Data quality in epidemiological studies is a basic requirement for good scientific research. The aim of this study was to examine an important indicator of data quality, data completeness, by investigating predictors of missing data.

Baseline data of a cohort study, the population-based Hamburg City Health Study, were used. Missingness was investigated at the levels of a whole research unit, on the two segments of health service utilisation and psychosocial variables, and two sensitive items (income and number of sexual partners). Predictors for missingness were sociodemographic variables, cognitive abilities and the mode of data collection. Associations were estimated using binary and multinomial logistic regression models.

Of 10 000 participants (mean age=62.4 years; 51.1% women), 32.9% had complete data at the unit level, 66.8% had partially missing data and 0.3% missed all items. The highest proportions of missing values were found for income (27.8%) and the number of sexual partners (36.7%). At both the unit, segment and item level, older age, female sex, low education, a foreign mother language and cognitive impairment were significant predictors for missingness.

For analysing population-based data, dealing with missingness is equally important at all levels of analysis. During the design and conduct of the study, the identified groups may be targeted to reach higher levels of data completeness.

Adolescents in informal urban communities, defined as settlements that fall outside of formal governmental planning and regulatory frameworks, are at increasing risk of poor-quality diets and malnutrition in all its forms. The food environment is the interface of adolescent food choice and the broader food system, and food environment interventions have the potential to improve adolescent diets and nutritional outcomes.

We will conduct a mixed-methods study, integrating methods from participatory systems science and nutritional epidemiology to characterise linkages among adolescents’ neighbourhood and home food environments, and their food choices, diets and nutritional outcomes. We will recruit adolescents, caregivers, school staff and food system actors from five communities along a gradient of urban informality in Nairobi, Kenya, to participate in cognitive mapping, group-based modelling and a cohort study over one academic year to evaluate dietary choices and nutritional outcomes.

The study has been approved by the Research Ethics Committee of Rutgers University (Pro2024001981) and Amref Health Africa (P1831-2025). Adult participants will provide written informed consent, and adolescents will provide written informed assent to participate in the study. Findings will be disseminated through peer-reviewed journals, conference presentations and to participants through planned participatory interaction throughout the study.

Distal radius fractures are the most common fractures seen in the emergency department in children in the USA. However, no established or standardised guidelines exist for the optimal management of completely displaced fractures in younger children. The proposed multicentre randomised trial will compare functional outcomes between children treated with fracture reduction under sedation versus children treated with simple immobilisation.

Participants aged 4–10 years presenting to the emergency department with 100% dorsally translated metaphyseal fractures of the radius less than 5 cm from the distal radial physis will be recruited for the study. Those patients with open fractures, other ipsilateral arm fractures (excluding ulna), pathologic fractures, bone diseases, or neuromuscular or metabolic conditions will be excluded. Participants who agree to enrol in the trial will be randomly assigned via a minimal sufficient balance algorithm to either sedated reduction or in situ immobilisation. A sample size of 167 participants per arm will provide at least 90% power to detect a difference in the primary outcome of Patient-Reported Outcomes Measurement Information System Upper Extremity computer adaptive test scores of 4 points at 1 year from treatment. Primary analyses will employ a linear mixed model to estimate the treatment effect at 1 year. Secondary outcomes include additional measures of perceived pain, complications, radiographic angulation, satisfaction and additional procedures (revisions, refractures, reductions and reoperations).

Ethical approval was obtained from the following local Institutional Review Boards: Advarra, serving as the single Institutional Review Board, approved the study (Pro00062090) in April 2022. The Hospital for Sick Children (Toronto, ON, Canada) did not rely on Advarra and received separate approval from their local Research Ethics Board (REB; REB number: 1000079992) on 19 July 2023. Results will be disseminated through publication in peer-reviewed journals and presentations at international conference meetings.

NCT05131685.

The study aimed to assess the trends and factors associated with modern contraceptive use among female youths (15–24 years) in Tanzania from 2004 to 2022.

We performed secondary analysis of cross-sectional data from four consecutive Demographic and Health Surveys (DHS) in Tanzania: 2004, 2010, 2015/2016 and 2022.

