Saudi Cultural Missions Theses & Dissertations
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Item Restricted CULTIVATING QUALITY OF LIFE: ASSESSING DIET, PHYSICAL ACTIVITY, AND MENTAL HEALTH AMONG ARAB-AMERICAN BREAST CANCER SURVIVORS - UNCOVERING BARRIERS AND FACILITATORS FOR HOLISTIC WELL-BEING(Claremont Graduate University, 2025) Alhomaidhi, Nouf Ali; Clague DeHart, JessicaThis dissertation examines the quality of life among Arab-American breast cancer survivors, with a particular emphasis on dietary practices, physical activity, and mental health. Despite increasing survivorship rates in this population, there remains a significant gap in the literature addressing their unique post-treatment experiences and needs. Employing a convergent parallel mixed-methods design, this study integrates quantitative survey data and qualitative narrative interviews to assess adherence to health behavior guidelines and to identify culturally specific barriers and facilitators to well-being. Quantitative findings indicated suboptimal adherence to recommended dietary and physical activity guidelines and highlighted prevalent psychological distress among participants. Thematic analysis of qualitative data revealed that enablers of healthy behaviors included fear of cancer recurrence, strong social support, and pre-existing cultural dietary patterns. Conversely, major barriers encompassed financial constraints, limited access to culturally appropriate resources, treatment-related physical limitations, and sociocultural stigma surrounding mental health. This research provides a nuanced understanding of the complex interplay between cultural, structural, and individual factors influencing survivorship among Arab-American women. The findings underscore the urgent need for culturally tailored, community-engaged public health interventions to improve survivorship outcomes and promote holistic well-being in this underserved population.15 0Item Restricted Mixed Method Study to Assess Behcet’s Syndrome Impacts on Quality of Life of Children(Saudi Digital Library, 2025-06-30) AlQahtani, Eman; Prof S. Albadri; Associate Prof. C. Pain; Dr L. Roper; Dr L. El SharkasiIntroduction: Behcet’s Syndrome (BS) is a rare, chronic inflammatory condition that can significantly affect the daily lives of children and young people (CYP). While BS is well-documented in adults, there is limited research on how it impacts CYP, particularly in terms of their quality of life (QoL) and access to appropriate healthcare, including dental care. Oral ulcers, a hallmark symptom, can cause considerable pain and difficulties with eating, speaking, and maintaining oral hygiene. This thesis explores the challenges faced by CYP with BS, the gaps in healthcare services, and the need for including a paediatric dentist within the multidisciplinary care. Method: This research is based on three interconnected studies: Literature Review – A comprehensive review of existing research on BS in CYP, highlighting the condition’s clinical manifestations, diagnostic challenges, and its impact on QoL, with a focus on oral health. A retrospective service evaluation was conducted using medical records of 34 CYP diagnosed with BS who attended the Multidisciplinary Clinic (MDT) at Alder Hey Hospital (AHH) between January 1, 2012, and December 31, 2021. The primary aim was to assess the oral health needs of these children. To achieve this, data were collected on their symptoms, clinical characteristics, referral pathways, and management approaches. As this was a service evaluation, ethical approval was not required, and the project was formally registered with the local governance team. Qualitative Study: Semi-structured interviews were conducted remotely via Zoom with CYP aged 8-18 years diagnosed with BS. Recruitment was facilitated by Behcet’s UK charity and AHH. Thematic analysis was conducted using an inductive approach to identify key themes. Ethical approval was granted by the Health Research Authority (REC; IRAS: 318222). Results: Service evaluation: Thirty-four children diagnosed with BS attended the MDT at AHH between 2012 and 2021, with an average age of 12.8 years (range: 5-17). A family history of BS was present in 26.5% (n=9) of cases. Oral ulceration was the most common initial symptom, affecting 97.1% (n=33), with frequent recurrences every 2-3 weeks. Other common findings included joint pain (79.4%), genital ulceration (44.1%), gastrointestinal symptoms (82.4%), and ocular involvement (41.1%). Only 14.7% (n=5) had a confirmed BS diagnosis, while 85.3% (n=29) remained probable cases. General paediatrics (47%) and rheumatology (17.6%) were the primary referral sources, with ophthalmology (35.3%) and physiotherapy (29.4%) receiving the highest number of onward referrals. Paediatric dental assessments were documented in only 52.2% (n=18), highlighting potential gaps in oral health management. Qualitative interviews: revealed Five key themes: (1) Living with BS Symptoms: CYP experienced disruptions to daily functions, including eating, sleeping, and maintaining hygiene, driven by symptoms such as oral and genital ulcers, fatigue, and joint pain. These challenges hindered their ability to socialise and participate in routine activities. (2) Living with Uncertainty: