http://theses.ncl.ac.uk/jspui/handle/10443/75 Tue, 21 Apr 2026 21:19:20 GMT 2026-04-21T21:19:20Z http://theses.ncl.ac.uk/jspui/handle/10443/6676 Title: Understanding the influence of ethnicity on medicines adherence Authors: Asiri, Rayah Abstract: Diabetes is a significant global public health issue, resulting in serious and costly complications and reduced life expectancy. Adherence to prescribed medication is an essential component of diabetes management to obtain optimal outcomes. Understanding the factors influencing adherence is key to optimising adherence to antidiabetic medication. One factor that has yet to be studied in this context is ethnicity and given the increased incidence of diabetes in certain ethnic groups, it is important to establish if or how adherence to diabetes medication varies by ethnic group (Chapter 1). A systematic review of the existing quantitative literature was conducted to explore whether medication adherence to antidiabetic medications in people with diabetes varied by ethnicity (Chapter 2). Most of the included studies showed statistically significant disparities in adherence among different ethnic groups, with minority ethnic groups in high-income countries often reporting the lowest rates. A second systematic review (meta- ethnography) was undertaken to synthesise the existing qualitative data to explore the barriers to and facilitators of adherence to antidiabetic medications experienced by people from minority ethnic communities in high-income countries (Chapter 3), revealing a gap in the literature concerning ethnicity-related factors from the perspectives of both minority ethnic communities and the majority within the context of socioeconomic deprivation. Chapters 4 and 5 detail two qualitative studies conducted in socioeconomically deprived settings in the United Kingdom and Saudi Arabia. The UK study (Chapter 4) explored the perspectives of people from South Asian and White British ethnic backgrounds in the North East of England. The results identified a range of barriers and facilitators, with some shared by both groups and others unique to the South Asian participants, including a preference for alternative medicine, certain religious-related beliefs and practices, social stigma associated with the condition, and unawareness of free prescription availability. The Saudi Arabian study (Chapter 5) involved participants from South Asian and Saudi Arabian backgrounds, highlighting a range of barriers and facilitators—some shared across both groups and others unique to each ethnic community. This research identified several factors influencing adherence, including ethnicity- related and socioeconomic influences, as well as personal and healthcare system-related factors; these findings should inform the development of tailored interventions (Chapter 6). Description: Ph. D. Thesis. Wed, 01 Jan 2025 00:00:00 GMT http://theses.ncl.ac.uk/jspui/handle/10443/6676 2025-01-01T00:00:00Z http://theses.ncl.ac.uk/jspui/handle/10443/6514 Title: Oral Healthcare in England: Workforce Perspectives and Public Priorities Authors: Carr, Katherine Abstract: The oral healthcare system in England comprises of the National Health Service (NHS), offering a variety of services accessible to everyone, and a private sector. However, persistent oral health inequalities and issues regarding accessibility of NHS dental appointments suggest a system performing sub-optimally. This thesis investigates the factors which influence dental professionals’ decisions about where to work, and patients’ views and priorities for NHS dentistry. Chapters 4 and 5 present data from qualitative interviews held with dental professionals (n=17) and the general public (n=20), analysed using a framework approach. The evidence presented demonstrates a range of push and pull factors which influence where dental professionals provide labour, highlighting the ideological commitment to the NHS, but that the working conditions detract from patient-centred care. The findings from the public interviews demonstrate a variety of interpretations of oral health and clinically necessary treatment under the NHS. The private sector was discussed as supplementary, but raised equity concerns. Chapters 6 introduces a preference elicitation exercise (a Benefit Trade-Off, or BTO) to establish if members of the general public (n=1,688) are willing to sacrifice efficiency (larger oral health gains) to reduce oral health inequalities. A series of methodological investigations follow in Chapter 7. The results from the BTO indicate that inequality aversion is low, meaning that maximising oral health is prioritised relative to reducing inequalities for most. The methodological results show that how the scenarios are presented can impact the result. This thesis offers significant contributions to our understanding of NHS dentistry. The qualitative studies identify key factors which drive the workforce and presents public