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Craig Murdoch,1 Brian H Brown,6 Vanessa Hearnden,1 Paul M Speight,3 Katy D’Apice,1,2 Anne M Hegarty,2 John A Tidy,4 T Jamie Healey,5 Peter E Highfield,7 Martin H Thornhill1,2 1Unit of Oral and Maxillofacial Medicine and Surgery, University of Sheffield School of Clinical Dentistry, Sheffield, United Kingdom; 2Unit of Oral Medicine, Charles Clifford Dental Hospital, Sheffield Teaching Hospitals National Health Service Foundation Trust, Sheffield, United Kingdom; 3Unit of Oral and Maxillofacial Pathology, University of Sheffield School of Clinical Dentistry, Sheffield, United Kingdom; 4Department of Gynaecological Oncology, 5Department of Medical Physics, Royal Hallamshire Hospital, Sheffield, United Kingdom; 6University of Sheffield Medical School, Beech Hill Road, Sheffield, United Kingdom; 7Zilico Ltd., The MedTECH Centre, Rutherford House, Manchester Science Park, Manchester, United Kingdom Abstract: The electrical properties of tissues depend on their architecture and cellular composition. We have previously shown that changes in electrical impedance can be used to differentiate between different degrees of cervical dysplasia and cancer of the cervix. In this proof-of-concept study, we aimed to determine whether electrical impedance spectroscopy (EIS) could distinguish between normal oral mucosa; benign, potentially malignant lesions (PML); and oral cancer. EIS data were collected from oral cancer (n=10), PML (n=27), and benign (n=10) lesions. EIS from lesions was compared with the EIS reading from the normal mucosa on the contralateral side of the mouth or with reference spectra from mucosal sites of control subjects (n=51). Healthy controls displayed significant differences in the EIS obtained from different oral sites. In addition, there were significant differences in the EIS of cancer and high-risk PML versus low-risk PML and controls. There was no significant difference between benign lesions and normal controls. Study subjects also deemed the EIS procedure considerably less painful and more convenient than the scalpel biopsy procedure. EIS shows promise at distinguishing among malignant, PML, and normal oral mucosa and has the potential to be developed into a clinical diagnostic tool. Keywords: oral cancer, head and neck cancer, potentially malignant lesions, dysplasia, impedance spectroscopy

Background: Addressing the wider determinants of mental health alongside psychological therapy could improve mental health service outcomes and population mental health., Objectives: To estimate the effectiveness of an enhanced 'Improving Access to Psychological Therapies' (IAPT) mental health service compared with traditional IAPT in England. Alongside traditional therapy treatment, the enhanced service included well-being support and community service links., Design: A real-world evaluation using IAPT's electronic health records., Setting: Three National Health Service IAPT services in England., Participants: Data from 17 642 service users classified as having a case of depression and/or anxiety at baseline., Intervention: We compared the enhanced IAPT service (intervention) to an IAPT service in a different region providing traditional treatment only (geographical control), and the IAPT service with traditional treatment before additional support was introduced (historical control)., Primary Outcome Measures: Patient Health Questionnaire-9 (PHQ-9) Depression Scale (score range: 0-27) and Generalised Anxiety Disorder-7 (GAD-7) Anxiety Scale (score range: 0-21); for both, lower scores indicate better mental health. Propensity scores were used to estimate inverse probability of treatment weights, subsequently used in mixed effects regression models., Results: Small improvements (mean, 95% CI) were observed for PHQ-9 (depression) (-0.21 to -0.32 to -0.09) and GAD-7 (anxiety) (-0.23 to -0.34 to -0.13) scores in the intervention group compared with the historical control. There was little evidence of statistically significant differences between intervention control and geographical control., Conclusions: Embedding additional health and well-being (H&W) support into standard IAPT services may lead to improved mental health outcomes. However, the lack of improved outcomes compared with the geographical control may instead reflect a more general improvement to the intervention IAPT service. It is not clear from our findings whether an IAPT service with additional H&W support is clinically superior to traditional IAPT models., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Introduction: Supporting adolescents with their health and wellbeing is an international public health priority. Schools are well placed to universally detect unmet health needs and support pupils. This study aimed to evaluate the effectiveness of a digital health and wellbeing screening tool, called the 'Digital Health Contact' (DHC) implemented in schools in the East Midlands of England. The DHC, delivered by Public Health Nurses (School Nurses) (PHN(SN)), aims to identify