The unpredictable nature of BS fostered anxiety, making it difficult to plan routines or attend school consistently. (3) Fear of Disbelief and Misjudgement: Participants reported being dismissed by teachers, peers, and healthcare professionals due to the invisibility of symptoms, exacerbating feelings of isolation. (4) Support Systems: Mixed experiences with school accommodations and healthcare highlighted systemic gaps, including inconsistent support and delayed diagnoses. (5) Walking the Tightrope of Treatment and Relief: CYP expressed frustration over limited relief despite ongoing treatment, coupled with the burden of medication side effects. Conclusion: The findings from this thesis sheds light on the challenges faced by CYP with BS, particularly in relation to their daily lives, healthcare experiences, and oral health needs. The service evaluation revealed that while oral ulcers were the most common symptom, paediatric dental assessments were not consistently recorded, suggesting gaps in oral healthcare within the MDT. The qualitative study highlighted how BS disrupts essential daily activities, causing physical discomfort, emotional distress, and social isolation. Many CYP struggled with the unpredictability of their symptoms, difficulties accessing appropriate care, and a lack of understanding from professionals. These findings underscore the need for a more integrated approach to care, with paediatric dentists playing a key role in the MDT. Addressing oral health early could help prevent long term dental complications and improve overall well-being. Greater awareness, better referral pathways, and improved support systems are essential to ensuring CYP with BS receive the care they need. Future research should explore ways to enhance early diagnosis, personalised treatment, and coordinated multidisciplinary management.12 0Item Restricted Quality of life, disability, health behaviours and recovery among women living with mental illness in Saudi Arabia: A mixed methods study(Saudi Digital Library, 2025) Almalki, Ibtihal; Inder, Kerry; Alqudah, Muhammad; O'Brien, Tony; Inder, KerryBackground Research on women with mental illness in Saudi Arabia is limited with the voices of these women not heard. Quality of life, disability and recovery are critical concerns for these women. Healthy lifestyle behaviours and their life experiences are not known. Aim To explore the experiences of women hospitalised with mental illness and to examine the quality of life, level of disability, health behaviours and personal recovery of women living with mental illness in Saudi Arabia. Methods A convergent mixed methods research design was conducted in two Saudi government-funded mental health hospitals in the cities of Taif and Jeddah in the Kingdom of Saudi Arabia. Face-to-face in-depth semi-structured interviews were used to collect qualitative data. For quantitative data, a cross-sectional survey administered three standardised and validated instruments to measure quality of life, disability and recovery: the World Health Organization Quality of Life Brief Version questionnaire, the World Health Organization Disability Assessment Schedule 2.0, and a Questionnaire about the Process of Recovery. Demographic characteristics, clinical information and health behaviours were collected from medical records and by self-report. Data were collected simultaneously and analysed separately. Qualitative data were analysed thematically. Quantitative data were summarised descriptively, and linear and logistic regression techniques were used to determine factors associated with quality of life, disability and recovery. Results from both methods were integrated and discussed to gain a comprehensive understanding of the research phenomenon with researcher reflexivity. Findings and results Individual interviews were undertaken with 19 women hospitalised with mental illness. Four major themes emerged: lived experiences with mental illnesses, the voice of recovery, lifestyle and wellness, and knowledge and understanding. The cross-sectional survey was administered to 201 women. There was a higher proportion of married women and women who were housekeepers from Taif, while there was a high proportion of single women and more highly educated women from Jeddah. Health behaviour characteristics indicated that many women were either overweight or obese and did not engage in physical activity. Final adjusted regression models revealed several key findings. Recent diagnoses with mental illness and unemployment status resulted in lower quality of life scores. Lack of exercise resulted in lower physical health and psychological health. Being single resulted in lower social relationships and environment domains, while being married resulted in lower scores for physical and psychological health domains. Married or widowed women who were recently diagnosed with a mental illness, unemployed women, women with no formal education, or who never exercised were more likely to have higher disability levels. Recent diagnosis, being younger, married or widowed, unemployed, not engaging in activity and having poor sleep resulted in lower recovery levels. This integrated approach demonstrates that face-to-face interviews can reveal deeper, context-specific factors