Saudi Cultural Missions Theses & Dissertations
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Item Restricted Prevalence and Risk Factors of Human Papilloma Virus (HPV) Infection in Saudi Arabia: An Extended Literature Review(SWANSEA UNIVERSITY, 2024-09-21) AlKhuraym, Nasser; Pockett, RhysAbstract The Human Papillomavirus (HPV) infection is a considerable public health risk worldwide, including in Saudi Arabia, where around 358 women are diagnosed each year, resulting in 179 fatalities due to HPV-related malignancies. More than 10.7 million women aged 15 and older are susceptible to HPV infection and its related malignancies. The prevalence of HPV among women in Saudi Arabia is estimated at 2.5%, with HPV-related malignancies constituting 72.4% of cases in the region. Sexual practices constitute a significant risk factor for HPV infections. Aim This comprehensive literature analysis seeks to evaluate the prevalence of HPV and its notable risk factors in women aged 12 to 40 years in Saudi Arabia. Methods The review methodology adhered to PRISMA recommendations, emphasising inclusion criteria for papers containing primary and secondary data for individuals at risk for HPV. The review utilised the POE framework for database searches, extracting data from 8 electronic databases, including Educational Research Information Centre (ERIC), Academic Search Complete, PubMed/Medline, Google Scholar, Directory of Open Access Journals (DOAJ), SCOPUS, Science Direct, and Web of Science. The CASP critical appraisal technique was employed to evaluate the risk of bias in the selected studies. Results Eleven papers fulfilled the inclusion criteria, with 90% being cross-sectional and one being a cohort study. The prevalence rates of HPV in Saudi Arabia varied between 5.9% and 31.6%. Principal risk factors encompassed insufficient understanding of HPV vaccination, the knowledge of healthcare providers, and sociodemographic variables. Identified effective strategies included educational programs, regular HPV screening, and focused public health initiatives. Conclusion The review finds that HPV is a complex concern with diverse risk factors shaped by regional and sociodemographic variables. Additional investigation is required to examine the influence of sexual behaviours and sociodemographic factors on HPV transmission. This will facilitate the formulation and execution of public health policies to enhance HPV prevention and health outcomes in Saudi Arabia.11 0Item Restricted Biomarkers to predict advanced liver diseases(University of Nottingham, 2024-08) Alenezi, Yusef; Morling, Joanne; Card, TimBackground: Chronic liver disease (CLD) is one of the leading causes of morbidity and mortality, accounting for more than two million deaths annually worldwide. In recent years, Non-alcoholic Fatty Liver Disease (NAFLD) has been a fast-emerging cause of CLD, which can progress to advanced conditions such as liver cirrhosis, hepatocellular carcinoma (HCC), and liver failure. While the condition of simple steatosis in NAFLD patients is usually benign, the risk of progression to advanced CLD underscores the importance of early detection, as late diagnosis frequently leads to poor patient outcomes. As a result, considerable effort is now being made to find non-invasive methods for the early detection of CLD. This study assesses the feasibility of using non-invasive biomarkers to predict the progression to advanced CLD. In order to achieve this, it begins by assessing the prevalence of NAFLD in the United Kingdom (UK) and the Kingdom of Saudi Arabia (KSA), and then determines the availability of non-invasive biomarkers among UK primary care patients. Methodology: Systematic review and meta-analysis were used to assess NAFLD prevalence among the general population in the UK and KSA. Then, three retrospective cohort studies were conducted using Clinical Practice Research Datalink (CPRD) data from 1 Jan 1990 – 31 Dec 2016. The first study determined the proportion of patients over 40 with data within their records to calculate normal or abnormal liver fibrosis biomarkers. The second and third studies utilised CPRD data, comprising all cases eligible for linkage to the National Cancer Registration and Analysis Service (NCRAS) cancer registry database, ONS death registration, and Hospital Episode Statistics (HES) data to identify patients who have been diagnosed with advanced CLD and determine whether the AST/ALT ratio, APRI score, and FIB-4 index could be used to predict subsequent advanced CLD in those for whom they were assessed. Findings: The systematic review studies showed an estimated