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Background: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality and residing in a rural and remote region is associated with an increased risk. The impact of rurality on CVD outcomes needs to be fully elucidated., Objectives: The purpose of this study was to assess the difference in mortality, readmission within 30 days, total readmissions, survival, and total emergency department (ED) presentations following an index CVD admission among patients from rural or remote areas as compared to metropolitan areas., Methods: This retrospective observational study included all index hospitalizations with heart failure (HF), atrial fibrillation (AF), or acute coronary syndrome (ACS) within the Hunter New England region of Australia, between January 1, 2008, and December 31, 2021., Results: There were 27,995 ACS admissions, 15,586 HF admissions, and 16,935 AF admissions. Patients from a rural or remote area presenting with CVD presentations had increased 30-day readmission (OR: 1.19; P  < 0.001), an increased number of readmissions (incident rate ratio: 1.19; P  < 0.001), and more ED presentations (incident rate ratio: 1.39; P  < 0.001) as compared to patients from metropolitan areas. This was consistent across patients presenting with ACS, HF, and AF. There was no difference in mortality (HR: 1.01; P  = 0.515). However, in the ACS subgroup, there was increased mortality in the rural and remote population (HR: 1.05; P  = 0.015)., Conclusions: This study highlights the increased incidence of ED presentations and hospital readmissions, for those living in rural Australia, illustrating the disparity in health care provided, and the ongoing need for interventions that address poorer access to specialized health care in the early discharge phase of hospitalization., Competing Interests: Dr Wilsmore has received speaker fees, grant support, and consultancy fees from Medtronic and Boston Scientific; and speaker fees from Boehringer, Pfizer, and Bayer. Dr Sverdlov is supported by the National Heart Foundation of Australia Future Leader Fellowship (Award ID 106025); has received research grants from AstraZeneca, Novartis, Biotronik, RACE Oncology, Bristol Myers Squibb, Roche Diagnostics, and Vifor; and speaker/consultancy fees from Novartis, Bayer, Bristol Myers Squibb, AstraZeneca, Janssen, and Boehringer Ingelheim. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Crown Copyright © 2024 Published by Elsevier on behalf of the American College of Cardiology Foundation.)

Introduction: Adolescent e-cigarette use, globally and within Australia, has increased in recent years. In response, public health agencies have called for the development of education and communication programmes targeting adolescents. Despite such recommendations, few rigorous evaluations of such interventions currently exist. The main objective of this study is to examine the potential effect of a text message intervention targeting parents and adolescents on adolescent susceptibility to e-cigarette use (eg, intentions towards using e-cigarettes). Secondary objectives are to (1): examine the effect of the intervention on adolescent e-cigarette and combustible tobacco use and (2) examine the acceptability of the intervention., Methods and Analysis: A randomised controlled trial employing a 2×2 factorial design will be conducted with parent-adolescent dyads (aged 12-15 years). Dyads will be randomly allocated to one of four arms: arm 1-a text message intervention delivered to adolescents only; arm 2-a text message intervention delivered to the parents of adolescents only; arm 3-a text message intervention delivered to both the parents and adolescents; and arm 4-an information only control, consisting of an e-cigarette factsheet provided to parents only. Participant recruitment commenced in March 2023 with the aim to recruit 120 parent-adolescent dyads. Data collection to assess study outcomes will occur at baseline, 6, 12 and 24 months post the commencement of the intervention. The primary endpoint will be 6-month follow-up. The primary outcome will be adolescent susceptibility to e-cigarette use, assessed using validated items. Analyses of trial outcomes will be undertaken under an intention-to-treat framework, with all participants included in the analysis in the group they were allocated., Ethics and Dissemination: Ethics approval has been obtained from the human research ethics committee of the University of Newcastle (H-2022-0340). Findings will be disseminated in peer-reviewed journals and at conferences., Trial Registration Number: The trial was registered prospectively with Australian New Zealand Clinical Trials Registry (ACTRN12623000079640)., Competing Interests: Competing interests: All authors declare that they have no competing interests., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Web-based interventions targeting parents with health and parenting support frequently report high rates of attrition. The SMS4dads text messaging program, developed in Australia, has delivered texts to over 10,000 fathers. The brief text messages, which are sent 3 times per week from 16 weeks of gestation to 48 weeks after birth, include regular reminders that participants can leave the program by texting back "STOP" to any message. Although acceptance of the program is high, almost 1 in 5 ask it to be removed. Analyzing the factors influencing attrition from digital parenting programs such as SMS4dads may assist in developing more effective interventions., Objective: This study aimed to examine factors associated with attrition in a text-based intervention targeting fathers., Methods: Demographic characteristics, requests to complete a psychological scale, individual message content, participant feedback, and automatically collected data registering clicks on links embedded in the texts were examined to identify attrition factors among 3261 participants enrolled in SMS4dads from 4 local health districts in New South Wales, Australia, between September 2020 and December 2021., Results: Participants who were smokers, recorded risky alcohol consumption, had a lower education level, or signed up prenatally had 30% to 47% higher hazard of dropout from the program, whereas participant age, Aboriginal or Torres Strait Islander status, rurality, and psychological distress score (as Kessler Psychological Distress Scale [K10] category) were not associated with dropout. Primary reasons for dropping out reported by 202 of 605 respondents included "other reasons" (83/202, 41.1%), followed by "not helpful" (47/202, 23.3%) and "too busy" (44/202, 21.8%). Program features such as repeated requests to complete a psychological scale (K10) and the content of individual messages were not linked to increased dropout rates. Analysis of a sample (216/2612) of inactive participants who had not engaged (clicked on any embedded links) for at least 10 weeks but who had not opted out identified a further 1.5% of participants who would opt to leave the program if asked., Conclusions: Identifying which features of the participant population and of the program are linked to dropout rates can provide guidance for improving program adherence. However, with limited information from feedback surveys of those exiting early, knowing which features to target does not, by itself, suggest ways to increase engagement. Planning ahead to include robust measures of attrition, including more detailed feedback from participants, could provide more effective guidance. A novel element in this study was seeking feedback from inactive participants to estimate dropout from this group and thereby provide an overall dropout rate of 20%. The retention rate of 80%, relatively high compared with other web-based parenting programs for fathers, suggests that tailoring the content to specifically address fathers' role may be an important consideration in reducing fathers' disengagement., (©Richard Fletcher, Casey Regan, Jason Dizon, Lucy Leigh. Originally published in JMIR Formative Research (https://formative.jmir.org), 18.08.2023.)

