered for pregnant adolescents by creating a conducive working environment and sensitising healthcare workers and the community to adolescent mothers' needs. Implications for practice There is a need for guidelines in Indonesia specifically on providing care for pregnant adolescents. Healthcare professionals require specialised training and facilities should be made adolescent friendly.

Examining deportation and detention-related separation and youth risk and protective factors and well-being

PurposeOne in four U.S. Latine children has a parent who is an undocumented immigrant, putting them at risk of parental separation due to deportation. This study examines differences in multiple dimensions of health and well-being among Latine youth who experienced separation from a caregiver due to deportation, separation due to other reasons, and no separation. MethodsOur sample included clinic patients 10–24 years of age who were assessed for caregiver separation between April 1, 2017 and December 31, 2019 (n = 194). All patients were administered a modified Guidelines for Adolescent Preventive Services (GAPS) at intake. For patients who reported any separation, trained coders reviewed charts to document separation due to deportation or other reasons. We conducted logistic regression of separation due to deportation, separation for other reasons, and no separation with predicting GAPS indicators for health and well-being. ResultsOf the 194 patients in our sample, 82 experienced caregiver separation, with 26 of these separated due to deportation. Compared to youth who had not been separated from a caregiver, youth experiencing deportation-related parental separation were 17 times more likely to have thought about running away and four times more likely to have seriously considered suicide. In addition, youth experiencing deportation-related separation were 68 % less likely to have at least one person they can trust, 70 % less likely to have daily meals with their family, and 70 % less likely to have a role model. DiscussionThough further research is needed to describe the connection between deportation-related caregiver separation and specific youth outcomes and ways to mitigate negative outcomes, this research stresses the traumatic effect of deportation-related caregiver separation on youth, highlighting the clinical implications of deportation policy in the US.

Recovery schools move to adapt to higher‐need student cohort

Academically focused recovery high schools for youths with substance use disorders aren't considered treatment programs and usually aren't affiliated with treatment centers, but several recent trends have forced some of these programs to include more treatment‐like components. Chief among these developments, according to the executive director of one of the nation's oldest recovery high schools, is the relative absence of adolescent treatment services in most communities, meaning that youths often arrive to these academic settings with limited skills for recovery.

Feasibility of Sexual Health and Contraceptive Web Services for Adolescents and Young Adults: Retrospective Study of a Pilot Program on Reunion Island.

Sexual health indicators for adolescents and young adults (AYAs) aged between 13 and 25 years are particularly poor on Reunion Island. Access to accurate information as well as sexual health and contraceptive services are vital to maintaining sexual well-being. Teleconsultations offer a promising approach to addressing the sexual health and contraceptive needs of AYAs who are more susceptible to engaging in unprotected sexual intercourse. However, the literature on digital sexual health services for this demographic group is limited. This study aims to describe the feasibility of a pilot sexual health and contraceptive teleconsultation web service used by AYAs on Reunion Island. A descriptive, retrospective study was conducted at the Reunion Island University Hospital Center using a convenient sample. Eligible participants were informed about the program through various communication channels, including seminars for health care professionals, radio broadcasts, posters, flyers, press articles, videos, and social media posts. AYAs accessed a web-based platform named SEXTUOZE from December 15, 2021, to September 30, 2022, that offered sexual health information and teleconsultations. Data collected included participant and teleconsultation characteristics, patient satisfaction, and the quality of completeness of medical records. A total of 22 teleconsultations were scheduled and 7 were completed, all via synchronous video communication (duration: median 35 min). Overall, 4731 sessions were generated on the SEXTUOZE website. Reasons cited for accessing the web services were to seek sexual health advice (8/22, 36%), receive an initial birth control prescription (12/22, 55%), and inquire about condom prescriptions (2/22, 9%). While teleconsultation use for sexual health was initially low, it rose toward the end of the study period. Considering all elements of the implementation theory, future research should design interventions that not only are more operative and tailored but also ensure their adoption and sustainability in various health contexts.

Adolescent reproductive health care services: knowledge, perspectives, and challenges among service providers in Makurdi, Benue State Nigeria

Adolescence is a phase of life characterized by several reproductive health challenges that require support to navigate. However, access to adolescent and youth-friendly health service (AYFHS) centers to provide this support is limited. Perspective of healthcare workers (HCW) towards understanding the challenges to service provision has not been systematically documented. This study therefore documents the perspectives of HCWs on the types of services accessed by adolescents, and associated challenges in Makurdi, Benue State, Nigeria. The facility-based descriptive qualitative study used an in-depth interview guide among program officers in the 11 youth-friendly health centers. The interviews were recorded, transcribed, and analyzed thematically. The provision of HIV prevention services and AYFHS was appropriate while adolescents have preferences for facilities where their confidentiality is protected, and other needs are met. Reported challenges were lack of privacy, high cost of transportation to facilities, high staff attrition, poor awareness of the facilities and services, and parental consent. Suggestions for improvement included prolonged retention of youth-friendly trained staff, better client confidentiality, and economic empowerment of the adolescents to access services when needed. While the providers’ perspective on AYFHS for adolescents was positive, related challenges were also identified. Government and other stakeholders should collaborate to ensure the right environment for accessibility and utilization of AYFHS.