pooled prevalence of NAFLD among disease-unrestricted populations to be 16.8% and 23.8% for KSA and the UK, respectively. There is good evidence that adults with type 2 diabetes mellitus (T2DM) have a higher prevalence of NAFLD in both countries. The CPRD findings showed that the most frequent calculable biomarker was the APRI score, followed by the AST/ALT, and the least calculable biomarker was the FIB-4. However, despite being the most calculable biomarker, the prevalence of abnormal APRI was lower than that of the other biomarkers. The findings also demonstrated that the AST/ALT ratio, APRI score, and FIB-4 index allow for the appropriate identification of patients at a higher risk of developing advanced CLD or the outcomes of liver transplantation and, possibly, death. Notably, based on conventional cutoffs, abnormal APRI scores showed a stronger association with the development of the outcomes than the abnormal AST/ALT ratio and Fib4 index. Conclusion: This thesis revealed a high prevalence of NAFLD among the general population in the UK and KSA. The studies in this thesis have clearly shown that abnormal biomarkers allow for the appropriate identification of patients at a higher risk of developing advanced CLD. The use of routinely collected data to measure the availability of these biomarkers reveals the potential and practicality of a large dataset for future biomarker studies11 0Item Restricted Investigation of Malnutrition, Sarcopenia and Frailty in Middle-Aged and Older People aged 50 years and above using UK Biobank(University of Manchester, 2024-04-18) Almohaisen, Nada; Burden, Sorrel; Gittins, Matt; Todd, ChrisBackground Malnutrition, frailty, and sarcopenia are widespread health conditions in older adults across different settings. These conditions are associated with negative impacts on physical and cognitive function, falls, disability, hospitalisation, increased risk of infections, and fractures. Despite similarities in diagnostic criteria and health outcomes, the relationship between these conditions is still poorly understood. Furthermore, these conditions are frequently underdiagnosis, leading to delayed treatment and management, resulting in deteriorating health status and increased healthcare costs. Thus, it is crucial to understand the relationship between these conditions for early detection and intervention to improve the overall well-being of adults who are ageing. Aims This project aimed to investigate the relationship between malnutrition, frailty, and sarcopenia in the middle-aged and older populations in the UK, using the UK Biobank database. It comprises of three quantitative studies. The first study evaluated the feasibility of mapping the three conditions in the database, determining their prevalence and overlap. The second study estimated their incidence and examined the relationship between them. Lastly, the third study explored the dietary habits of participants with these conditions. The project is important for improving the understanding of the overlap between the three conditions and the dietary habits of people who are malnourished, frail or sarcopenic. Methods This quantitative project analysed secondary data from the UK Biobank. Study 1 was a cross-sectional study of participants aged 50 and over at the baseline assessment visit to estimate the prevalence and overlap of malnutrition, frailty and sarcopenia. Study 2, a prospective cohort design, used data from Study 1 and the reassessment phase to estimate the incidence and overlap of new cases of these conditions. Lastly, Study 3 used a cross-sectional design to explore the dietary habits of participants with these three conditions using the results of Study 1 and data from the baseline assessment. Results Study 1 included 384,609 participants, the number of participants and estimated prevalence of those at risk of malnutrition was 63,489(16.5%), for frailty 17,589 (4.6%) and for sarcopenia 13,833 (3.6%), in participants aged 50 years and over. The overlap between these conditions showed that 51,156 (13.3%) were at risk of malnutrition and prefrailty, and all participants with sarcopenia had a minimum of two of the conditions. The presence of all three conditions was observed in only 2,325 individuals (0.6%). The cohort study included 18,545 participants, aged 50 and above who were condition free at baseline. The incidence of those “at risk of malnutrition” was 44.4 per 1,000 person-years among 13,863 participants. For “frailty”, the incidence was 3 per 1,000 person-years among 10,461 participants, while for “sarcopenia” it was 11 per 1,000 person-years