Background: Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease in which circulatory biomarkers have the potential for guiding management in clinical practice. We assessed the prognostic role of serum biomarkers in three independent IPF cohorts: Australian Idiopathic Pulmonary Fibrosis Registry (AIPFR), Trent Lung Fibrosis (TLF) and Prospective Observation of Fibrosis in the Lung Clinical Endpoints (PROFILE)., Methods: In the AIPFR cohort, candidate proteins were assessed by ELISA as well as in an unbiased proteomic approach. LASSO (least absolute shrinkage and selection operator) regression was used to restrict the selection of markers that best accounted for the progressor phenotype at 1 year in the AIPFR cohort, and subsequently prospectively selected for replication in the validation TLF cohort and assessed retrospectively in the PROFILE cohort. Four significantly replicating biomarkers were aggregated into a progression index model based on tertiles of circulating concentrations., Results: 189 participants were included in the AIPFR cohort, 205 participants from the TLF cohort and 122 participants from the PROFILE cohort. Differential biomarker expression was observed by ELISA and replicated for osteopontin, matrix metallopeptidase-7, intercellular adhesion molecule-1 and periostin for those with a progressor phenotype at 1 year. Proteomic data did not replicate. The progression index in the AIPFR, TLF and PROFILE cohorts predicted risk of progression, mortality and progression-free survival. A statistical model incorporating the progression index demonstrated the capacity to distinguish disease progression at 12 months, which was increased beyond the clinical GAP (gender, age and physiology) score model alone in all cohorts, and significantly so within the incidence-based TLF and PROFILE cohorts., Conclusion: A panel of circulatory biomarkers can provide potentially valuable clinical assistance in the prognosis of IPF patients., Competing Interests: Conflict of interest: B. Clynick has nothing to disclose. Conflict of interest: T.J. Corte reports grants, personal fees and nonfinancial support from Boehringer Ingelheim, grants and personal fees from Roche, grants from Galapagos, Actelion and Bayer, outside the submitted work. Conflict of interest: H.E. Jo reports other (travel support and lecture fees) from Boehringer Ingelheim and Roche, outside the submitted work. Conflict of interest: I. Stewart has nothing to disclose. Conflict of interest: I.N. Glaspole reports personal fees for advisory board work from Boehringer Ingelheim and Roche, outside the submitted work. Conflict of interest: C. Grainge reports personal fees for advisory board work from Boehringer Ingelheim and Roche, outside the submitted work. Conflict of interest: T.M. Maher reports grants, personal fees and nonfinancial support from UCB, grants and personal fees from GlaxoSmithKline and AstraZeneca, personal fees from Boehringer Ingelheim, Roche, Bayer, Prometic, Samumed, Galapagos, Celgene, Indalo, Pliant, Blade Therapeutics, Respivant, Novartis and Bristol-Myers Squibb, other (stock options) from Apellis, outside the submitted work. Conflict of interest: V. Navaratnam has nothing to disclose. Conflict of interest: R. Hubbard has nothing to disclose. Conflict of interest: P.M.A. Hopkins has nothing to disclose. Conflict of interest: P.N. Reynolds has nothing to disclose. Conflict of interest: S. Chapman reports personal fees for advisory board work from Boehringer Ingelheim and Roche, outside the submitted work. Conflict of interest: C. Zappala has nothing to disclose. Conflict of interest: G.J. Keir has nothing to disclose. Conflict of interest: W.A. Cooper has nothing to disclose. Conflict of interest: A.M. Mahar has nothing to disclose. Conflict of interest: S. Ellis has nothing to disclose. Conflict of interest: N.S. Goh reports grants from the National Health Medical Research Council (NHMRC) (APP1066128, APP114776) and the Centre of Research Excellence in Pulmonary Fibrosis (CRE-PF), Australia (NHMRC GNT116371; 2017-2021), during the conduct of the study; the PROFILE study was funded by the Medical Research Council (G0901226) and GlaxoSmithKline R&D (CRT114316). Conflict of interest: E. De Jong has nothing to disclose. Conflict of interest: L. Cha has nothing to disclose. Conflict of interest: D.B.A. Tan has nothing to disclose. Conflict of interest: L. Leigh has nothing to disclose. Conflict of interest: C. Oldmeadow has nothing to disclose. Conflict of interest: E.H. Walters has nothing to disclose. Conflict of interest: R.G. Jenkins reports other (sponsored research agreements) from AstraZeneca, Biogen and Galecto, outside the submitted work; is on advisory boards for Boehringer Ingelheim, NuMedii, Promedior and Redex; reports lecture fees and consultancy for AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Heptares, Pliant and Roche; and is a trustee for Action for Pulmonary Fibrosis. Conflict of interest: Y. Moodley reports personal fees for advisory board work from Boehringer Ingelheim and Roche, outside the submitted work., (Copyright ©The authors 2022. For reproduction rights and permissions contact permissions@ersnet.org.)