From legislation to actual health service: evaluation of health provisions in the disability law of Ghana by adolescents with mobility and visual impairments and their families

BackgroundDespite Ghana’s Persons with Disability Act, 2006 (Act 715) making provisions for access to healthcare services for adolescents with disabilities and their families, a corpus of literature has reported that persons with disabilities continue to face challenges in accessing healthcare services. However, the voices of adolescents with disabilities and their families are very scarce in such discourse. This study explored the experiences of adolescents with disabilities and their families in accessing healthcare services as per the provisions described in Ghana’s Act 715.MethodsThis study involved 45 participants, including 25 adolescents with disabilities and 20 family members from a municipality in Ghana. Employing a qualitative descriptive design, semi-structured interviews were conducted which was then analyzed thematically and interpreted using Critical Disability Theory.ResultsThe study identified two major categories of barriers to healthcare access: environmental (socio-economic difficulties, poor built environment, unavailability of rehabilitation services) and systemic (cultural beliefs, poor support at healthcare facilities and inadequate healthcare legislative provisions for families of children with disabilities). Despite legal provisions for free healthcare, participants faced significant financial barriers, with specialist services often not covered by the National Health Insurance Scheme.ConclusionsThe study calls for policy adjustments to fully cover specialist care under Ghana’s National Health Insurance Scheme, establishment of local-level health assessment and resource centers, educational campaigns to change cultural perceptions, and training of healthcare workers to promote quality access to healthcare.

Survey of GP registrars' training experience and confidence in managing children and adolescents with mental health conditions in primary care.

The aim of thisstudy is to assess General Practitioner (GP) trainees' training experience, and confidence in assessing and managing children and adolescents with common mental health conditions in primary care in Ireland. An online anonymous questionnaire was distributed to third and fourth year GP registrars enrolled in the Irish College of General Practitioners training schemes. The online questionnaire evaluated participants' training experiences and confidence levels in key areas of child and adolescent mental health in primary care. Sixty participants completed the survey out of 406, yielding a response rate of 14.8%. The majority (88%) reported no formal training or experience working in Child and Adolescent Mental Healthcare Services (CAMHS) during their GP training scheme. Responses indicated that many participants rated their competency, skills, and knowledge in essential areas of Child and Adolescent Mental Health as needing improvement. Similarly, their awareness of referral pathways and specialty services was below expectations, with poor perceived access to services. A large proportion (91.7%) expressed a definite need for further training in child and adolescent mental health disorders. The results highlight the need for enhanced training and support for GP trainees in the field of Child and Adolescent Mental Health, ensuring their ability to effectively and confidently address these common issues in primary care.

What can we know about legal minors who inject drugs? Exploring register data in three high-income countries

Background Research on legal minors who inject drugs is rare and beset with methodological problems. We explore the potential of register data for researching this population and present illustrative analyses contributing to the knowledge base. Method We obtained register data with national coverage from three high-income countries and assessed its analytic potential across two research themes. Descriptive analyses of the obtained data explored prevalence, mean age of debut, delay to accessing services, and treatment needs. Results There were differences in register types and variables collected within and between each country. The analytical potential of register data was assessed as good. Prevalence of injecting debut before the age of 18 (IDU < 18) was 29% (Sweden), 23% (Switzerland), and 5%–9% (Wales). IDU < 18 took longer to access services in each country than those with debut as adults. Complex treatment needs were identified, including mental health, education, and housing. Conclusion Register data is a viable method for better understanding this small, ‘hidden’ population, albeit with important caveats. Adolescent drug services may need to deliver or link to a range of treatment responses beyond drug use. Innovative outreach, and legal and policy change may be needed to ensure harm reduction access while injecting continues.

Parents' Experiences of Accessing Mental Health Services for Their Adolescents With Mental Health Challenges: A Scoping Review.

