Saudi Cultural Missions Theses & Dissertations
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Item Restricted Machine Learning Based Predication of Diabetes(University of Notingham, 2024) Almhmadi, Anas; Wilkinson, RichardDiabetes mellitus, commonly known as diabetes, is a chronic disease related to the metabolic system of humans. It is part of a broader category of chronic diseases, including cardiovascular disease, acute kidney infection, eye problems, and foot ulcers. Currently, 537 million people worldwide are living with diabetes, a figure expected to rise to 643 million by 2030. Given the limited availability of medical professionals, there is an increasing need to develop automated tools to assist decision-making for various diseases using prevalence datasets. This dissertation focuses on the implementation of both deterministic models, such as decision trees, random forests, support vector machines, and neural networks, and probabilistic models, including logistic regression, Naïve Bayes, Gaussian Naïve Bayes, and nonparametric Naïve Bayes, for binary diabetes classification. Seven input features—age, gender, BMI, blood glucose level, HbA1C level, hypertension (yes/no), and heart disease (yes/no)—along with the binary response variable (diabetes), are utilized to develop these classification models. The dataset comprises 100,000 patients and eight features, with a significant class imbalance: 91.5% do not have diabetes. Among the models, the decision tree exhibited the highest balanced accuracy of 98.48%, with a sensitivity of 100% and a specificity of 96.95%. The decision tree outperformed all other models when applied to the imbalanced data. For the balanced data, the random forest model demonstrated superior performance (except logistic regression) with a balanced accuracy of 92.42%, sensitivity of 92%, and specificity of 92.85%. These models can be further refined by considering additional relevant variables and applying advanced deep-learning models.9 0Item Restricted MODULATION OF HYPOXIA INDUCIBLE FACTOR 1 ALPHA PLAYS A KEY ROLE IN THE TREATMENT OF HEPATOCELLULAR CARCINOMA AND ACCELERATES WOUND HEALING IN DIABETIC PATIENTS(Cleveland State University, 2024-07-21) Alghamdi, Uthman; Zhou, AiminHypoxia Inducible Factor 1 (HIF-1) is a heterodimeric transcriptional factor that plays a physiological role in low oxygen concentration or hypoxia. HIF-1 consists of two dimers: HIF-1alpha (HIF-1α) and HIF-1beta (HIF-1β). HIF-1 is the active oxygen-sensing domain in the cytoplasm that leads to stabilizing and overexpression of HIF-1 in the cells during hypoxia. On the other hand, HIF-1β is a stable domain in the nucleus that is required to form a dimer with HIF-1α in the DNA to express the HIF-1 gene. Upregulation of HIF-1α by either hypoxia or drug molecules has been elucidated to overexpress more than 100 tumor genes. These genes are involved in developing angiogenesis (vascularization), metastasizing, cellular proliferation, switching to anaerobic metabolism, and cellular survival. Hepatocellular carcinoma (HCC) is one of the solid tumors that have a hypoxic intratumor environment and relies on overexpression of HIF-1α to overcome hypoxia and allow cancer cells to survive, proliferate, and metastasize in these harsh conditions. Targeting or downregulating the HIF-1α gene in HCC with chemical compounds may provide a treatment for this cancer. However, inducing and overexpression of HIF-1α has many of benefits, such as accelerating wound healing in diabetic patients. Diabetic patients suffer from hyperglycemia and thick blood that delay wound healing and may cause infections. Upregulation of HIF-1α expression in diabetic wounds will increase the speed of the repair process of wound healing. HIF-1α plays a crucial role in all phases of wound healing by facilitating cell division, growth factor secretion, cell migration, survival in hypoxic environments, and matrix synthesis. We screened the LOPAC drug library to discover several chemical compounds that either inhibit or stimulate HIF-1α expression. These drug candidates have been further investigated to confirm their activity against HIF-1α expression. These findings suggest that up or downregulation of HIF-1α expression by these drugs has played a key role in treating HCC and accelerating the wound healing process.19 0Item Restricted EVALUATION OF A WHATSAPP-DELIVERED DIABETIC SELF-MANAGEMENT EDUCATION PROGRAM FOR PEOPLE WITH TYPE 2 DIABETES: A MIXED METHODS STUDY(The University of Newcastle, 2024-06-07) Yaagoob, Esmaeel; Regina, Lee; Chan, Sally; Stubbs, MichelleDiabetes is a severe chronic health and potentially devastating medical condition that has increased in prevalence over the past few decades to constitute a significant public health challenge of the twenty-first century. Inadequate diabetes management can result in severe complications, including cardiovascular diseases and strokes, impacting the