Portsmouth Hospitals NHS Trust

Purpose While research has improved understanding of prosthetic use in Cambodia, little is known about how individuals with lower limb amputation and their families experience access to prosthetic and rehabilitation services. This qualitative study explores these experiences to inform equitable and contextually appropriate service provision. Methods A qualitative study was conducted using semi-structured interviews with adult lower-limb prosthetic users and their family members attending prosthetic and rehabilitation services provided by a Non-Governmental Organisation. The study design and research materials were co-produced with the Cambodian partner research team to ensure cultural appropriateness, accessibility, and acceptability. Data were analysed inductively using reflexive thematic analysis. Results Three overarching thematic categories were identified, each comprising three themes: (1) heavy reliance on a well-functioning prosthesis, (2) accessing and using prosthetic and rehabilitation services, and (3) sources of support and impacts on quality of life. Participants described prosthetic devices as essential to mobility, independence, and social participation, while also highlighting challenges related to device durability and fit, travel and financial constraints, service continuity, and the central role of family support in enabling ongoing prosthetic use. Conclusions Prosthetic and rehabilitation services are critical to supporting life after lower limb amputation in Cambodia; however, their effectiveness is shaped by the availability of durable, well-fitting devices and services that actively address structural, social, and cultural barriers to access. Service models that are responsive, culturally sensitive, and community-oriented are required to support sustained prosthetic use holistically and to inform the future development of data-driven approaches to improving service accessibility. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by the Engineering and Physical Sciences Research Council, National Institute for Health Research Global Challenges Research Fund, grant EPR0142131, and the Royal Academy of Engineering, RAEng grant RF130. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Full ethical approval was granted by the Ministry of Health, National Ethics Committee for Health Research, Cambodia No. 311, NECHR and Faculty of Engineering & Physical Sciences at the University of Southampton ERGO45577. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors

Workforce burnout is the highest in the history of the National Health Service (NHS) and is recognised as a dangerous risk to its future functioning. The extent of the crisis means that there is an urgent need for innovative, sustainable solutions that can be delivered at scale. The Heritage and Wellbeing for NHS Staff (HerWellNHS) pilot and feasibility study investigates the potential for self-directed visits to heritage sites to promote the wellbeing, compassion and work engagement for NHS staff who do not yet meet the clinical thresholds for support. This paper reports on visit choices made by NHS staff in HerWellNHS including site types, their characteristics, and how motivations for site choice align with self-described wellbeing needs. It includes the novel application of a machine learning model to extract predictors for participant visits to heritage with a green component versus urban built heritage. The results provide important insights into the feasibility of self-directed heritage visits as a scalable and sustainable public health intervention to support the wellbeing of NHS staff. They point to choice in heritage visit opportunities as vital in enabling NHS staff to build agency in meeting self-identified wellbeing needs in ways that respond to individual circumstances. They also provide insights into the development of strategies to support agency and independence, including removing barriers and providing positive opportunities as part of future intervention design, the role of psychological distance, and the potential for the Five Ways of Wellbeing to structure future heritage engagement by NHS staff.

This is a systematic review that addresses the psychological and social determinants of smoking initiation in adolescents (ages 10–19) in Asia. However, while nicotine addiction is a significant factor influencing smoking, the growing body of research indicates that a combination of psychological stressors, social factors, and cultural factors plays a crucial role in the initiation process. A systematic search was performed in PubMed, Scopus, and Google Scholar that retrieved 2,184 records, and 1,732 records were selected after removal of duplicates. After filtering items based on title and abstract, 214 full-text articles were filtered through eligibility criteria before 48 articles were selected. This study is in compliance with the PRISMA 2020 guidelines, as the review included both quantitative and qualitative data. The risks of bias were evaluated with the help of conventional instruments, and the narrative synthesis was used to interpret the psychosocial mechanisms of tobacco smoking initiation. Parental and peer smoking are important risk factors for starting to smoke; almost two-thirds of the studies indicate that peer smoking has a strong influence. Additionally, cultural factors such as gender patterns, social influences, and media coverage play a critical role in shaping adolescents' decisions to start smoking. These elements interact with peer and parental smoking behaviors, contributing to an environment that normalizes tobacco use among young people, which can lead to increased smoking initiation rates and long-term addiction issues. The research results of this review show that the initiation of smoking among Asian adolescents is not entirely caused by nicotine addiction but also by psychological distress, social factors (peer and parental smoking), and culture. To respond to these, the interventions in most of the Asian countries should rely on mental health services, family-based initiatives, and culturally sensitive prevention efforts that address the social and cultural uniqueness of Asia.

Introduction Solitary fibrous tumours of the pleura (SFTP) are rare neoplasms for which surgical resection is considered the gold standard treatment. Anecdotally, SFTPs are sometimes conservatively managed, but there are little data on this in published literature. In this study, we aimed to collect data on radiological features in SFTP which might be associated with a benign clinical course to assist in risk stratification, and therefore selection for a more conservative management pathway. Methods A service evaluation of outcomes of radiologically diagnosed SFTP was completed in 12 UK centres, between 2005 and 2015. Cases were included via initial search of local radiology databases using key words ("Pleural fibroma" OR "fibrous tumour of the pleura" OR "SFTP"). Baseline characteristics and outcome data were obtained from medical records. Results A total of 270 patients were included in the study. Factors associated with the need for surgical intervention included lesion size (>128 mm), lesion position (abutting the mediastinum or diaphragm), associated pleural effusion, radiological evidence of necrosis within the lesion and heterogeneous density. In multivariate analysis, computed tomography-measured attenuation and homogeneous density were independent risk factors for adverse clinical outcomes in patients with resected fibromas. Conclusion This is the largest study to date on SFTP to include conservatively managed cases who underwent radiological follow-up only. The results suggest several features associated with adverse clinical outcomes, and thereby may identify cases which could be more conservatively (observation only) managed. Further prospective studies are required to assess the identified risk factors as part of a potential radiological scoring system.