Saudi Cultural Missions Theses & Dissertations
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Item Restricted The Association between Frailty and Quality of Life in Older People(University of Leeds, 2024-07) Alattas, Ali; West, RobertThis thesis examines the association between frailty and quality of life (QoL) in older adults, emphasizing successful aging as a primary goal for individuals and healthcare systems. Frailty and QoL are crucial concepts in understanding aging, as they encompass major concerns and extend into broader domains of successful aging. Using data from the English Longitudinal Study of Ageing, this research comprises three interconnected studies. The first study analyses frailty progression over 18 years, categorized by the number of long-term conditions (LTCs). Findings indicated that frailty increased with the number of LTCs for both genders, with males showing accelerated frailty with one or more LTCs, while females exhibited this acceleration with two or more LTCs. In the second study, several structural factor models for the CASP-12, a measure of quality of life, were tested. The study also examined the consistency of the best model across various demographics and two time periods. The results showed that the CASP-12 with the second-order common factors is a better model, and it maintained strong invariance across genders, age, and education, as well as over two different time points when the sample was divided into three subsamples based on age group. However, this invariance was not observed for net wealth. The third study investigated the two-way relationship between frailty and QoL, revealing a strong inverse and almost linear relationship over time. Although the cross-lagged relationship between QoL and frailty was statistically significant, the impact was minimal. Differences were noted at the group level, considering gender, age, net wealth, and multimorbidity, but not at the within-person level. By considering these findings, healthcare providers and policymakers can develop more effective strategies to support the well-being of older adults.11 0Item Restricted PREDICTORS OF HEALTH-RELATED QUALITY OF LIFE AFTER LUNG CANCER SURGERY(University of Birmingham, 2024) Algaeed, Saffana Khalid; Naidu, Babu; Thickett, DavidGlobally, lung cancer is the leading cause of death. Surgical removal of a primary non-small cell lung cancer (NSCLC) tumour offers a significant chance of cure for those suffering. Additionally, it is anticipated that the introduction of screening programs for lung cancer will result in an increase in survival rates. Therefore, health-related quality of life (HRQOL) following surgery has become an important consideration for these patients. However, a considerable number of lung cancer patients who have undergone surgery have not experienced improvement in their breathing afterwards, a condition that can persist for several months following surgery. Computed Tomography (CT) scans of lung cancer patients often demonstrate concurrent emphysema with low attenuation areas (LAAs), the significance of which is unclear. Moreover, sarcopenia is observed in about half of lung cancer patients and is linked to impaired health outcomes and lower survival rates. Identifying the predictors of postoperative HRQOL decline is vital; however, little information is available regarding the relationship between baseline HRQOL, quantitative computed tomography (QCT) of emphysema, or CT-based body composition with postoperative dyspnoea and global health. This thesis aims to examine the predictors of HRQOL of dyspnoea and global health six months following lung cancer surgery. This is a prospective observational study. The European Organisation for Research and Treatment of Cancer (EORTC QLQ-C30) questionnaire and lung cancer module LC13 were introduced at baseline pre-surgery, eight weeks, and six months after lung surgery. Using the CT scans, lung density measurements using %LAA at thresholds of -950 Hounsfield Units (HU) and -910 HU for the assessment of emphysema were quantified and the cross-sectional area of thoracic and abdominal muscles, specifically pectoralis (PM), erector spinae (ESM), psoas (PSM), and skeletal muscles (SM), were analysed using an open-access software. Univariate and multivariate linear, ordinal and multinational regression analyses were performed to find out the predictive value of preoperative HRQOL and CT scan density measurements. Comparative analyses, as well as intra-class correlation coefficients and Bland Altman plots, have also been employed. A total of 1064 patients were recruited over 10 years, and 906 consented patients were included in the study. A significant increase in dyspnoea scores was observed beyond the minimal clinical difference, with values at baseline, eight weeks, and six months were 20.5 ± 22.6, 39.6 ± 24.5, and 33.2 ± 24.7, respectively. In an eight-week period, global health scores dropped from 73.2 ± 20.5 to 63.3 ± 20.5, with only a minimal improvement observed at six months (66.6 ± 22.2). In the multivariate regression analyses, we have demonstrated that baseline dyspnoea is a strong predictor