quality of life. Effective self-management is crucial, with individuals making daily decisions related to their diabetes care. Diabetes self-management education and support (DSMES) provides people with type 2 diabetes mellitus (T2DM) the necessary knowledge, skills, and confidence to manage their condition. It has been found that increasing individual knowledge regarding disease and its complications has significant benefits in compliance with treatment and decreasing complications associated with diabetes. Traditionally, such programs are conducted via face-to-face group sessions. However, there are challenges in accessing face-to-face programs due to factors such as geographic location and travelling distances. In regions where digital technology and social media are pervasive, there is potential to increase innovative delivery methods such as social media platforms to provide accessible and flexible DSMES, thereby reaching a wider audience and improving health outcomes for individuals with T2DM. Considering the widespread use of WhatsApp in Saudi Arabia, online delivery of the DSMES may serve as a viable platform to decrease the burden and impact of living with T2DM. All research in this thesis was conducted in Saudi Arabia using a mixed-methods experimental design to examine the effectiveness of DSMES delivered via WhatsApp for people with T2DM. There are three phases in this study. In Phase One, a qualitative descriptive study was conducted using semi-structured phone interviews. The objective of this phase was to gain an in-depth understanding of the experiences and perceptions of people with T2DM regarding diabetes self-management. Insights from this phase guided the development of the teaching materials for the online diabetes self-management education program implemented in Phase Two. In Phase Two, a randomised controlled trial (RCT) was conducted. The objective of the RCT study was to evaluate the effectiveness of the WhatsApp-based DSMES in enhancing self-efficacy and diabetic knowledge (primary outcomes), as well as evaluating its impact on glycemic control (HbA1c), health-related quality of life (HRQoL), and levels of anxiety and depression (secondary outcomes). Subsequently, the third phase was a process evaluation to explore the experiences of people with T2DM who participated in the newly developed WhatsApp-based DSMES. In Phase One (qualitative interviews), nineteen (n=19) participants were recruited from the diabetes centres located within Jazan General Hospital and King Fahd Central Hospital in the Jazan region, Saudi Arabia. Themes generated from the qualitative analysis included knowledge deficit regarding disease management and its complications, difficulties in coping with the disease, adjusting to lifestyle changes and coping mechanisms influenced by a blend of culture and religion. Participants shared their experiences in accessing diabetic services via social media. Data generated from Phase One were used to develop an intervention that was tailored to the specific needs and experiences of people with T2DM in Saudi Arabia, as identified through the qualitative inquiry. The intervention was developed based on self-efficacy theory and aimed to enhance the self-management skills of people with T2DM through a structured educational delivered via WhatsApp. Common outcomes of WhatsApp-based DSMES for people with DM is to increase motivation to modify behaviours, adopt healthier lifestyles and adhere to prescribed medications. The educational content of the WhatsApp-based DSMES included general diabetes care information, signs and symptoms of diabetes, pathophysiology, aetiology, diet therapy, exercise, and other self-care behaviours. The intervention was delivered over six weeks, with each week focusing on a specific topic related to diabetes management. Participants received text messages, photos, and videos through a WhatsApp group, and were encouraged to interact, share experiences, and ask questions. The educational sessions were designed to take about one hour per week, and participants indicated their engagement by sending a thumbs-up emoji or the word "done" after reviewing the weekly content. In Phase Two (RCT), 80 participants were recruited from the diabetes centres at Jazan General Hospital and King Fahd Central Hospital in the Jazan region, Saudi Arabia were randomly assigned into intervention (n=40) and control groups (n=40). The intervention group received a 6-week intervention via WhatsApp, while the control group received usual care. The primary outcomes measured included UK-Diabetes Management Self-Efficacy Scale (DSMES-UK) and the Diabetes Knowledge Test2 (DKT2). The secondary outcomes measured included glycaemic blood test (HBA1C), the Hospital Anxiety and Depression Scale (HADS), and Diabetes Quality-Of-Life scale (DQOL). These outcomes were assessed at three time points: baseline, immediate post intervention at 6th week and