influencing the quality of life and recovery and underscores the necessity of a holistic approach to the mental health care of women with mental illness. The interviews revealed significant challenges related to stigma, social isolation and the impact of educational background on participants’ lives, which were less apparent in the quantitative component. The survey data provided a better understanding of potentially modifiable factors to impact quality of life, disability and recovery. Both data sources aligned with the Connectedness, Hope, Identity, Meaning and Empowerment framework revealing a shared emphasis on the five key aspects of personal recovery. Conclusion This thesis uniquely explores the experiences of women with mental illness in Saudi Arabia focusing on their quality of life, disability, health behaviours and recovery providing valuable insights and implications for enhancing support and care for women. This study provides new insights into their experiences and significantly advances the understanding of women’s challenges and perspectives. Delivering recovery-based practices and advocacy programs for community and mental health professionals is recommended. Incorporating counselling services into healthcare policies, enhancing community-based support, and improving nursing practices are critical. Advancing mental health education and addressing stigma through public awareness are crucial to building a more inclusive and supportive society. Future research should focus on understanding the mental health needs of women with mental illness, addressing socio-cultural barriers to help seeking, and reducing stigmatisation and discrimination. Including more women from this vulnerable group in research allows their voices to be heard.55 0Item Restricted Forecasting the Benefits of Nationwide Home Energy Efficiency Improvements on NHS and Social Care Budgets by 2040 in UK(Saudi Digital Library, 2024-08-27) Alkhathami, Saleh; Yaghi, AbdallahHealthcare and social care expenditures in the UK have risen significantly due to factors such as an aging population, advancements in medical technology, and the increasing prevalence of chronic illnesses. This study explores the intricate relationships between household energy efficiency, health outcomes, socioeconomic conditions, and social care needs. Using advanced statistical techniques, including time-series analysis and ARIMA modeling, the research forecasts the financial benefits of nationwide home energy efficiency improvements on NHS and social care budgets by 2040. The analysis reveals key trends, such as reduced electricity usage, stable gas demand, and the impact of energy efficiency measures on respiratory and cardiovascular health outcomes. The findings demonstrate the potential for significant cost savings and quality-of-life improvements, providing a robust foundation for policymaking and resource allocation. This study highlights the importance of sustainable practices in reducing public sector spending and advancing environmental and public health goals.7 0Item Restricted Does Integrating Cognitive Behavioural Therapy into Cardiac Rehabilitation Improve Depression and Quality of Life in Adults with Cardiovascular Disease? A Systematic Review.(Cardiff University, 2025) Alqahtani, Ola; Gale, NicholaDoes Integrating Cognitive Behavioural Therapy into Cardiac Rehabilitation Improve Depression and Quality of Life in Adults with Cardiovascular Disease? A Systematic Review. Background & Rationale Cardiovascular disease (CVD) is the world’s leading cause of death and disability, placing significant clinical and economic burdens on healthcare systems. While cardiac rehabilitation (CR) encompassing exercise, education, and routine psychosocial support has been shown to improve clinical outcomes, up to thirty percent of cardiac patients experience clinically meaningful depressive symptoms which reduce CR adherence and long-term success. Cognitive behavioural therapy (CBT) offers a structured approach to modifying maladaptive thoughts and behaviours, potentially addressing psychological barriers more effectively than generic psychosocial support. However, many reviews have evaluated heterogeneous ‘psychological interventions’ rather than isolating CBT’s specific impact. This systematic review set out to determine whether CBT, when integrated into CR, alleviates depression and enhances health-related quality of life (HRQoL) more effectively than CR alone. Methods A systematic literature search was conducted across five major databases (Medline, EMBASE, CINAHL, Cochrane CENTRAL, and PsycINFO) from inception to the most recent feasible date, adhering to PRISMA guidelines for study selection and reporting. Six randomised controlled trials, totalling 708 participants, satisfied the inclusion criteria by focusing on adults (≥18 years) undergoing CR for various cardiac conditions (such as myocardial infarction, heart failure, or post-cardiac surgery). Studies which integrated structured CBT sessions into standard CR were compared to CR alone or other forms of standard care. The primary outcome was the reduction in depressive symptoms, measured by validated scales (e.g., the Hamilton Rating Scale for Depression or the Hospital Anxiety and Depression Scale (HADS)). Secondary