pupils with unmet health needs (via a 'red flag' system) and provide appropriate support., Materials and Methods: Using data from 22 schools which took part in the DHC and 14 schools which did not take part, across three academic years (2018-2020), we conducted a controlled interrupted timeseries analysis with negative binomial regression to explore the effect of the DHC on the number of annual referrals to PHN(SN). Using DHC data from 164 pupils, we further conducted a Difference-in-Difference analysis to explore the impact of 'red flag' and referral via the DHC in Year 9 (age 13-14) on the number of red flags in Year 11 (age 15-16)., Results: Across all schools, the mean annual number of referrals increased over the three year follow-up period. In the adjusted model, the number of referrals was comparable between schools taking part in the DHC and non-participating schools (0.15 referrals [95% CI -0.21, 0.50]). Red flag score was not significantly different among Year 11 pupils, after being referred via the DHC in Year 9 (-0.36 red flags [95% CI -0.97, 0.24])., Discussion: The DHC, and similar screening tools, have the potential to raise awareness of the health and wellbeing support in schools and provide an additional pathway of referral to this support for pupils with unmet health needs, without replacing the traditional pathway where pupils refer themselves or are referred by teachers., Competing Interests: AP, KD, PA, NW, HF, KB and FDV have no competing interests. The funders had no additional role in this study. We should note that CM is employed at the DHCs commissioning organisation (at Leicester City Council), and ST is employed at the DHCs provider organisation (at Leicestershire Partnership NHS Trust). This study, and the wider research project evaluating the DHC, has been co-produced with the DHC’s commissioners (at Leicester City Council) and providers (at Leicestershire Partnership NHS Trust). The commissioner and the provider are committed to helping to facilitate a robust evaluation of the DHC in order to inform potential changes and wider roll out of the programme. There has been no pressure or influence to modify, restate, weaken, omit or frame findings, conclusions and recommendations from any team member. The study did not receive funding from the commissioner or provider., (Copyright: © 2024 Porter et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Early language difficulties are associated with poor school readiness and can impact lifelong attainment. The quality of the early home language environment is linked to language outcomes. However, few home-based language interventions have sufficient evidence of effectiveness in improving preschool children's language abilities. This study reports the first stage in the evaluation of a theory-based programme, Talking Together (developed and delivered by BHT Early Education and Training) given over 6 weeks to families in the home setting. We aimed to test the feasibility and acceptability of delivering Talking Together in the Better Start Bradford community prior to a definitive trial, using a two-armed randomised controlled feasibility study., Methods: Families from a single site within the Better Start Bradford reach area were randomly allocated (1:1) to the Talking Together intervention or a wait list control group. Child language and parent-level outcome measures were administered before randomisation (baseline), pre-intervention (pre-test), 2 months post-intervention start (post-test), and 6 months post-intervention start (follow-up). Routine monitoring data from families and practitioners were also collected for eligibility, consent, protocol adherence, and attrition rates. Descriptive statistics on the feasibility and reliability of potential outcome measures were analysed alongside qualitative feedback on trial design acceptability. Pre-defined progression-to-trial criteria using a traffic light system were assessed using routine monitoring data., Results: Two-hundred and twenty-two families were assessed for eligibility; of these, 164 were eligible. A total of 102 families consented and were randomised (intervention: 52, waitlist control: 50); 68% of families completed outcome measures at 6-month follow-up. Recruitment (eligibility and consent) reached 'green' progression criteria; however, adherence reached 'amber' and attrition reached 'red' criteria. Child- and parent-level data were successfully measured, and the Oxford-CDI was identified as a suitable primary outcome measure for a definitive trial. Qualitative data not only indicated that the procedures were largely acceptable to practitioners and families but also identified areas for improvement in adherence and attrition rates., Conclusions: Referral rates indicate that Talking Together is a much-needed service and was positively received by the community. A full trial is feasible with adaptations to improve adherence and reduce attrition., Trial Registration: ISRCTN registry ISRCTN13251954. Retrospectively registered 21 February 2019., (© 2023. The Author(s).)