desires for oral health under the NHS. The BTO provides the first insight into inequality aversion in oral health globally. Future policies need to reflect the diversity of perspectives and be underpinned by sustainable approaches to improving oral health. Description: PhD Thesis Wed, 01 Jan 2025 00:00:00 GMT http://theses.ncl.ac.uk/jspui/handle/10443/6514 2025-01-01T00:00:00Z http://theses.ncl.ac.uk/jspui/handle/10443/6481 Title: Amalgam phase-out: what next for dentistry? Costs and benefits of the alternative direct restorations Authors: Bailey, Oliver Samuel Abstract: Introduction Dental amalgam has been used to restore posterior teeth for centuries. It contains mercury and concerns around its toxicity have mandated a phase-down of its use and an exploration of the feasibility of its phase-out in England by 2030. This thesis explored the current use of amalgam and the relative costs and benefits of the directly placed alternatives in the English NHS primary care setting. Methods This thesis comprised three complimentary phases. Phase one quantified the use of materials and techniques to restore posterior teeth by UK primary care clinicians, alongside their opinions of the phase-down using an online questionnaire. Phase two quantified UK public preferences for different aspects of posterior restorations in terms of differences in their willingness to pay using a discrete choice experiment. Phase three was an economic evaluation of amalgam versus the alternative restorations in the English NHS setting. A model of restoration and reintervention was built to compare the lifetime costs and outcomes of amalgam with the alternatives. Data from all phases were then used in a cost-consequence analysis which quantified the differences in various outcomes and costs from the perspective of funders, patients and clinicians. Results Amalgam is frequently used in NHS primary care and clinician confidence in the alternatives is limited, with significantly higher reported post-operative complications. The lifetime monetary and time costs to patients, funders and clinicians are significantly higher for composite than amalgam and clinical outcomes are significantly worse. In terms of preferences, the UK public value amalgam more than composite, with the largest relative difference seen in low-income groups. Discussion An imminent phase-out of amalgam in England would lead to concerns around survival of restored teeth, funding, patient safety and access to care, which risk exacerbating existing health inequalities. Description: PhD Thesis Wed, 01 Jan 2025 00:00:00 GMT http://theses.ncl.ac.uk/jspui/handle/10443/6481 2025-01-01T00:00:00Z http://theses.ncl.ac.uk/jspui/handle/10443/6444 Title: Implications of stress-induced dsRNA in melanoma in the context of activating MAPK mutations in vitro/ex vivo Authors: Sadeq, Shaymaa Abstract: Many studies in the past 10 years have drawn attention to the presence of endogenous RNA structures that can adopt double strand form (Dhir et al., 2018). These dsRNA have been proposed to play important biological roles in the pathogenesis of many inflammatory and autoimmune diseases as well as cancers (Hur, 2019a). The exact trigger for the forma4on of these dsRNA has yet to be identfied. Moreover, there is no direct method to quantify and locate dsRNA inside cells. This thesis will discuss the dsRNA stress response in melanoma in vitro/ex vivo. DsRNA derived from repetitive DNA elements has the potential to induce an interferon response that renders resistant melanoma sensitive to immunotherapy. As a consequence, dsRNA has the potential to add a new approach to treating melanoma. Tissue culture and molecular biology were used to induce dsRNA formation in melanoma cell lines using hypomethylating drugs and other stressors. The impact was measured by quantifying cytosolic dsRNA sensors, also known as pattern recognition receptors PRRs (pPKR, MDA5, RIG1, and ADAR1) using RT-qPCR and western bloVng. Immunofluorescence and high- resolution microscopy were then applied to investigate the co-localisation of dsRNA and its sensors in melanoma cell lines and melanoma patient skin biopsy samples. Moreover, a novel method of labelling dsRNA by flow cytometry to investigate its effect on the cell cycle and proliferation in BRAF mutant and WT cell lines was performed. Analysis revealed that inducing endogenous dsRNA significantly activates PRRs and promotes subcellular co-localisation with dsRNA and the mitochondria. FACS experiments indicated a potential role of dsRNA and PKR in regulating the cell cycle and proliferation. To summarize, our data support the hypothesis that inducing endogenous dsRNA activates dsRNA sensors and triggers innate immune signalling. Hence, dsRNA signalling may be explored as a potential therapeutic strategy to treat resistant melanoma. Description: Ph. D. Thesis. Mon, 01 Jan 2024 00:00:00 GMT http://theses.ncl.ac.uk/jspui/handle/10443/6444 2024-01-01T00:00:00Z