Tanzania.

Sexually active female youths (n=8659).

The use of any modern contraceptive method, coded as Yes or No.

The sample had a median age of 21 (IQR 18–22 years), with 63.7% aged 20–24 years. Modern contraceptive use among female youths increased from 24.6% in 2004 to 32.1% in 2022. Consistent across surveys, modern contraceptive use was positively associated with secondary or higher education level, having one or more live births and engaging in sexual activity within the month preceding the survey. Additionally, adolescents (15–19 years) demonstrated a weak protective association, indicating a reduced likelihood of modern contraceptive use compared with young women (20–24 years). In 2015/2016 and 2022 surveys, primiparous, multiparous and married/cohabiting women were more likely to use modern contraceptives than nulliparous women.

Modern contraceptive use among female youths increased gradually in Tanzania between 2004 and 2022 Tanzania DHS. To sustain these upward trends and reduce the risk of unwanted pregnancies and sexually transmitted infections, public health policies should consider the factors positively associated with modern contraceptive use, particularly among young women aged 20–24 years, married/cohabiting, who have initiated childbearing and those with high education levels.

Disabled resident doctors face persistent structural, cultural and institutional barriers to career progression. This integrative review synthesises empirical and grey literature to identify the challenges disabled doctors encounter, the practices that support their careers and the potential solutions applicable to healthcare, in particular National Health Service (NHS), settings.

Integrative literature review using a content analysis approach to data analysis. Included sources were published in English and examined disabled doctors’ career progression or included disabled doctors as a separate subgroup. Opinion pieces without empirical grounding and articles not available in full text were excluded.

International postgraduate medical education, with consideration for transferability and applicability to the UK NHS.

Focused on the experiences and careers of disabled resident doctors, at any stage of their career, prior to completion of training.

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity guidelines, 53 sources were included and analysed. Structural ableism, inaccessible systems and stigma around disclosure were consistently identified as barriers to career progression. Facilitators included mentorship, affirming supervisory relationships and identity-affirming networks. Promising practices included universal design approaches, anticipatory rather than reactive approaches to making adjustments and integration of disability equity into organisational governance. However, most initiatives remain unevaluated, and UK-specific evidence is limited.

While awareness of barriers is growing, evidence-based solutions remain underdeveloped and unevenly implemented. To build a sustainable and representative medical workforce, workforce policy and planning must not only remove barriers to progression for disabled doctors, but also embed disability inclusion into the structures and cultures that shape medical career paths.

The Quadrivalent human papillomavirus (HPV) Vaccine Evaluation Study with Addition of the Nonavalent Vaccine Study (QUEST-ADVANCE) aims to provide insight into the long-term immunogenicity and effectiveness of one, two and three HPV vaccine doses. Here, we describe the protocol for QUEST-ADVANCE.

QUEST-ADVANCE is an observational cohort study including males and females who are unvaccinated or vaccinated with the quadrivalent or nonavalent HPV vaccine in British Columbia, Canada. Female participants who are unvaccinated or vaccinated with 1–3 doses of the quadrivalent or nonavalent HPV vaccine at 9–14 years of age will be recruited approximately 5 or 12 years postvaccination eligibility. Male participants who are unvaccinated or vaccinated with 1 or 2 doses of the nonavalent HPV vaccine at 9–14 years of age will be recruited at approximately 5 years postvaccination eligibility. The study involves a maximum of four visits over a period of 4–5 years for female participants, and two visits over a 12-month period for male participants. At each visit, self-collected swabs (cervico-vaginal or penile) and questionnaire data will be collected. In each study group, a subset of participants will be invited to participate in a substudy evaluating the long-term humoral immunogenicity of the HPV vaccine. Additional blood samples will be collected from participants who are part of the immunogenicity substudy. The total required sample size is 7180 individuals. The primary objectives are (1) to examine vaccine effectiveness in males and females against prevalent genital HPV infections for one, two and three doses of the HPV vaccine compared with unvaccinated participants and (2) to evaluate if there is non-inferior immunogenicity as indicated by type-specific antibody response of one dose of the HPV vaccine in 20–27-year-old females vaccinated at 9–14 years of age compared with historical data of three doses of the HPV vaccine females vaccinated at 16–26 years of age up to 12 years postvaccination.