outcomes involved changes in HRQoL, assessed by either generic or cardiac-specific instruments (such as the Minnesota Living with Heart Failure Questionnaire). Quality appraisal followed the Joanna Briggs Institute guidelines and due to heterogeneity in intervention formats, population characteristics, and outcome measures, a narrative synthesis approach was applied rather than a meta-analysis. Key Findings and Discussion Although the six trials varied in terms of sample size, intervention intensity, and follow-up duration, they shared an overarching conclusion that integrating CBT within CR can lead to notable reductions in depressive symptoms and meaningful improvements in HRQoL. The degree of benefit was generally greater in patients presenting with moderate-to-severe baseline depression. Face-to-face CBT delivery typically achieved better adherence (often exceeding 75%) and larger effect sizes, whereas fully digital CBT programmes suffered from low engagement (approximately 15% module completion). These findings suggest that the personal interaction and therapeutic alliance inherent in face-to-face sessions remain critical for maximising CBT’s clinical impact in cardiac populations, particularly those facing multiple stressors related to their disease. CBT combined with exercise, in several trials, appeared to deliver synergistic benefits for depression and HRQoL, possibly through complementary behavioural (cognitive restructuring and skill-building) and physiological (improved cardiovascular function) mechanisms. The interplay between exercise encouragement and cognitive-behavioural strategies against fear-avoidance thinking also emerged as an important determinant of enhanced functional capacity and sustained improvements in mood. Limitations Several limitations may constrain the generalisability of these results. First, the overall sample predominantly comprised of male participants (approximately two-thirds were male), leaving questions regarding whether women, who often exhibit different depressive symptom profiles and a greater prevalence of depression post-myocardial infarction, would experience similar outcomes. Second, varied measures of depression and HRQoL, along with wide differences in the intervention ‘dose’ (ranging from five-session brief interventions to twelve-week combined programmes), precluded direct quantitative comparisons across studies. Some trials were also underpowered and only a few extended follow-up beyond six to twelve months. Digital CBT approaches did not yield strong results in this review but that may reflect poor adherence rather than intrinsic ineffectiveness, highlighting a need for more engaging and personalised technological platforms. Finally, these RCTs spanned multiple healthcare settings in Europe and the United States where infrastructural and cultural factors might influence both the feasibility of CBT delivery and participant engagement. Conclusions and Recommendations This review provides evidence that structured CBT, when delivered in tandem with cardiac rehabilitation, can significantly alleviate depressive symptoms and promote better quality of life. The most robust outcomes were observed in trials that targeted moderate-to-severe depression, employed face-to-face group or individual CBT sessions, and ensured consistent patient follow-up. These findings strengthen the case for systematically screening CR entrants for depressive symptoms and offering a dedicated CBT component to those above a certain severity threshold. Practical feasibility can be enhanced by training nurses, physiotherapists, or other allied professionals in CBT skills, as illustrated in studies where task shifting maintained strong outcomes. Policy-making bodies, such as national cardiac societies and health agencies, may wish to recommend CBT as a priority psychological intervention in CR programmes, particularly for patients with moderate or severe depression. Future research should further refine the optimal ‘dose’ of CBT, compare blended or stepped-care digital and in-person models, and evaluate the cost-effectiveness to guide broader adoption. By focusing on cognitive restructuring and behaviour change within the supportive framework of CR, healthcare systems can potentially improve both the mental health and functional recovery of individuals with CVD.7 0Item Restricted STUDY OF PAIN, MOTION, AND MUSCLE ACTIVITY FOR LOWER LIMB AMPUTEES(University of Birmingham, 2024) Alsayed, Khalid; Ziyun, DingThis thesis investigates the interplay between pain and gait biomechanics in unilateral transtibial amputees (TTAs) to understand compensatory mechanisms and adaptations in the musculoskeletal system. The aim is to explore how pain influences gait performance by analysing spatial and temporal parameters, kinematics/kinetics, muscle activity, and pain outcomes using advanced tools such as motion capture, force plates, electromyography (EMG), and musculoskeletal modelling. The study first developed a rigorous experimental protocol to acquire multi-modal biomechanics gait data (i.e., marker trajectories, ground reaction force, EMG, and self-reported pain measures). This protocol was then successfully applied to capture gait data from eight able-bodied controls and six individuals with