for patients’ postoperative HRQOL after lung cancer surgery (OR = 3.07 – 12.3, p = 0.00). Additionally, baseline global health significantly predicts postoperative HRQOL (coefficient = 0.45 – 0.5, p = 0.00). The data demonstrate that %LAA-950 is a significant predictor of postoperative dyspnoea and global health (OR = 1.2-1.3, p = 0.00), while %LAA-910 is not consistently a strong predictor after adjusting for clinical and perioperative factors. AI-based and semi-automated software showed strong consistency in measuring %LAA-950 and whole lung volume, 15th percentile, and mean lung density. However, there was a lower degree of agreement between the two programs in lobar measurements. Finally, no statistically significant differences were observed in the changes in HRQOL following lung surgery among the small number of patients with sarcopenia6 0Item Restricted Factors Influencing the Quality of Life and Behavioural Intentions of Heritage Tourists in Saudi Arabia(Victoria University, 2024-05-31) Alhelal, Abdulrahman; Nguyen, Thu-HuongTourism has emerged as a critical industry in Saudi Arabia, particularly with the recent implementation of the Vision 2030 ‘roadmap’ to diversify the country’s income. This has led to the creation of plans, policies, and related entities designed to attract tourists at both the domestic and international levels. Heritage tourism is especially important since each region in Saudi Arabia possesses its own unique tangible and intangible heritage resources. These different regions provide a variety of heritage tourism experiences. Previous research has identified the role that behavioural intention plays in tourists’ decisions to visit a destination. Understanding tourists’ behaviour is crucial since it helps government entities and businesses to predict tourist demand for a destination. Previous studies have also confirmed that tourists’ behavioural intentions vary according to different factors, including cultural background, nationality, age, and gender. Therefore, understanding the role of these factors on tourist behaviour helps government entities develop effective marketing plans at local, national, and international levels. However, only a few research studies have examined the association between tourist motivations (push and pull factors), experience quality, perceived value, place attachment, quality of life, and behavioural intention. Therefore, this research sought to address this gap in the literature by developing a conceptual framework to investigate the relationships among motivation (push and pull factors), experience quality, perceived value, place attachment, quality of life, and behavioural intention in the context of domestic heritage tourism in Saudi Arabia. Moreover, this study aimed to understand the differences in perceptions associated with these constructs across two groups: Saudi and non-Saudi. This represents an original perspective of heritage tourism in Saudi Arabia. Means end theory was determined to be the most appropriate for examining the model developed in this study and to achieve the research objectives. A quantitative approach was adopted using a survey-based method for collecting data. The survey questionnaire was distributed in two heritage destinations, AlUla and Diriyah, to domestic heritage tourists and visitors in both destinations. A variety of statistical techniques were used to examine the 11 hypotheses developed in this study. These techniques were descriptive analysis, Chi-square testing, exploratory factor analysis (EFA), a two-stage structural equation modelling (SEM) approach, and multigroup analysis (MGA). ii Only a limited number of research studies have been conducted in the area of quality of life in heritage tourism. This study makes several contributions to address this gap. The findings of this research confirmed significant relationships for all hypotheses, with the exception of two (the association between pull factors and experience quality, and the association between perceived value and quality of life). This research also addressed the different perceptions of motivation, experience quality, perceived value, place attachment, quality of life, and behavioural intention between two groups: Saudis and non-Saudis. The findings confirmed that only four hypotheses were found to be significant when comparing the two tourist groups. This study addresses identified gaps in the research. It contributesto both the literature and the industry by providing a deeper understanding of heritage tourists’ motivations, experience quality, perceived value, place attachment, quality of life, and behavioural intention in Saudi Arabia. This research has the potential to advance the investigation, especially in the area of quality of life and tourism in developing countries. It also provides insightful information on the characteristics of domestic heritage tourists in Saudi Arabia, which can help decision-makers and planners develop tourism products and services. The framework in this research has been empirically examined and provides a solid foundation for conducting further empirical research. This thesis concludes with some proposed future research directions in related areas of interest. It also offers some suggestions for practitioners and decision-makers in the tourism industry to enable them to develop more effective strategies and boost tourism in Saudi Arabia.43 0Item Restricted Real-Life Effectiveness of Benralizumab Compared to Other Biological Therapies for Severe Asthma.