Le travail s'est concentré sur la mesure des valeurs des isotopes stables du carbone (δ13C) et de l'azote (δ15N) dans un groupe de 189 adultes des deux sexes et 74 animaux. Le groupe étudié était représenté par différents ensembles de populations (les centres du pouvoir vs. l’arrière-pays) et périodes : la Grande-Moravie (IXe – Xe siècles) et la période de « late Hillfort » (XIe siècle). L'analyse a également concerné un groupe d’immatures âgés de moins de six ans. Les données isotopiques du groupe des adultes indiquent que l'alimentation de la population de la Grande-Moravie était basée sur les ressources terrestres riches en plantes dites en C4. Des différences dans la proportion des protéines animales ont été observées au niveau de l'alimentation des habitants des centres et de leur arrière-pays. Des modifications diachroniques ont été observées au niveau de l'alimentation – l'alimentation du groupe de la période de late Hillfort était caractérisée par une consommation significative de plantes en C4. Les données isotopiques du groupe des immatures indiquent que la population de la Grande-Moravie ne connaissait aucune norme obligatoire pour la durée de l'allaitement maternel. Les résultats de cette étude démontrent que la société de la Grande-Moravie présentait un taux élevé de stratification socio-économique. Les changements diachroniques observés indiquent que malgré le développement apparent de la population au XIe siècle, la qualité des conditions de vie accuse une aggravation par rapport à la période de la Grande-Moravie. Les statistiques ont démontré l'impact de la qualité de l'alimentation sur l'état de la dentition de la population de la Grande-Moravie. / In this study carbon (δ13C) and nitrogen (δ15N) isotopic values were measured in a sample of 189 adult individuals of both sexes and 74 animals representing different socio-economic contexts (power centers versus the hinterlands) and chronology: the Great Moravian (9th -10th century AD) versus late Hillfort (11th century AD) period. A sample of 41 sub-adults aged 0–6 years was also selected for isotopic analyses.Isotopic data of the adult sample showed that the Great Moravian population had a terrestrial diet with a substantial proportion of C4 plants. Dietary analysis revealed statistically significant differences in the consumption of animal protein between power centers and the hinterlands. Diachronic changes in the diet were observed: the diet of the 11th century sample was characterized by higher consumption of C4 plants.For sub-adults, the isotopic results suggested there was not solely one established norm for the duration of breastfeeding in the Great Moravian population. These results confirmed that Great Moravia represented a highly stratified society socio-economically. The diachronic change in dietary behavior suggested that even after the apparent recovery in the 11th century, Moravian society did not reach its original level of welfare. The quality of diet significantly influenced dental health in the Great Moravian population sample.

L’objectif de ce travail a été de tester l’hypothèse selon laquelle l’effet bénéfique de l’administration de la forme recombinante de l’activateur tissulaire du plasminogène (rt-PA) chez le patient victime d’un accident vasculaire cérébral (AVC) ischémique ne résulte pas uniquement de son action fibrinolytique mais aussi de sa capacité à augmenter le brain-derived neurotrophic factor (BDNF) dans le cerveau. Dans ce but, nous avons conduit une première étude visant à évaluer chez l’animal sain, l’effet du rt-PA sur les taux cérébraux de BDNF. Dans une seconde approche, nous avons étudié l’effet du rt-PA sur les taux sériques de BDNF chez le