transtibial amputation (TTA). The data analysis and modelling identify significant gait deviations in TTAs, including reduced walking speed, altered stride length, and asymmetrical ground reaction forces, correlating these with pain levels. Advanced musculoskeletal simulations provide further insights into joint kinematics, kinetics, and muscle forces, highlighting the compensatory strategies adopted by amputees. The findings emphasise the need for multidisciplinary approaches in rehabilitation, integrating biomechanical analysis and pain management to enhance mobility and quality of life for TTAs. This research bridges key knowledge gaps, offering practical recommendations for improved prosthetic development and rehabilitation strategies.56 0Item Restricted Do retinal implants provide long-term efficacy and safety and improve implantees' quality of life? A Systematic Literature Review(Cardiff University, 2024-10-15) Alqahtani, Hanan Badah; Regini, JustynObjective: Severe visual impairment and blindness are considered to be among the most feared disabilities worldwide (Chader et al. 2009). Approximately half of all visual impairments are associated with retinal disorders (Özmert and Arslan 2019). Degenerative retinal conditions such as retinitis pigmentosa (RP) and dry age-related macular degeneration (AMD) can result in severe vision loss and blindness due to a progressive loss of the retinal photoreceptors (Özmert and Arslan 2019; Ayton et al. 2020). Unfortunately, the therapy possibilities and options for patients with advanced stages of these retinal degeneration conditions are limited and any vision restoration is minimal (Chader et al. 2009; Ayton et al. 2020). Retinal implants have been developed and have emerged as novel interventions to restore some degree of vision in patients with severe vision loss due to these retinal degenerative diseases (Özmert and Arslan 2019). This review evaluates the long-term efficacy and safety of various types of retinal implants (epiretinal, subretinal and suprachoroidal) over a follow-up period of at least one year. In addition, the impact that these retinal implants have on the recipient’s quality of life is also assessed. Study design: A systematic search of the Web of Science, PubMed, Medline, Scopus, Cochrane Library and Embase databases was conducted and 222 papers were found. After removing 105 duplicate papers, 117 unique papers remained for eligibility screening, initially by title and abstract and then full-text screening. This process resulted in 13 studies which satisfied the inclusion criteria for the current review and were taken forward to the critical appraisal. Critical appraisal was performed using the Critical Appraisal Skills Programme (CASP) and the Joanna Briggs Institute (JBI) critical appraisal checklists appropriate for the study design. At this stage, one further paper was excluded from the review due to its poor quality. Consequently, 12 studies progressed to the data extraction stage using a tool adapted from a similar review by Hallum and Dakin (2021). Results: All of the included studies were single-arm, prospective, non-randomised clinical trials, except for one which was a retrospective interventional case series. There was considerable heterogeneity in terms of sample size, population, duration of follow-up, and intervention type. Therefore, narrative synthesis was utilised for the purpose of data synthesis. The results were encouraging and indicated that different retinal implant technologies were effective at restoring some degree of vision for blind patients. They improved visual function, functional vision and the quality of life in subjects with substantial vision loss from RP or dry AMD. These improvements appeared to be sustained over time. Furthermore, based on the reported adverse events, these various types of retinal prostheses appeared to have an acceptable risk profile. However, all of the included studies were at risk of bias due to their design, such as how the experiments were conducted or the lack of randomisation, a control group or masking. Conclusion: Although the retinal implants confer some useful vision, the regained vision is still limited and patients remain legally blind. Given the considerable risk of bias in the available literature, better quality evidence is required to evaluate retinal implants’ efficacy, safety and impact on subjects’ quality of life.23 0Item Restricted Rapid review of longitudinal studies on the association between oral health and frailty(King’s College London , 2024-08) Alhumaidi, Meshari; sabbah, waelAbstract Background Frailty and sarcopenia are prevalent conditions in the elderly, contributing to increased healthcare costs and higher mortality rates. Poor oral health, characterized by issues such as tooth loss and periodontal disease, has been associated with the onset and progression of these conditions. Despite this, there is a lack of comprehensive longitudinal studies examining the relationship between oral health and frailty in older populations. Objective This rapid review aims to consolidate and analyse the existing body of research from longitudinal studies on the association between various oral health conditions and frailty among older adults. The goal is to identify key