(Saudi Digital Library, 2023-08-25) Almarhabi, Mohammed; Mansur, Adel; Ellis, PaulBackground: Severe asthma affects a small proportion of patients, remaining uncontrolled despite high-dose medications. It encompasses phenotypes including allergic, non-allergic, eosinophilic, and neutrophilic severe asthma. Biologic therapies such as anti-IgE, anti-IL5, and anti-IL4 may be used for severe asthma. The aim of this research is to evaluate and compare the efficacy of benralizumab in the treatment of severe asthma and eosinophilic asthma to that of other biological therapies, including dupilumab, reslizumab, mepolizumab, and omalizumab. Methods: In a cross-sectional study utilising the Birmingham Regional Severe Asthma Registry data, outcomes of benralizumab versus other biologic treatments were compared in terms of oral corticosteroid use, FeNO levels, blood eosinophils count, lung function, quality of life indices, emergency visits, and hospital admissions. Parametric (t-test) or non-parametric (Kruskal-Wallis) analyses were undertaken to compare continuous variables depending on data distribution, whilst cross-tabulation was performed to compare categorical data underwent evaluation via cross-tabulation (Chi-square tests). Results: The study included 516 patients using biological treatments, distributed across the following groups, benralizumab (n=97), omalizumab (n=196), dupilumab (n=16), and mepolizumab (n=207). Medians, accompanied by p-values were utilised to compare outcomes across the biologics. Just around 29.9% of benralizumab remained on oral steroids, similar to other biologics (25-31%). Benralizumab, dupilumab, and omalizumab showed an FEV1% improvement ranging from 77% to 102.5% compared to pre-biological treatment database 71.2%. While all biologics demonstrated clinically meaningful improvements in quality-of-life scores greater than 55 compared to the pre-biological treatments database, the differences in pre-bronchodilator FEV1 and quality-of-life scores among biologics were not statistically significant. Unique to benralizumab was an elevated FeNO level with a median of 48 ppb (IQR 9, 239) and a reduced blood eosinophil count to a median of 0 x109 /L (IQR 0, 2), aligning with its anti-IL5 mechanism and distinguishing it from anti-IL4 and anti-IgE medications. Furthermore, emergency visits decreased across biologics, with benralizumab, dupilumab and mepolizumab reducing median visits to 0 and omalizumab lowering to 1 visit, compared to 5 median visits pre-biologics database. Furthermore, all biologics, on average, reduced hospital admissions to a median of 0 hospital admission, down from a median of 1 in the pre-biological treatment database. Conclusion: Real-world data suggest that benralizumab may demonstrate differences in FeNO levels and blood eosinophils. However, other clinical outcomes appeared consistent when compared with other biologics in patients with severe asthma. In general, all biologics including benralizumab showed improvements in clinical outcomes when compared to the pre-biologics database.55 0Item Restricted Exercise and quality of life in patients with alpha-1 antitrypsin deficiency(Saudi Digital Library, 2023-12-04) Alshahrani, Mohammed; Pye, Anita; Turner, AliceIntroduction Alpha-1 antitrypsin deficiency (AATD) is a genetic disorder that affects the production of a protein called alpha-1 antitrypsin. This protein helps to protect the lungs from damage. People with AATD are at increased risk of developing lung and liver diseases. This dissertation explores the effectiveness of exercise on the quality of life in AATD patients. Physical activity is known to have many health benefits, including improving lung function, and reducing the risk of chronic diseases. However, it is not clear whether physical activity is beneficial for people with AATD. The main aim of this study is to examine the relationship between exercise and quality of life in AATD patients who lead physically active or sedentary lifestyles. Methods This cross-sectional study examined the associations between physical activity, quality of life, and well-being in 64 participants with AATD. Utilising a customised questionnaire, activity levels and perspectives were evaluated. More clinical information was extracted from the AATD registry. Results There were 64 participants whose ages and lung function varied considerably. Perspectives on physical activity varied; some were physically active while others were sedentary. The impact of AATD on activity capacity varied among participants. The majority of respondents reported that physical activity improves Quality of life (QOL) and emotional health, but some described barriers. Diverse forms of exercise were preferable. Patients who engaged in more physical