To analyse the literature on parents' experiences of accessing mental health services with their adolescents for mental health challenges in Ireland. Health systems globally have inadequately addressed mental health service needs resulting in notable gaps between population needs and access to adolescent mental health services. This scoping review followed Arksey and O'Malley's six-stage framework and PRISMA-ScR reporting guidelines. Five electronic databases SocINDEX, MEDLINE, CINHAL, Scopus and EBSCO were searched and reference lists screened 2015-2024. Twenty-three studies were included. Applying Braun and Clarke's thematic analysis identified three themes: adolescent community mental health services for adolescents with mental health challenges, accessing mental healthcare services via emergeny departments for adolescents with mental health challenges and parents' experiences of accessing mental health services for their adolescents with mental health challenges. Parents' experiences of accessing mental health services for their adolescents are not fully understood, and further research is required to map key concepts to inform practice and policymaking. The findings from this scoping review highlight challenges for adolescent mental health services in Ireland and internationally. Heightening awareness of these issues is necessary to improve the clinical practice of nurses. This was a scoping review study.

Prehospital use of spinal precautions by emergency medical services in children and adolescents.

Limited evidence exists to guide the management of children with possible spinal injuries in the prehospital setting. As a first step to address this, we set out to describe the epidemiology and management of children <18 years presenting with possible cervical spinal injuries to EMS in Victoria, Australia. Retrospective case record review of all children with concerns of head or neck trauma and/or documented cervical spine collar use presenting to the statewide Ambulance Victoria (AV) EMS service, Victoria, Australia, between 1 July 2019 and 30 June 2020. Demographic, clinical features, mechanism of injury and spinal immobilisation practices were extracted. 2100 children were included; 61% were male and the median age was 13 years (interquartile range: 9-15). Over half of the children were transported to suburban (32.2%) and rural/regional (22.9%) EDs, with 37.5% taken to designated trauma centres. The most common mechanisms of injury were sports/activity, motor vehicle accidents and falls in 35.4%, 27.9% and 26.3%, respectively. Spinal precaution use was recorded in 93.7% of cases; cervical collar use was the most common procedure recorded (87.1%). Younger age groups were less likely to have spinal precautions initiated; 51% of children aged 0-3 years, compared to 96.3% of children aged 12 and older (odds ratio = 23.8; 95% confidence interval = 14.5-37; P < 0.001). Prehospital spinal precautions were initiated commonly in children, with use increasing with age, and most were transported to suburban, regional and rural hospitals, not trauma centres. These data will inform the integration of emerging paediatric-specific evidence into prehospital guidelines to risk stratify children.

Prevalence of psychotic-like experiences and their association with depression symptoms among patients entering adolescent psychiatric care

Background Psychotic-like experiences (PLEs) are common in clinical adolescent samples and form a continuum based on their frequency and intensity. PLEs can have harmful effects on both behaviour and affect. Methods Prevalence and subjective distress due to PLEs were assessed with the Prodromal Questionnaire-Brief (PQ-B) and depressive symptoms with the Beck Depression Inventory (BDI-21A) among adolescents (N = 399; 71.7% female, mean age 14.9 years, range 13–18) entering specialized adolescent psychiatric services. Various PQ-B Distress scale cut-off points were tested for their ability to detect high and low BDI scores using the superiority index, the effect size for mean difference, and spline regressions. Results The mean number of endorsed PLEs assessed with the PQ-B was 3.27 (SD 3.64; males: M 1.75; SD 2.78; females: M 3.89; SD 3.78), while mean PQ-B Distress scores were 20.33 (SD 18.03; males: M 11.84; SD 13.90; females: M 23.74; SD 18.40). The most common PLE within both genders were experiences of paranoia and suspiciousness, with a prevalence of 59.9%. BDI scores and PQ-B distress scores were strongly associated (r = 0.534, p<.001). Superiority indices, effect sizes, and spline regressions indicated that a low PQ-B Distress cut-off of 2 or 3 was most informative both when using BDI as a continuous variable and when dichotomized as mild depression (≥10) or major depressive disorder (≥16). Conclusion PLEs are common among adolescent entering psychiatric care. Even a relatively small amount of distress due to PLEs indicates clinical levels of depressive symptoms.

230 Two Years of Screening and Linkage to HIV Preventive Services for At-Risk Adolescents and Young Adults in a Safety-Net Pediatric Emergency Department

230 Two Years of Screening and Linkage to HIV Preventive Services for At-Risk Adolescents and Young Adults in a Safety-Net Pediatric Emergency Department

US Public Opinion About Reproductive Health Care in School-Based Health Centers

(Abstracted from Contraception 2024;132:110374) Reproductive education and health services for adolescents are extremely variable, depending on location and community access. Restrictions on abortion and the end of Medicaid continuous enrollment have contributed to regressions in access to different varieties of reproductive health care, and thus research targeting ways to mitigate these regressions is paramount.