among 16,293 participants. The overlap between these conditions was observed in 44 (0.4%) participants, with most participants “at risk of malnutrition” (n 1,629) also having prefrailty 1,502 (4.3%) among 10,479 participants. Study 3 found that participants with all three conditions had a higher intake of meat and vegetables than the control group, with odds ratios (OR) of 1.13 (95% CI 1.04 to 1.23) and 1.4 (95% CI 1.07 to 1.89), respectively. However, they had a lower intake of cheese, fibre, and fish, with OR 0.49 (95% CI 0.45 to 0.53), 0.44 (95% CI 0.39 to 0.49), and 0.87 (95% CI 0.79 to 0.96), respectively. In addition, individuals with all three conditions consumed less drinking milk infrequently compared to the control group (OR 0.59, 95% CI 0.52 to 0.66). Conclusion The study found a considerable prevalence and incidence of malnutrition risk, frailty, and sarcopenia in middle-aged and older adults. Notably, malnutrition risk decreases with ageing at a population level, whereas frailty increases as did sarcopenia. There was a strong coexistence between malnutrition risk and prefrailty, as well as between sarcopenia, prefrailty, and frailty. Moreover, participants with these three conditions were found to be following standard dietary guidelines aimed at the general population instead of consuming high-energy foods, underscoring the need for tailored dietary advice for some middle-aged and older. Future research should explore multimodal interventions to prevent and manage the coexistence of these conditions, focusing on their interrelating nature and potential synergistic effects.22 0Item Restricted An investigation into prevalence reasons consequences and interventions in relation to alcohol consumption in the Kingdom of Saudi Arabia(Saudi Digital Library, 2023-11-03) Hazazi, Yahya; McLaughlin, DerekBackground: Alcohol use poses complex public health challenges worldwide, although prevalence and patterns vary across cultural contexts. In the Kingdom of Saudi Arabia (KSA), alcohol consumption is prohibited under Islamic Sharia law and is stigmatised socially, yet evidence indicates rising usage rates, particularly among youths. Aims and Objectives: This systematic review synthesised current findings regarding the prevalence of alcohol use in the KSA. It examined reasons, consequences, and interventions around alcohol use and aimed to integrate results from recent studies to provide a comprehensive understanding of this issue. Methodology: This study utilised a systematic review approach. The researcher searched for literature within the last 10 years on the following databases: Embase, PubMed, Cochrane Control Register of Trials, Google Scholar, BMC, Web of Science, and Science Direct. Qualitative, quantitative, and mixed methods studies were included. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT). Data extraction and thematic analysis were utilised to synthesise and analyse findings. Results: The review found evidence of increasing but underreported alcohol use in the KSA, with prevalence being highest among young adult males. Key themes identified included physical, mental, social, and academic consequences of alcohol use; the influence of familial, peer, emotional, and structural factors on use; issues relating to prohibition policies and their unintended consequences; and the need to address stigma and enhance screening and evidence-based treatment. The study categorised themes into five main categories: prevalence of alcohol use in the KSA, alcohol prohibition in the KSA, interventions and solutions regarding alcohol use, risk factors and reasons for alcohol use, and impacts of alcohol use in the KSA. Discussion and Implications: The review highlighted crucial information gaps around the prevalence of alcohol use in the KSA that require further investigation. Cultural stigma poses major barriers to prevention and treatment. Findings suggested the need for public messaging to increase awareness, capacity building 8 for screening and early intervention, training to reduce provider stigma, and improving access to culturally informed treatment services. A pragmatic, public health approach grounded in empathy and scientific evidence is required. Conclusion: This review contributed insights into the landscape of alcohol use in the KSA, while acknowledging limitations related to the small number of included studies. Further research is critical, but current evidence indicates a specific need for a multifaceted response spanning systemic, community and individual levels to mitigate the harms of problematic alcohol use in the Saudi population.89 0