Jo Wu

Background
Stress adversely affects nursing students’ well-being and clinical communication. This study examined the effects of a newly developed mindfulness-based nursing education programme (MINDNUEDU) on perceived stress, resilience, and heart rate variability (HRV) among nursing students.

Methods
A quasi-experimental, two-arm pre–post design was conducted at a university in Taiwan. Seventy nursing students were allocated to either an eight-week mindfulness intervention group (n = 36) or a standard curriculum control group (n = 34) based on academic scheduling constraints. Primary outcomes were perceived stress, measured using the Perceived Stress Scale, and resilience, measured using the Connor–Davidson Resilience Scale. Secondary outcomes included HRV indices (SDNN, RMSSD, and HF power), assessed within the intervention group. Adjusted between-group differences over time were analyzed using Generalized Estimating Equations, controlling for baseline values and year of study.

Results
After adjustment for baseline differences, significant Group × Time interactions were observed for perceived stress (p = .004) and resilience (p < .001), indicating greater improvements in the intervention group compared with controls. The mean increase in resilience exceeded the minimal clinically important difference. A significant dose–response relationship was also identified, with higher attendance linearly associated with greater reductions in stress (p = .003) and greater gains in resilience (p = .004). Within the intervention group, session-level analyses demonstrated acute post-session increases in parasympathetic-related HRV indices across several weeks.

Conclusions
Participation in the MINDNUEDU programme was associated with reduced perceived stress and increased resilience among nursing students. While physiological findings reflected short-term autonomic changes during sessions rather than confirmed long-term trait adaptation, the results support the feasibility of integrating structured mindfulness training into nursing education. Randomized controlled trials with longitudinal follow-up are needed to confirm sustainability and causal effects.

The IMPACT-CKM scoping review protocol aims to map and synthesize global evidence on predictors, mechanisms, and major adverse cardiovascular events (MACE) associated with Cardiovascular–Kidney–Metabolic (CKM) syndrome. The review will use a structured search of biomedical databases to identify studies related to metabolic syndrome, chronic kidney disease, diabetes mellitus, hypertension, and related conditions. It will characterize key risk factors, disease progression patterns, and clinical and social determinants influencing adverse cardiovascular outcomes. The findings will highlight evidence gaps and inform future research, risk stratification, and integrated CKM care strategies.

This registration contains the protocol for a scoping review titled “Interactive AI for Patients with Cardiovascular Disease and Comorbidities.” The review aims to map the existing literature on the feasibility and acceptability of AI-guided mindfulness and relaxation interventions for individuals with cardiovascular disease and comorbidities. It will examine the types of AI-based interventions used, user acceptance, usability, and ease of use across different modalities, including interactive, embodied, and video-based systems. The review will also summarize reported outcomes related to emotional wellbeing, such as anxiety, mood, and psychological distress. This registration outlines the eligibility criteria, search strategy, study selection process, and data charting methods in accordance with scoping review methodology.

Background and Aim: The Vietnamese has committed to introducing human papillomavirus (HPV) vaccination into the National Expanded Immunization Program from 2026. To inform effective national implementation, we conducted a review of existing evidence on HPV vaccination coverage, barriers, facilitators, and delivery experiences in Vietnam.

Methods: We searched PubMed, Embase, national health surveys databases for published studies reporting on HPV vaccination in Vietnam. Eligible studies included data on HPV vaccination coverage, uptake determinants, and implementation experiences between 2010 and 2025.

Outcomes: Nationally, HPV vaccination coverage among women aged 15–29 years was of 12.0%. The mean age at first dose was 19.2 years and at last dose was 20.0 years, indicating that vaccination often occurs after the recommended early adolescent period. Limited knowledge and awareness of HPV and cervical cancer prevention were the most consistently reported barriers to vaccine uptake. Among individuals aware of the HPV vaccine, high cost was the primary reason for remaining unvaccinated, cited by 50% - 75% of respondents.
Rural populations experienced greater financial barrier but demonstrated higher acceptability of vaccination. In contrast, urban populations reported greater affordability but lower willingness to vaccinate. Vaccination decisions were typically made jointly by parents and adolescents, following consultation with friends, family members, health workers, and community opinion leaders. Adolescents’ decisions were influenced by perceived sexual activity status, whereas many parents, particularly girls, did not perceive their teenage children to be at risk. Several research gaps were identified, including limited evidence on male vaccination and public-sector implementation strategies.