patient victime d’un AVC ischémique et chez l’animal soumis à une ischémie cérébrale focale. Le sang a été prélevé chez l’Homme à l’admission (J0), J1, J7 et J90 après l’AVC, et chez le Rat avant et après (1h, 4h et 24h) l’ischémie. Le BDNF a été mesuré dans le cerveau par technique de Western blot et dans le sang par technique ELISA. Dans les deux études le rt-PA (Actilyse®) a été administré sous forme d’un bolus suivi d’une perfusion d’une heure. La première étude montre que 1) le rt-PA augmente les taux de BDNF dans l’hippocampe, 2) le traitement par MK801 (un antagoniste des récepteurs NMDA) mais pas par l’acide tranexamique (un inhibiteur de la plasmine) annule l’effet du rt-PA sur les taux de BDNF. La deuxième étude met en évidence que 1) la récupération neurologique est meilleure chez les patients recevant le rt-PA, 2) le traitement par rt-PA augmente les taux sériques de BDNF à J1 et J7 chez l’Homme, mais ne modifie pas les taux sanguins de BDNF chez l’animal, 3) les taux de BDNF ne sont pas corrélés à la récupération neurologique mais sont inversement corrélés au score cardiovasculaire du patient. En conclusion, nos résultats suggèrent que le rt-PA peut exercer un effet protecteur extra-fibrinolytique en augmentant les taux de BDNFm par une potentialisation de l’activité glutamatergique. Même si le rt-PA induit une meilleure récupération neurologique et augmente les taux circulants de BDNF chez les patients victimes d’un AVC, l’absence de corrélation entre ces deux paramètres n’est pas en faveur de l’utilisation du BDNF circulant comme un marqueur prédictif de récupération neurologique, mais pourrait être un reflet de la capacité de l’endothélium à sécréter le BDNF. / Our objective was to test the hypothesis that the beneficial effect of the administration of the recombinant form of tissue plasminogen activator (rt-PA) in ischemic stroke patient not only results from its fibrinolytic activity but also from its ability to increase brain-derived neurotrophic factor (BDNF) in the brain. To this end, we conducted an initial study to evaluate the effect of rt-PA on brain BDNF levels in healthy animals. In a second study, we investigated the effect of rt-PA on serum BDNF levels in ischemic stroke patients and in animals subjected to permanent focal cerebral ischemia. Blood samples were obtained from patient on admission (D0), D1, D7 and D90 after stroke and in rats before and after (1h, 4h and 24h) ischemia. BDNF was measured in the brain by Western blot and in the blood by ELISA. In both studies, the rt-PA (Actilyse®) was administered as a bolus followed by an infusion of one hour. The first study evidences that 1) rt-PA increases the BDNF levels in the hippocampus, 2) treatment with MK801 (a NMDA receptor antagonist) but not with tranexamic acid (a plasmin inhibitor) canceled the effect of rt-PA on BDNF levels. The second study exhibits that 1) neurological recovery was higher in the patients receiving rt-PA, 2) treatment with rt-PA increases serum BDNF at D1 and D7 in patients, but does not change the blood BDNF levels in animals, 3) BDNF levels are not correlated with neurological recovery but are inversely correlated to the patient cardiovascular score. In conclusion, our results suggest that rt-PA may have a protective extra-fibrinolytic effect by increasing in BDNF levels through a potentiation of glutamatergic pathway. Although rt-PA induces a better neurological recovery and increases circulating BDNF levels in stroke patients, the lack of correlation between these two parameters is not in favor of using circulating BDNF as a predictive marker of neurological recovery, but could be a reflect of the endothelium ability to synthesize BDNF.