QUEST-ADVANCE was approved by the Research Ethics Board of the University of British Columbia/Children’s and Women’s Health Centre of British Columbia (H20-02111). Individual electronic informed consent or assent will be obtained from each participant before any study-specific procedures are undertaken. Results will be published in an international peer-reviewed journal and on the study website.

To examine the impact of the COVID-19 pandemic on the substitution of surgical procedures in benign gynaecology in the Netherlands.

Quantitative longitudinal study evaluating the effects of the COVID-19 pandemic.

Nationwide healthcare delivery was analysed across six benign gynaecological pathways from 2016 to 2022 using Vektis and Dutch Hospital Data (DHD), accessed via Statistics Netherlands (Centraal Bureau voor de Statistiek).

The study focused on six benign gynaecological pathways classified using Dutch Diagnosis Treatment Combinations (DTCs): heavy menstrual blood loss (G11), uterine fibroids (G15), endometriosis (G17), prolapse (G25), infertility treatment (F11) and first trimester pregnancy complications (Z12). All patients receiving care within these pathways between 1 January 2016 and 31 December 2022 were included. Exclusions applied to all patients under 18 years old and, only within the menstrual disorder pathway, patients over 51 years old to exclude most postmenopausal blood loss cases where no alternative treatment applies.

Cohorts from the initial pandemic year (2020) were compared with four prepandemic cohorts (2016–2019) and late-pandemic (2021) and postpandemic (2022) cohorts.

The primary outcome was the trend in the total number of patients in surgical and non-surgical procedure groups across cohort periods. Secondary outcomes included trends within individual pathways.

The analysis identified a significant reduction in benign gynaecological care during 2020, with an 18.3% (p

The COVID-19 pandemic significantly disrupted both surgical and non-surgical procedures within benign gynaecological pathways. Reduced care uptake during the pandemic waves was not recovered but instead forgone. The reduction in surgical procedures did not correspond with increased use of non-surgical alternatives. Future research should prioritise evaluating the long-term impacts of this disruption on patients and society.

While group, task-oriented, community-based exercise programs (CBEPs) delivered in-person can increase exercise and social participation in people with mobility limitations, challenges with transportation, cost and human resources, threaten sustainability. A virtual delivery model may help overcome challenges with accessing and delivering in-person CBEPs. The study objective is to estimate the short-term effect of an 8-week, virtual, group, task-oriented CBEP called TIME™ (Together in Movement and Exercise) at Home compared with a waitlist control on improving everyday function in community-dwelling adults with mobility limitations.

A randomised controlled trial incorporating a type 1 effectiveness-implementation hybrid design is being conducted in four Canadian metropolitan centres. We aim to stratify 200 adults with self-reported mobility limitations by site, participation alone or with a partner, and functional mobility level, and randomise them using REDCap software to either TIME™ at Home or a waitlist control group. During TIME™ at Home classes (2 classes/week, 1.5 hours/class), two trained facilitators stream a 1-hour exercise video and facilitate social interaction prevideo and postvideo using Zoom. A registered healthcare professional at each site completes three e-visits to monitor and support implementation. Masked evaluators with physical therapy training evaluate participants and their caregivers at 0, 2 and 5 months using Zoom. The primary outcome is the change in everyday function from 0 to 2 months, measured using the physical scale of the Subjective Index of Physical and Social Outcome. The study is powered to detect an effect size of 0.4, given α=0.05, power=80% and a 15% attrition rate. Secondary outcomes are mobility, well-being, reliance on walking aids, caregiver assistance, caregiver mood, caregiver confidence in care-recipient balance and cost-effectiveness. A multimethod process evaluation is proposed to increase understanding of implementation fidelity, mechanisms of effect and contextual factors influencing the complex intervention. Qualitative data collection immediately postintervention involves interviewing approximately 16 participants and 4 caregivers from the experimental group, and 8 participants and 4 caregivers from the waitlist control group, and all healthcare professionals, and conducting focus groups with all facilitators to explore experiences during the intervention period. A directed content analysis will be undertaken to help explain the quantitative results.