The Relationship Between Family Support and Teenage Activity in Youth Integrated Service post in Purwosari District, Surakarta

&lt;div&gt;&lt;table cellspacing="0" cellpadding="0" align="left"&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left" valign="top"&gt;&lt;p&gt;&lt;em&gt;Adolescence is a transition period from childhood to adulthood where a person experiences significant biological, psychological, and social changes. This development encourages more mature behaviors in adolescents related to various adolescent health problems, thus requiring comprehensive and integrated services that include all elements of different programs and sectors, such as the development of adolescent care health services in the form of an Adolescent Integrated Service Post. This study aimed to determine the relationship between family support and adolescents' activity in adolescent integrated service posts in Purwosari district, Surakarta, Central Java. This study is a quantitative study with a cross sectional design. This research was conducted from October to December 2023 in Purwosari Village, Laweyan District, Surakarta. The total population was 818 adolescents aged 15-19 years. The research sample was 80 adolescents selected by snowball sampling technique. The research instrument used a questionnaire. The research data were analyzed univariately and bivariately (chi-square test). The results showed a p-value = 0.028, which means that there is a relationship between family support and adolescents' activeness at the integrated youth service post in Purwosari Village. Recommendations given to the health department to improve the implementation of integrated service post activities aimed at adolescents so that it can run optimally and more often conduct activities that can arouse the interest of adolescents who do not participate in youth activities, as well as appeal to parents to encourage the younger generation to start actively participating in youth integrated service post activities.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;em&gt; &lt;/em&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt;&lt;/div&gt;&lt;strong&gt;&lt;em&gt;Keywords: Family Support, Adolescent Activities, Youth Integrated Service Post&lt;/em&gt;&lt;/strong&gt;

The Prevalence of Postpartum Contraception Use among Teenage Mothers at Vajira Hospital, Thailand

OBJECTIVES: To determine the prevalence of postpartum contraception use among teenage mothers and to identify the factors influencing both postpartum contraception use and loss to postpartum follow-up at the Faculty of Medicine Vajira Hospital in Thailand.METHODS: Four hundred and seventy-five participants were randomly selected from 1,060 Thai teenage pregnant that gave birth at the Faculty of Medicine Vajira Hospital between 1 January 2017 and 31 December 2020 and were scheduled postpartum visits. The clinical factors associated with postpartum contraception use and loss to postpartum follow-up were studied using multiple logistic regression analysis.RESULTS: A total of 451 participants remained after excluding criteria. Of these, 212 participants did not follow-up on their postpartum visits, leaving the limitation to summarize the true prevalence of postpartum contraception use of the total population. However, of the 232 participants who visited postpartum follow-ups, the prevalence of contraceptive use was 95.8%. Married status was the only factor associated with higher postpartum contraceptive use (odds ratio (OR) 12.81 [3.38-48.64]). Age 18 years and older (ORadj1.71 [1.16-2.53]), absence of previous contraceptive use (ORadj1.91 [1.29-2.80]), and total antenatal care visits fewer than 8 (ORadj 1.61 [1.07-2.42]) were significantly related with loss to postpartum follow-ups.CONCLUSION: The prevalence of contraceptive use was high among teenage mothers who had follow-up postpartum visits. However, this population also had a high loss rate of postpartum visits. Interventions and close monitoring should be considered to evaluated further for effective adolescent reproductive services.

Protocols for transitioning to adult mental health services for adolescents with ADHD

BackgroundFor Attention Deficit/Hyperactivity Disorder (ADHD) youth transitioning from child to adult services, protocols that guide the transition process are essential. While some guidelines are available, they do not always consider the effective workload and scarce resources. In Italy, very few guidelines are currently available, and they do not adhere to common standards, possibly leading to non-uniform use.MethodsThe present study analyzes 6 protocols collected from the 21 Italian services for ADHD patients that took part in the TransiDEA (Transitioning in Diabetes, Epilepsy, and ADHD patients) Project. The protocols’ content is described, and a comparison with the National Institute for Clinical Health and Excellence (NICE) guidelines is carried out to determine whether the eight NICE fundamental dimensions were present.ResultsIn line with the NICE guidelines, the dimensions addresses in the 6 analyzed documents are: early transition planning (although with variability in age criteria) (6/6), individualized planning (5/6), and the evaluation of transfer needs (5/6). All protocols also foresee joint meetings between child and adult services. The need to include the families is considered by 4 out of 6 protocols, while monitoring (2/6), and training programs (1/6) are less encompassed. In general, a highly heterogeneous picture emerges in terms of quality and quantity of regulations provided.ConclusionsWhile some solid points and core elements are in common with international guidelines, the content’s variability highlights the need to standardize practices. Finally, future protocols should adhere more to the patients’ needs and the resources available to clinicians.