Made available in DSpace on 2014-12-17T15:30:58Z (GMT). No. of bitstreams: 1 JanioRR_DISSERT.pdf: 1059779 bytes, checksum: 2f156563089ccdb68afd0585079055aa (MD5) Previous issue date: 2011-05-27 / The assessment of oral health status in elderly patients is essential for the development of specific health policies. The prevalence of oral diseases is high in this population. The self-perception of oral health conditions influences the demand for oral care and quality of life for seniors. The aim of this study was to assess self-perception of oral health status in 100 elderly of both sexes, aged 60 years or older and functionally independent the Basic Health Unit of Felipe Camar?o II, Natal, Brazil. For comparison of self-perception data was collected in Bom Pastor, Natal / RN. In this research data were collected a questionnaire grouped into two parts. The first part with the socio-demographic data, subjective and objective condition of oral health and access to the service, the second part GOHAI Index. This index consists of 12 items that make it possible to obtain information involving aspects of chewing, speech, phonation, and self-assessed oral health. The results were subjected to statistical tests of Mann-Whitney and Kruskal-Wallis test (&#945; = 0.05), to identify possible predictors of self-evaluation. As a result, 69% were female, ages ranged from 60 to 86 years, with a median of 65 years. In relation to marital status 48% were married. For the years of study, the sample had an average of 3 years. For the last visit to the dentist, only 27% of seniors had visited the Dentist for less than a year. Regarding the questions about the presence of gingival and dental problems were answered by 46% and 21% respectively. The data on the perception of your teeth and gums, 44%. The index showed GOHAI value for self-perception of 30 points to Felipe Camar?o and 28 points for the Bom Pastor, both considered a low perception. We identified predictors of self-rated number of people in the room, participate in any associational activity, there is problems with your teeth and your gums. Concluded a negative self-perception of oral health condition by Gone in both areas, influenced by socioeconomic and cultural issues, although they realize the importance given to oral health, but by the misfortunes of other prominent favored little valuing of oral health / O envelhecimento, antes considerado um fen?meno, hoje, faz parte da realidade da maioria das sociedades. Contribuir para uma longevidade em que mais pessoas alcancem idades avan?adas com o melhor estado de sa?de poss?vel ?, sem d?vida, um triunfo. A avalia??o das condi??es de sa?de bucal em pacientes idosos ? essencial para o desenvolvimento de pol?ticas p?blicas de sa?de. O objetivo desse estudo foi avaliar a auto-percep??o das condi??es de sa?de bucal em idosos. Foram examinados 100 idosos de ambos os sexos, com idade de 60 anos ou mais e funcionalmente independentes, da Unidade B?sica Sa?de de Felipe Camar?o II, Natal, Brasil. Para efeito de compara??o da auto-percep??o foi coletado dados no bairro Bom Pastor, Natal/RN. Os dados foram coletados atrav?s da aplica??o de um question?rio agrupado em duas partes. A primeira parte correspondeu aos dados s?cio-demogr?ficos, condi??o subjetiva e objetiva da sa?de bucal e acesso ao servi?o e a segunda parte ao ?ndice GOHAI. Este ?ndice ? composto de 12 itens que possibilitam a obten??o de informa??es envolvendo aspectos ligados ? mastiga??o, ao discurso, ? fona??o, e de auto-avalia??o da condi??o bucal. Os resultados foram submetidos aos testes estat?sticos de Mann-Whitney e de Kruskal-Wallis (&#945;=0,05), para identificar poss?veis preditores dessa auto-avalia??o. Dos 100 idosos, 69% eram do sexo feminino, a idade variando entre 60 a 86 anos, mediana igual a 65 anos. Em rela??o ao estado civil, 48% eram casados. Referente aos anos de estudo, a amostra teve uma m?dia de 3 anos. Em rela??o ? ?ltima visita ao dentista, somente 27% dos idosos haviam consultado o Cirurgi?o-Dentista h? menos de um ano. Em rela??o ?s quest?es sobre a presen?a de problemas dent?rios e gengivais, estas foram respondidas por 46% e 21% respectivamente. Os dados referentes ? percep??o sobre a sa?de dos seus dentes e gengivas foi de 44%. O ?ndice GOHAI apresentou valor para auto-percep??o de 30 pontos para Felipe Camar?o e de 28 pontos para Bom Pastor, ambos considerados segundo a escala desenvolvida pelos autores como uma percep??o baixa. Foram observadas diferen?as significativas na associa??o de poss?veis preditores dessa auto-avalia??o: n? de pessoas no c?modo (p = 0,487), se participa de alguma atividade associativa (p=0,006) , existe problemas com seus dentes e com sua gengiva (p=<0,001). Conclu?mos existir uma auto-percep??o negativa sobre a condi??o bucal por parte dos idosos em ambos os bairros, influenciada pelas quest?es socioecon?mica e cultural, embora se perceba a import?ncia dada ? sa?de bucal, com pouca valora??o a sa?de

Conselho Nacional de Desenvolvimento Científico e Tecnológico / O Brasil é um dos maiores consumidores per capita de açúcar e estudos têm mostrado um papel específico do consumo excessivo de açúcar no ganho de peso. Com o aumento do ganho de peso observado em vários países, e também no Brasil, é importante testar quais mensagens, estratégias e propostas de intervenção seriam eficazes na prevenção dessa epidemia. Os dados reportados são referentes a um ensaio randomizado por conglomerado, controlado, conduzido em 20 escolas municipais na cidade metropolitana de Niterói no Estado de Rio de Janeiro, de março a dezembro de 2007, que testou a eficácia de orientações para merendeiras objetivando reduzir a disponibilidade de açúcar e de alimentos fontes de açúcar na alimentação escolar e no consumo delas. A intervenção consistiu em um programa de educação nutricional nas escolas usando mensagens, atividades e material educativo que encorajassem a redução da adição de açúcar na alimentação escolar pelas merendeiras e no consumo delas. A redução da disponibilidade per capita de açúcar pelas escolas foi analisada através de planilhas com dados da utilização dos itens do estoque. O consumo individual das merendeiras foi avaliado através de questionário de freqüência de consumo alimentar. As medidas antropométricas e bioquímicas foram realizadas de acordo com técnicas padronizadas. As escolas de intervenção apresentaram maior redução da disponibilidade per capita de açúcar quando comparadas às escolas controle (-6,0 kg vs. 3,4 kg), mas sem diferença estatisticamente significante. Houve redução no consumo de doces e bebidas açucaradas nas merendeiras dos dois grupos, mas o consumo de açúcar não apresentou diferenças estatisticamente significativas entre eles. Houve redução do consumo de energia total nos dois grupos, mas sem diferença entre eles, e sem modificação dos percentuais de adequação dos macronutrientes em relação ao consumo de energia. Ao final do estudo somente as merendeiras do grupo de intervenção conseguiram manter a perda de peso, porém sem diferença estatisticamente significante. A estratégia de redução da disponibilidade e do consumo de açúcar por merendeiras de escolas públicas não atingiu o principal objetivo de redução de adição de açúcar. Uma análise secundária dos dados avaliou a associação entre a auto-percepção da saúde e da qualidade da alimentação com o excesso de peso e concentração elevada de colesterol sérico das merendeiras na linha de base. As perguntas de auto-percepção foram coletadas por entrevista. Dentre as que consideraram a sua alimentação como saudável, 40% apresentavam colesterol elevado e 61% apresentavam excesso de peso vs. 68% e 74%, respectivamente, para as que consideraram a sua alimentação como não-saudável. Dentre as que consideraram a sua saúde como boa, 41% apresentavam colesterol elevado e 59% apresentavam excesso de peso vs. 71% e 81%, respectivamente, para as que consideraram a sua saúde como ruim. A maioria das mulheres que relatou ter alimentação saudável apresentou maior frequência de consumo de frutas, verduras e legumes, feijão, leite e derivados e menor freqüência de consumo de refrigerante. Conclui-se que perguntas únicas e simples como as utilizadas para a auto-avaliação da saúde podem também ter importância na avaliação da alimentação. / Brazil is one of the largest per capita consumers of sugar and several studies have shown a specific role of excessive consumption of sugar on weight gain. With the increased weight gain observed in several countries, including