TIME™ at Home has received ethics approval at all sites. Participants provide verbal informed consent. A data safety monitoring board is monitoring adverse events. We will disseminate findings through lay summaries, conference presentations, reports and journal articles.

NCT06245135.

To evaluate various prioritisation strategies within an algorithm designed to ascertain the most likely ethnicity and create a standardised methodology to benefit future research.

Retrospective cohort study.

The Clinical Practice Research Datalink (CPRD) primary care and linked Hospital Episode Statistics (HES) data sets.

The population of 54 029 174 patients included all acceptable patients registered at English practices in CPRD GOLD or CPRD Aurum from the May 2023 to May 2022 builds, respectively.

Ethnicity data within CPRD and HES data sets were identified by employing established code lists and subsequently categorised into broader ethnic groups. Changes were made to a previously used algorithm to assess their effect on ethnic categorisations. Modifications included prioritising primary over secondary care data, recent over frequent records and ‘non-other’ ethnicity categories. Different data sources were examined: CPRD with all HES data sets, CPRD with HES Admitted Patient Care (APC) only, CPRD only and HES APC only. Ethnic distributions from these variations were compared using counts and percentages, evaluating inter-rater reliability using Cohen’s kappa. Sensitivity analyses included repetition using only currently registered patients and after removing cases with unknown ethnicity. Ethnic distributions were compared with English Census 2021.

There was almost perfect agreement in ethnicity distributions whether prioritising primary over secondary care data (kappa=1.0000, SE=0.0001), whether prioritising most frequently or most recently recorded data (kappa=0.9824, SE=0.0001) and whether prioritising ‘non-Other’ categories (kappa=0.9705, SE=0.0001). There was moderate agreement in ethnicity distributions when sourcing data from single data sources (CPRD only (kappa=0.5554, SE=0.0001) or HES APC only (kappa=0.5526, SE=0.0001)) compared with combined data sources (CPRD and HES datasets).

All variations of the algorithm produced similar population-level ethnicity distributions. Versions using data from multiple sources had higher inter-rater reliability than those using a subset of sources; however, there was little difference in categorisations produced by varying the hierarchical decision-making of the ethnicity algorithm. The CPRD population was representative of the English population in terms of ethnicity. While researchers should remain vigilant of the limitations of using these data, the CPRD Ethnicity Records provide a standardised and pragmatic approach to ascertaining ethnicity for future research.

Skin temperature assessment is essential for the diagnosis of cellulitis and monitoring treatment response, but is currently subjective and can contribute to overdiagnosis. We aimed to characterise skin temperature changes over time in cellulitis and compare two objective measurement approaches, a thermal imaging camera (TIC) and a non-contact infrared thermometer (NCIT).

A device comparison study nested within a prospective cohort. We measured limb temperatures daily for 4 days using a TIC and two NCITs.

Two acute hospitals in the UK’s National Health Service.

202 adults (age ≥18 years) diagnosed with lower limb cellulitis who attended hospital for antibiotic treatment.

We used linear mixed-effects models to quantify changes in temperature over time and intraclass correlation coefficients (ICC) to assess reliability. We compared temperature measurements between devices using Lin’s concordance coefficients and Bland-Altman plots with estimated 95% limits of agreement.

202 patients were included: 95% white ethnicity. Baseline limb temperature differences varied between 2.4°C and 3.4°C, depending on the device. All devices showed significant reductions in affected limb temperature per day, with the largest decrease recorded by the TIC (–0.34°C per day, 95% CI –0.48°C to –0.19°C, p

Daily temperature changes may be too small for reliable monitoring at the individual patient level, but cumulative changes from day 0 to day 3 may be sufficient for clinical interpretation, despite limitations in the precision of device measurements. NCITs’ measurement capabilities differ widely, so these devices cannot be used interchangeably. Due to this and the potential benefits of advanced thermal image analysis, TICs should be prioritised for further study in cellulitis. Future research should confirm our findings in different skin tones and explore the clinical utility of thermal imaging in enabling earlier diagnosis or detecting signs of therapeutic failure.