Conclusion and Future actions: HPV vaccination coverage in Vietnam remains low, with substantial financial, knowledge, and sociocultural barriers. As Vietnam prepares for national introduction of HPV vaccination in 2026, improving affordability, strengthening public awareness, and engaging trusted community stakeholders will be essential to achieving high and equitable coverage.

Background
Cardiac rehabilitation is a structured secondary prevention program delivered in three phases that aims to improve health outcomes, quality of life, and economic benefits for people with cardiovascular disease. Despite its proven effectiveness, participation in Phase II cardiac rehabilitation remains low due to a range of individual, clinical, logistical, and health‑system barriers.
Aim
Our study aimed to identify contemporary trends and factors associated with cardiac rehabilitation referrals and assessments for patients undergoing elective percutaneous coronary intervention.
Methods
We performed a secondary analysis using extracted data for all patients who underwent elective percutaneous coronary intervention between July 2014 and December 2021 among six public hospitals in Queensland, Australia.
Results
Of 3081 patients, 1845 (59.9%) had cardiac rehabilitation referrals within 30 days of hospital discharge. Of the 1845 patients with a referral, 1022 (55.4%) underwent an initial assessment, and of those, 400 (39.1%) completed a final assessment. There was variation in the trends of referrals (declining from 69.7% to 57.1%), initial assessment (declining from 62.4% to 51.1%), and final assessment (increasing from 32.2% to 40.5%) across the study period. Those who stayed overnight were 10.2 times more likely to receive a referral than those who were discharged the same day. However, overnight stay was not a factor associated with completing the initial and final assessments.
Discussion
Cardiac rehabilitation participation showed decreasing referral and initial assessment rates, with slight improvement in final assessment completion. Although overnight stay strongly increased referral likelihood, discharge status did not influence engagement once patients entered the program.
Conclusion
Referral rates were moderate, and same-day discharge patients had lower odds of referral. More work is needed to understand barriers to referral, especially for same-day discharge patients. Also, strategies are required to promote sustained participation in cardiac rehabilitation activities.

Vulnerable populations include low-income individuals and families, ethnic minorities living in rural areas, older adults, and people with disabilities [1]. The population at risk for chronic diseases may experience daily social, physical, economic, and environmental challenges [2]. Advancing health services for vulnerable populations by reducing avoidable disparities and ensuring equitable access to high-quality, culturally responsive care is paramount [3].

Aim: To explore Taiwanese adolescents' experiences with asthma.

Design: Exploratory qualitative study using semi-structured face-to-face interviews, framed within Bronfenbrenner's Ecological Systems Theory.

Methods: Data were collected until saturation was reached. The interviews focused on adolescents who experienced asthma during their developmental stages. Data were managed using NVivo V12 program.

Data Sources: This study was conducted at an outpatient paediatric clinic located within a tertiary teaching hospital (anonymised for review) in Taiwan.

Results: Seventeen Taiwanese adolescents with asthma were interviewed, resulting in the emergence of eight main themes: 'asthma exacerbation and its impacts’, ‘maintaining physical comfort’, ‘increased compliance with medication or treatment regimes’, ‘peer interactions’, ‘available resources at school’, ‘uncertainty’, ‘changes in social participation to manage symptoms’, and ‘conflicts in asthma care across different generations of family caregivers’.

Conclusion: Taiwanese adolescents with asthma experience regular disruptions to their social participation and school attendance. As a result, maintaining peer relationships may be challenging.

Implications for the Profession and/or Patient Care: Understanding the experiences of adolescents with asthma provides insights in optimising asthma care at home and school settings. Our findings highlight the importance of enabling teachers to respond appropriately to the needs of adolescents with asthma. A lack of understanding among teachers can aggravate adolescents' fear of embarrassment when using an inhaler in the presence of their peers. This may lead to reduced social interactions and feelings of isolation. To create a supportive environment, it is crucial to equip teachers and peers to recognise and respond to asthma symptoms.

Impact: This study addressed the lack of understanding of the developmental needs of Taiwanese adolescents with asthma. Adolescents' home and school environments impact asthma management. Families, teachers and healthcare professionals must consider the developmental experiences of adolescents living with asthma in order to provide appropriate care.

Reporting Method: COREQ was used.