Brazil, it is important to test which messages, strategies and proposals for intervention would be effective in preventing this epidemic. The data reported are for an intervention study that tested the efficacy of guidelines for school lunch cooks aiming to reduce the added sugar in schools meals and their sugar intake. A cluster randomized controlled trial was carried out in twenty public schools in the metropolitan city of Niterói in Rio de Janeiro, Brazil, from March to December 2007, to assess the change in the availability and consumption of sugar. The intervention consisted of a nutrition educational program in schools using messages, activities and printed educational materials that encouraged the reduction of added sugar in the schools meals by the school lunch cooks and in their consumption. The reduction in per capita sugar availability by the schools was examined through spreadsheets with data from the use of inventory items. Individual food intake of the school lunch cooks was evaluated by a Food Frequency Questionnaire. Anthropometric and biochemical measurements were performed according to standard techniques and the variation in weight change was measured throughout the study. Per capita sugar availability reduced most markedly in the intervention schools compared to the control schools (-6,0 kg vs. 3,4 kg), however this difference was not statistically significant. Both groups of school lunch cooks showed a reduction in the consumption of sweets and sweetened beverages, but the difference in sugar intake was not statistically significant. A reduction in total energy consumption was observed in both groups, but there was no difference between them. Also, there was no difference in the percentage of adequacy of nutrients in relation to energy consumption. Sweetened beverages presented the most important consumption reduction. At the end of the study, only school lunch cooks in the intervention group were able to maintain weight loss, but not statistically significant. The strategy of reducing the availability and consumption of sugar by the school lunch cooks from public schools did not achieve the main goal of reducing added sugar. A secondary analysis examined the association between self-perceived health status and diet quality with overweight and high serum cholesterol concentration of the school lunch cooks at baseline. The self-perception questions were collected by interview. Among women who reported healthy diet, 40% presented high serum cholesterol and 61% were overweight. Among women who reported unhealthy diet, 68% presented high serum cholesterol and 74% presented overweight. Most women who reported healthy diet showed a higher frequency of consumption of sweets, fruits, vegetables, beans, dairy products and lower frequency of consumption of soft drink. In conclusion, single and simple questions, such as those used for self-perceived health status may also be important in assessing the diet.

This paper reviews a study of the skulls from the anatomy collection at Gustavianum, Uppsala university museum, historical collections in Uppsala, Sweden. The skulls were found in the central parts of Uppsala, on an area called Östra Ågatan, which is known for being one of the oldest parts in town. The skulls have been dated to medieval period between 11th and 14th centrury and came to be a part of the anatomical collection. Only skulls are available today in the big collection.  Cranial metrics were recorded, probably by the Anatomical department for all skulls in the large anatomical collection. Östra Ågatan is today a road located near Fyrisån, a river that flows through the city. Uppsala is well known for being one of the oldest city in Sweden and Europe. People have lived here for several centuries, and today the area are currently being used the same. The study aims to collect information about the health status on the medieval humans living in Uppsala. Also, to see if the skulls had a connection to the nearby churches that were located near the area under the same period. Questions that the study are examining is, -If the skulls have any connection to a church in the nearby area that they were found in? -Do the skulls have any pathologies, non-metric features or damage?