Background: A new Health and Wellbeing pathway was introduced into the Improving Access to Psychological Therapies (IAPT) service in one geographical area of the UK in 2021 to address the wider determinants of mental health problems. It comprised assisted signposting to wider services and physical health promotion. This qualitative study aimed to understand stakeholders' experiences of implementing and receiving this new support and the barriers and facilitators to its delivery., Methods: Forty-seven interviews were conducted, with service developers (n = 6), service deliverers (n = 12), service users (n = 22) and community and clinical partners (n = 7), as part of a larger mixed-methods evaluation. Interviews were recorded, transcribed, and analysed using reflexive thematic analysis., Results: Three themes spanned all participant groups and represented key aspects of the service: (1) identifying suitability, (2) a holistic service, and (3) moving forward. The sub-themes represent the barriers and facilitators to processes working in practice, lending insight into potential service improvements. These included strengthening the quality of communication during referral and assessment, tailoring the support and delivery mode, and increasing transparency around continued care to drive sustained benefits., Limitations: Service users may have been selected due to their positive experiences of IAPT and were not demographically representative of the population, although participants' experiences of the service did suggest variation in our sample., Conclusions: The Health and Wellbeing pathway was perceived as having a positive impact on mental health and could reduce the burden on therapeutic services. However, service- and individual-level barriers need to be addressed to enhance statutory and community support links, manage service users' expectations, and improve accessibility for certain groups., (© 2023. The Author(s).)

We explored if children's age moderated associations between their early life language experiences and their linguistic and cognitive skills. For 107 British children, aged 24 to 48 months, and their families, we collected 3 day-long audio-recordings of their naturalistic home environments ( M  = 15.06 h per day, SD  = 1.87). Children's cognitive ability was assessed by parent-ratings and with a cognitive testing booklet that children completed at home. We found that the quantity, lexical diversity and vocabulary sophistication of adult speech were associated with children's linguistic and cognitive skills. However, these associations were not moderated by children's age. Our findings suggest that the influence of early life language experience is not differentiated at age 24 to 48 months, at least in the current sample., Competing Interests: None., (© 2023 The Authors. Published by Elsevier Inc.)

Children's early life experiences of language and parenting are thought to have pervasive, long-term influence on their cognitive and behavioural development. However, studies are scarce that collected naturalistic observations to broadly assess children's early life experiences and test their associations with developmental outcomes in middle childhood. Here, we used digital audio-recorders to collect three full days of naturalistic observations from 107 British families with children (46 boys) aged 2-4 years, of whom 89 participated in a follow-up assessment four years later when the children were 5-8 years old. We found that children's early life experiences of language and parenting were not significantly associated with their later language ability, academic performance and behavioural outcomes. We explore differences in methodology, sample characteristics and the role of developmental periods as possible explanations for the discrepancy in findings between the current and previous studies., (© 2022 The Authors. British Journal of Developmental Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Despite high levels of need, many young people who experience health issues do not seek, access or receive support. Between May and November 2021, using semi-structured interviews, we explored the perspectives of 51 young people (aged 13-14) from two schools who had taken part in a novel online health and wellbeing screening programme, the Digital Health Contact (DHC). One school delivered the DHC during home-learning due to COVID-19 restrictions, whilst the other delivered it in school when restrictions were lifted. The DHC was seen as a useful approach for identifying health need and providing support, and had high levels of acceptability. Young people appreciated the online format of the DHC screening questionnaire and thought this facilitated more honest responses than a face-to-face approach might generate. Completion at home, compared to school-based completion, was perceived as more private and less time-pressured, which young people thought facilitated more honest and detailed responses. Young people's understanding of the screening process (including professional service involvement and confidentiality) influenced engagement and responses. Overall, our findings afford important insights around young people's perspectives of participating in screening programmes, and highlight key considerations for the development and delivery of health screening approaches in (and out of) school.