two months after the intervention at 12th week. Findings at 6- and 12-week time points showed significant improvement in DSMES-UK and DKT2 in the intervention group compared to the control group. No significant difference in secondary outcomes was observed in HbA1c, total HADS, total DQoL, T0 to T1. In Phase Three (process evaluation), twenty-three (n=23) participants from the intervention group were recruited. Those who had previously consented during Phase Two and had indicated their willingness to share their experiences of the intervention were invited to participate in semi-structured phone interviews. Qualitative analysis found the participants expressed positive feedback surrounding the acceptability, flexibility, and relevance of the intervention content along with elements of cultural inclusion of the WhatsApp-based program. The participants also supported that the 6-week WhatsApp-based DSMES intervention enhanced a healthy change in lifestyle choices. They offered recommendations for enhancing the WhatsApp-based DSMES including more interactive and real-time features, the inclusion of allied health professionals for specialized support, the involvement of family members, and the integration of the program into standard diabetes care practices. These suggestions could increase the WhatsApp-based DSMES effectiveness, engagement, and overall impact on diabetes management. Findings of this study highlighted the positive effects of a WhatsApp-based DSMES on self-efficacy and diabetic knowledge of people with T2DM. Findings also provided feasibility data for the delivery of an evidence-based social media intervention to achieve optimal diabetes control, health outcomes, and quality of life for people with T2DM within communities. Findings further demonstrated DSMES was easily accessible, flexible, and assisted participants in modifying their behaviours to adopt a healthier lifestyle. By incorporating social media and culturally specific needs into DSMES, we can enhance health outcomes for people with T2DM and alleviate disease burden. Healthcare providers and policymakers may improve health outcomes for people living with T2DM by implementing the delivery of DSMES via social media platforms such as WhatsApp. Future research should focus on multicentre clinical trials with longer follow-up periods to investigate the long-term and cost-effectiveness of WhatsApp-based DSMES. Future studies should also explore the perspectives of diabetes educators and nurses and the readiness of healthcare centres to implement such online educational interventions. Expanding the scope to include a family-centred approach may lead to more sustainable interventions to promote self-management skills for people living with T2DM within communities.31 0Item Restricted DIABETES-RELATED DISTRESS EXPERIENCED BY SAUDI ADULTS WITH TYPE TWO DIABETES MELLITUS(Alqahtani, Ibtesam Mohammed, 2023-05-18) Alqahtani, Ibtesam; Chin, ClaudetteBackground: Living with a chronic condition such as diabetes mellitus (DM) and adhering to its complex treatment regimen strongly affect patients’ psychological well-being as well as their physical health. Diabetes-related distress (DRD) is a common issue, affecting 40% of DM cases, but it often goes unnoticed and untreated. Despite the high prevalence of DM in the Saudi population, DRD has received little research attention. Purpose: This study explored the lived experience of DRD among Saudi adults with type 2 diabetes mellitus (T2DM) in the Kingdom of Saudi Arabia. Philosophical Underpinnings: A transcendental phenomenological qualitative approach guided by the interpretivist–constructivist paradigm was employed to gain an understanding of DRD from the lived experiences of Saudi adults with T2DM. Methods: Purposive and snowball sampling were used to select participants, and the data analysis was guided by Moustakas’s transcendental phenomenology. Results: Five themes emerged from the experiences of 14 Saudi adults with DRD: living a restricted life, fearing the unknown, feeling frustrated, feeling ignored by healthcare professionals, and self-soothing. The essence of the experience, derived from a synthesis of participants’ descriptions, was Resilience to DRD through thriving instead of despairing. The transactional theory of stress and coping provided further insights to study’s findings. Conclusions: The study revealed that despite their restricted life, fears of the unknown, feelings of frustration, and being ignored by healthcare professionals, Saudi adults with T2DM find ways to calm themselves and overcome adversity. The findings highlight the importance of a holistic approach to diabetes care: healthcare providers should screen for DRD and develop care plans that support individuals in managing their T2DM. More research is needed to explore factors associated with DRD in depth to formulate effective medical and psychosocial supportive interventions.26 0