O tratamento cirúrgico das neoplasias espinais intradurais primárias está indicado para conseguir ressecação completa, diminuir morbidade e aumentar a sobrevida livre de doença, em busca da cura. Há dúvidas sobre as consequências do tratamento cirúrgico influenciando a qualidade de vida. Entretanto, até o momento, não foram encontrados dados disponíveis na literatura especializada sobre a qualidade de vida dos pacientes que foram submetidos à cirurgia. Os objetivos foram avaliar a qualidade de vida e testar as propriedades psicométricas dos instrumentos utilizados, verificando a consistência interna e a confiabilidade. O estudo foi realizado no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no período de 2009 a 2011, com aplicação do questionário genérico The Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), e das escalas específicas de McCormick e de Aminoff-Logue para a avaliação da qualidade de vida sob o ponto de vista funcional. Todos os pacientes incluídos foram avaliados uma única vez e encontravam-se no período de, no mínimo, seis meses após a data da cirurgia. O banco de dados resultante foi analisado no Departamento de Medicina Preventiva da Faculdade de Medicina da Universidade de São Paulo. A série de casos constou de 148 pacientes, dos quais 48 foram excluídos por não completarem o protocolo. Dentre os 100 casos estudados, 55 eram do sexo feminino, com média de idade de 42,3 anos e tempo de acompanhamento pós-operatório de 20 meses. A pontuação global da qualidade de vida pelo SF-36 foi de 50,5, com resultado geral do componente físico de 46,8. A consistência interna foi demonstrada segundo a validade de construto e de critério, confirmando a hipótese da relação existente entre as pontuações do SF-36 e a escala de McCormick (p = 0,003), as escalas de Aminoff-Logue componente de marcha (p = 0,025), vesical (p = 0,013) e intestinal (p = 0,004). A confiabilidade foi demonstrada em todos os oito domínios do SF-36, alcançando em cada um o alpha Cronbach, satisfazendo o critério de Nunnally > 0,85. Estes resultados sugerem associação consistente entre a qualidade de vida e as funções medulares nesta série de casos, caracterizando melhor a percepção de saúde dos pacientes submetidos ao tratamento cirúrgico. O avanço do conhecimento aplicado à prática neurocirúrgica focada no paciente aponta para a necessidade de avaliação longitudinal da qualidade de vida para auxílio no planejamento terapêutico destas doenças. A qualidade de vida pode ser avaliada pelo questionário SF36, que se correlaciona bem com as escalas específicas de McCormick e Aminoff-Logue / The surgical treatment of intradural primary spinal tumors is indicated to obtain total ressection, decrease morbidity rate and increase survival rate, aiming at the cure. There are doubts about the consequences of surgical treatment influencing the quality of life. However, until now there have been no available data in specialized literature on the quality of life of patients who have undergone this surgery. The objectives of this study were to evaluate the patient´s quality of life and to test the psychometric properties of the instruments used, verifying consistency and reliability. The study was carried out at the Clinics Hospital of the University of São Paulo Medical School, between 2009 and 2011, by means of The Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) generic questionnaire and the McCormick and the Aminoff-Logue specific scales to assess the patient´s quality of life from the functional perspective. All patients included in the study were assessed only once, at least six months postoperatively. The resulting data were analyzed at the Department of Preventive Medicine of the University of São Paulo Medical School. The series of cases comprised 148 patients; 48 patients were excluded because they did not complete the protocol. The study was finally conducted with 100 patients. Fifty-five patients were women, the mean age was 42,3 years and the mean postoperative follow-up period was 20 months. The quality of life total score on the SF-36 was 50,5, and the Physical Component Summary (PCS) score was 46,8. Based upon construct validity and criterion, the internal consistency was demonstrated, confirming the hypothesized relationship between the scores of the SF-36 and the McCormick scale (p = 0.003), the Aminoff-Logue gait subscale (p = 0.025), the Aminoff-Logue micturition subscale (p = 0.013), and the AminoffLogue defecation subscale (p = 0.004). Reliability was demonstrated for all eight SF-36 domain scales and the Physical Component Summary and the Mental Component Summary of the SF-36, where in each the Cronbach alpha satisfied the Nunnally criterion of > 0,85. These results suggest a consistent relationship between the quality of life and the spinal cord functions in this series of cases, better characterizing the evaluation of the health of the patients who underwent surgical treatment. The advancement of knowledge applied to neurosurgery practice with a patient-focused approach shows the necessity of a longitudinal evaluation of the quality of life to help tailor a treatment plan for these diseases. The quality of life can be analyzed by the SF-36 questionnaire, which is well correlated with the McCormick and the Aminoff-Logue specific scales

The objective of this thesis was to defend an alternative approach by health policy makers for improving health outcomes through investing on social factors of peoples' lives, rather than by increasing health expenditures. In order to defend this theory, this master thesis addresses two research questions: Which are the social determinants of health with largest impact on health status of individuals? And what is the statistical correlation between those social determinants of health and self-reported health status, and psychological health, for Germany, Denmark, Spain and Ireland? The first question was answered by developing a comprehensive research among the mostrelevant literature in the field of social determinants of health and the second through the construction of a statistical multiple regression model. According this study the social determinants with largest impact on the health status of individuals are: physical activity, education level, the welfare state, emotional support, socio-economic status, living conditions, working conditions, and life balance. Regarding the results of multiple regression models all variables followed the expected trend and it was possible to proof significant statistical correlation in 7 of the 8 determinants chosen, especially in the cases of working conditions and life balance, where those having problems managing these aspects of life experienced 50% or in some cases 30% of the health status of individuals with positive experiences in these life dimensions.