Background: Supporting children and young people's (CYP) mental and physical health is a global policy priority but detecting need and facilitating access to health services and support is challenging. This paper explores professional stakeholders' perspectives of the acceptability, utility and effectiveness of a school-based online health and wellbeing screening tool, the Digital Health Contact (DHC). The DHC, delivered by Public Health School Nurses (PHSN), aims to identify, and put in place strategies to support, unmet health needs among CYP., Methods: We employed a qualitative study design, using semi-structured interviews. Fourteen key stakeholders involved in the design and implementation of the DHC (commissioners, providers, PHSN and healthcare staff, school leaders) were purposively sampled. Data were analysed thematically., Results: Our analysis generated two key themes: the perceived benefits of the DHC; and challenges in delivering the DHC. Stakeholders perceived the universal application of the DHC with linked follow-up intervention as an effective means of identifying and supporting CYP with unmet needs, and an efficient way to target limited service resources. There were barriers around enabling school engagement in the DHC, typically in terms of logistics, school infrastructure, and perspectives of fit with schools. These barriers were seen as being negated through developing effective working relationships between schools and PHSN. Effective relationships could highlight the potential benefits of participation. Overall, the DHC was seen as a valuable and effective use of resources, with a low burden on school staff., Conclusions: The DHC, as a universal school-based health and wellbeing screening tool with linked follow-up intervention, has great potential in identifying and supporting unmet health needs among CYP. The perspectives and experiences of those involved in delivering the DHC highlight important considerations which may enable effective implementation and delivery of school screening programmes across other areas., (© 2022. The Author(s).)

Genome-wide association (GWA) studies have shown that genetic influences on individual differences in affect, behavior, and cognition are driven by thousands of DNA variants, each with very small effect sizes. Here, we propose taking inspiration from GWA studies for understanding and modeling the influence of the environment on complex phenotypes. We argue that the availability of DNA microarrays in genetic research is comparable with the advent of digital technologies in psychological science that enable collecting rich, naturalistic observations in real time of the environome, akin to the genome. These data can capture many thousand environmental elements, which we speculate each influence individual differences in affect, behavior, and cognition with very small effect sizes, akin to findings from GWA studies about DNA variants. We outline how the principles and mechanisms of genetic influences on psychological traits can be applied to improve the understanding and models of the environome.

Although early life experiences of language and parenting are critical for children's development, large home observation studies of both domains are scarce in the psychological literature, presumably because of their considerable costs to the participants and researchers. Here, we used digital audio-recorders to unobtrusively observe 107 children, aged 2.03 to 3.99 years (M = 2.77, SD = 0.55), and their families over 3 days (M = 15.06 hr per day, SD = 1.87). The recording software estimated the total number of words that a child heard over the course of a day. In addition, we transcribed six 5-min excerpts per family (i.e., 30 min overall) to extract estimates of children's and their parents' lexical diversity, positive and critical parenting, and children's internalizing and externalizing behaviors. We found that home language input (i.e., number of words and lexical diversity) was positively associated with children's cognitive ability and lexical diversity but not with their behaviors. In addition, we observed that home language input varied as much within as between families across days (intraclass correlation = .47). By comparison, parenting predicted children's behavioral outcomes but was not related to their cognitive or lexical ability. Overall, our findings suggest that home language input affects child development in cognition and language, while positive and parenting informs their behavioral development. Furthermore, we demonstrated that digital audio-recordings are useful tools for home observation studies that seek to disentangle the complex relationships between early life home environments and child development. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Objectives: This study was conducted to determine the prevalence of and associated risk factors for infection with oral high-risk human papillomavirus (HR-HPV) in adult participants within England, and to explore any association with oral mucosal buccal epithelial cell and whole blood folate concentration., Design: This was an observational study to determine oral HR-HPV prevalence in the study population. A case-control study was performed to explore the association between infection and folate status., Setting: This study was conducted in Sheffield, UK, between April 2013 and August 2014., Participants: Seven hundred participants, aged 18-60 years, were recruited from university students (n=179), university and hospital staff (n=163), dental hospital patients (n=13), Sexual Health Sheffield patients (n=122) and the general public (n=223)., Interventions: Participants completed a lifestyle and sexual behaviour questionnaire, provided an oral rinse and gargle sample for the detection of oral HR-HPV and an oral mucosal buccal epithelial cell sample for the measurement of oral mucosal buccal epithelial cell folate. A blood sample was collected for measurement of whole blood folate concentration., Outcome Measures: The prevalence of oral HR-HPV infection in the study population was the primary outcome measure. Secondary outcome measures included associations between risk factors, folate status and infection., Results: The prevalence of oral HR-HPV infection in this cohort was 2.2% (15/680) with 0.7% (5/680) positive for HPV16 or HPV18. Twenty samples were excluded due to insufficient material for HPV detection. Participants with oral HR-HPV infection were more likely to be a former smoker, and have a greater number of sexual and oral sexual partners. Folate status was not linked to likelihood of HPV infection., Conclusions: The prevalence of oral infection with HR-HPV in adult men and women in Sheffield in the North of England was low. Smoking and sexual behaviour were associated with HR-HPV positivity., Trial Registration Number: ID14106., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Unlabelled: Despite significant advances in surgical procedures and treatment, long-term prognosis for patients with oral cancer remains poor, with survival rates among the lowest of major cancers. Better methods are desperately needed to identify potential malignancies early when treatments are more effective., Objective: To develop robust classification models from cytology-on-a-chip measurements that mirror diagnostic performance of gold standard approach involving tissue biopsy., Materials and Methods: Measurements were recorded from 714 prospectively recruited patients with suspicious lesions across 6 diagnostic categories (each confirmed by tissue biopsy -histopathology) using a powerful new 'cytology-on-a-chip' approach capable of executing high content analysis at a single cell level. Over 200 cellular features related to biomarker expression, nuclear parameters and cellular morphology were recorded per cell. By cataloging an average of 2000 cells per patient, these efforts resulted in nearly 13 million indexed objects., Results: Binary "low-risk"/"high-risk" models yielded AUC values of 0.88 and 0.84 for training and validation models, respectively, with an accompanying difference in sensitivity+specificity of 6.2%. In terms of accuracy, this model accurately predicted the correct diagnosis approximately 70% of the time, compared to the 69% initial agreement rate of the pool of expert pathologists. Key parameters identified in these models included cell circularity, Ki67 and EGFR expression, nuclear-cytoplasmic ratio, nuclear area, and cell area., Conclusions: This chip-based approach yields objective data that can be leveraged for diagnosis and management of patients with PMOL as well as uncovering new molecular-level insights behind cytological differences across the OED spectrum., Competing Interests: Principal Investigator, John T. McDevitt, has an equity interest in SensoDX, LLC. and also serves on their Scientific Advisory Board. The terms of this arrangement have been reviewed and approved by New York University in accordance with its conflict of interest policies., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: Interobserver agreement in the context of oral epithelial dysplasia (OED) grading has been notoriously unreliable and can impose barriers for developing new molecular markers and diagnostic technologies. This paper aimed to report the details of a 3-stage histopathology review and adjudication process with the goal of achieving a consensus histopathologic diagnosis of each biopsy., Study Design: Two adjacent serial histologic sections of oral lesions from 846 patients were independently scored by 2 different pathologists from a pool of 4. In instances where the original 2 pathologists disagreed, a third, independent adjudicating pathologist conducted a review of both sections. If a majority agreement was not achieved, the third stage involved a face-to-face consensus review., Results: Individual pathologist pair κ values ranged from 0.251 to 0.706 (fair-good) before the 3-stage review process. During the initial review phase, the 2 pathologists agreed on a diagnosis for 69.9% of the cases. After the adjudication review by a third pathologist, an additional 22.8% of cases were given a consensus diagnosis (agreement of 2 out of 3 pathologists). After the face-to-face review, the remaining 7.3% of cases had a consensus diagnosis., Conclusions: The use of the defined protocol resulted in a substantial increase (30%) in diagnostic agreement and has the potential to improve the level of agreement for establishing gold standards for studies based on histopathologic diagnosis., (Copyright © 2015 Elsevier Inc. All rights reserved.)