oral health issues that significantly impact frailty and to provide insights for healthcare providers and policymakers. Methods The review systematically gathered and synthesized data from relevant studies using a standardized methodological approach. It focused on studies involving older adults aged 65 and above, examining conditions such as tooth loss, periodontal diseases, and overall oral hygiene status. The analysis included comparisons between individuals with poor oral health and those with healthier oral conditions, assessing the impact on frailty indicators. From an initial search yielding 1404 records (702 from PubMed, 93 from Ovid, and 609 from Cochrane Library), 609 records remained after removing duplicates. After screening titles and abstracts, 16 articles were assessed for eligibility. Ultimately, 11 studies met the inclusion criteria and were included in the final review. Results The findings highlight significant associations between poor oral health and increased frailty in the elderly. Conditions like tooth loss and periodontal disease were found to be major risk factors for frailty, affecting physical functions such as strength, mobility, and overall vitality. The review also identified gaps in the literature, particularly the need for more longitudinal studies to establish causal relationships. A total of 11 longitudinal studies met the inclusion criteria and were included in this systematic review. These studies provide valuable insights into the association between various oral health conditions and frailty among older adults, highlighting the importance of maintaining good oral health to mitigate the progression of frailty. However, the predominance of cross-sectional designs in some studies limits the ability to establish causal relationships and introduces potential biases, including measurement bias from self-reported data and residual confounding. Conclusion The review underscores the importance of integrating oral health assessments into routine geriatric care. Early interventions targeting oral health could potentially delay the onset of frailty, improving quality of life and reducing healthcare costs. These findings provide a foundation for developing comprehensive geriatric care models that prioritize oral health and for future research to address the identified gaps in the literature.23 0Item Restricted Religiosity Moderates the Relationship Between Religious Discrimination and Quality of Life(2024-06-29) Almutairi, Khulud; Gattamorta, KarinaThis dissertation explores the prevalence and impact of religious discrimination toward Muslim nurses working in the United States, employing a comprehensive analysis that incorporates the Stress and Coping Model and the Intersectionality Framework. Data collection started in December of 2023, during a period marked by a significant surge in Islamophobia, influenced by the ongoing conflict between Palestine and Israel. This dissertation aimed to investigate how this heightened environment affected the experiences of Muslim nurses. The findings reveal notable levels of perceived religious discrimination, with 82% of the sample reporting medium to high level of religious discrimination. This proportion suggests that approximately 4 out of every 5 Muslim nurses experience significant religious discrimination in their workplace. This dissertation identified that individual factors such as age, gender, and years in the U.S., along with professional factors like clinical experience and location, significantly influenced perceptions of discrimination. Positive religious coping strategies were found to moderate but not mitigate the effects of religious discrimination on work-related quality of life, contradicting some previous research findings. Overall, this research highlights the complex and multifaceted nature of religious discrimination faced by Muslim nurses, underscoring the need for ongoing dialogue, policy development, and targeted interventions to promote an inclusive and equitable work environment in the health care sector.26 0Item Restricted How effective are over-the-counter hearing aids for adults? A systematic review(University of Manchester, 2024) Almobarak, Aljoharah; Munro, KevinOBJECTIVE: Over-the-counter (OTC) hearing aids are designed to improve access and affordability by removing the need to involve an audiologist. The aim of this review was to assess the effectiveness of OTC hearing aids for adults with mild-to-moderate hearing loss compared to conventional hearing aids or in the unaided condition. DESIGN: This review was pre-registered in PROSPERO (CRD42023434820) and follows the PRISMA guidelines. STUDY SAMPLE: Thirteen studies were eligible to be included in this review after identifying 1201 records that were potentially related to the research question. RESULTS: The studies were compared based on the primary outcome of self-reported benefit and secondary outcomes, including speech intelligibility in quiet and in noise. In addition to other outcomes, including sound quality and adverse effects. The studies varied in quality from poor to excellent. CONCLUSION: The OTC outcomes were potentially promising. However, due to the lack of meta-analysis in this review and limited studies, a robust conclusion cannot be drawn.8 0