activity reported improved quality of life, including less shortness of breath, fatigue, and anxiety, according to the results. In addition, they reported having higher levels of energy and generally feeling better. Positive correlations were observed between physical activity, QOL, and emotional well-being. Conclusion These findings suggest that physical activity would be a beneficial intervention for AATD patients. in addition, this dissertation highlights the importance of incorporating exercise as an integral component of holistic health management for individuals with AATD, showcasing its potential to improve various dimensions of quality of life, both physically and emotionally. However, more research is needed to confirm these findings and to determine the optimal amount and type of physical activity for AATD patients with larger sample size.14 0Item Restricted COPING STRATEGIES AND HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH HEART FAILURE(ProQuest, 2023-10-13) Alanazi, Mohammed; Wyatt, GwenHeart failure (HF) contributes to poor physical and emotional health-related Quality of Life (HRQoL) and poor health outcomes. Coping strategies have been identified as essential in enhancing HRQoL. This 3-manuscript dissertation focuses on the stressor of heart failure (HF) associated severity and its relationship with coping and health-related quality of life (HRQoL). This dissertation is comprised of 3 manuscripts (a) a scoping review of literature on coping strategies and HRQoL; (b) a quantitative study of the associations between the stressor (HF severity), influencing factors (demographics [age, sex, education, and income] and HF duration), coping strategies (problem-focused, active emotion-focused, and avoidant emotion-focused), and physical and emotional HRQoL outcomes; and (c) a multiple mediation study that examines the mediating role of coping strategies between the stressor of HF severity and physical and emotional HRQoL. In chapter 2, a literature review was conducted following the Arksey and O’Malley template. This scoping review was guided by the TSCM. Eligibility criteria involved patients with HF, reported on coping strategies and HRQoL, and published in English. In chapters 3 and 4, a cross-sectional survey design was used. A convenience sample of individuals with HF were recruited online using Researchmatch.org. Using PROCESS macro for SPSS, a multiple mediation model was applied to evaluate if one or more coping strategy types served as a mediator between HF severity and emotional and/or physical HRQoL. In chapter 2, thirty-five studies were included (4 RCTs, 27 cross-sectional, and 4 qualitative/mixed methods). Active emotional coping (e.g., acceptance) and problem-focused (e.g., seeking social support) coping strategies were linked with better HRQoL, while avoidant emotional coping (e.g., denial) was linked to worse HRQoL. In the presence of the stressor of HF severity, key factors that influenced the types of coping strategy included sex, age, social support, income, education, spiritual beliefs, and illness duration. However, the evidence on the effectiveness of the type of coping on HRQoL remains inadequate due to the majority of studies being cross-sectional. The results of chapter 3 showed that 108 participants completed the study with an age range of 20-81 years (37.03±11.77 years). Most participants were male (57.4%, n=62) and self-identified as Black or African American (60.2%, n=65). The mediation analysis results showed that active emotion-focused coping mediated the relationship between all three NYHA classifications (II, III, and IV) and emotional, but not physical HRQoL. Finally, chapter 4 showed a statistically significant indirect effect on the emotional HRQoL through only active emotion-focused coping (X1=0.74 [95% CI: 0.01 to 1.97]; X2=0.73 [95% CI: 0.01 to 1.91]), which suggests that active emotion-focused coping served as a mediator between HF severity (all three NYHA classifications) and emotional HRQoL. This dissertation contributes to the science by recommending a consistent definition of the three types of coping and a better understanding of the influence of age, sex, education, income, and HF duration on coping strategies. This dissertation found that problem-focused and active emotion-focused coping were linked with improved physical and emotional HRQoL. Factors such as older age, male, and having a low level of education and lower level of income were showed as significantly associated with using more avoidant emotion-focused coping strategies, which can direct interventional work. Finally, this dissertation advances science by demonstrating that active emotion-focused coping serves as a mediator, playing an important role in mediating the effects between HF severity and emotional HRQoL. This will help initiating new intervention directions for nursing research, broadening the scope of education to enhance symptom management and QoL through nursing programs, and providing empirical evidence for clinicians to smoothly integrate into their practice. These contributions are expected to advance the field of HF science and care.53 0