We studied the dietary behavior and health status of a population that lived in the context of rapid change, including the development of the economic and political structures of states, the adoption of Christianity as well as the subsequent disruption of social structure and the recovery of society. Carbon (δ13 C) and nitrogen (δ15 N) isotopic values were measured in a sample of 189 adult individuals of both sexes and 74 animals representing different socio-economic contexts (power centers versus the hinterlands) and chronology: the Great Moravian (9th -10th century AD) versus late Hillfort (11th century AD) period. A sample of 41 sub-adults aged 0-6 years, representative of both Great Moravian power centers (Mikulčice) and its rural hinterlands (Josefov), was selected for isotopic analyses of breastfeeding and weaning behavior. Data on growth and frequency of nonspecific stress indicators (cribra orbitalia, porotic hyperostosis, and endocranial lesions) were analyzed in a sub-adult group. In adults, we focused on dental health (caries, periapical lesions, dental wear, and periodontal disease), the presence of cribra orbitalia and estimated adult stature. Isotopic data of the adult sample showed that the Great Moravian population had a terrestrial diet with a substantial proportion of C4 plants....

Thesis (M. Sc. Agriculture (Agricultural Economics)) -- University of Limpopo, 2021 / This study investigated the food security indicators in the rural communities of Ba-Phalaborwa Local Municipality of the Limpopo Province. Quantitative data were gathered from five villages in the municipality using the probability proportionate to size. Data were collected from 185 households. The analytical tools that were used in this study include: Descriptive Statistics, Food Security Indicator Measures and the Logistic Regression Model. Food security is a multidimensional concept; thus it is difficult to measure it comprehensively. Hence, three food security indicators measures, namely; the Household Food Insecurity Access Scale (HFIAS), Household Dietary Diversity Score (HDDS) and Coping Strategies Index (CSI) were combined in this study to measure food security in the study. Each indicator measure was used independently. The Logit Regression Model was used to determine the factors affecting the status of household food security. Certain explanatory variables, namely; household size, marital status and receiving government grant, had a negative relationship with the dependent variable. On the other hand, other variables such as educational level, employment status, gender distance to the markets and health status of the household head were positively correlated with the household’s food security status. The study rejected the null hypothesis which stated that socioeconomic factors do not have influence on the households’ food security status in the Ba-Phalaborwa local municipality. Out of the 11 variables, only four variables were significant, with the household size at 10%, educational level at 5%, household monthly food expenditure at 1% and distance to the market at 10%, respectively. Therefore government should direct more focus should on the introduction of feeding schemes in order to reduce the burden on the poor and at the same time, make it easier for young children to attend school to improve their educational statuses. The households in the study area are not food secured because 65.4 % of households could not afford the food that they preferred and were depending on borrowing food from their relatives and creating debts.

In recent years, the transplant community has explored and adopted tools for quantifying clinical insight into illness severity and frailty. This dissertation work explores the interplay between objective and subjective assessments of physical health status and the implications for liver transplant candidate and recipient outcomes. The first aim characterizes national epidemiologic trends and the impact of Centers for Medicare and Medicaid quality improvement policies on likelihood of waitlist removal based on the patient being too frail to benefit from liver transplant (“too sick to transplant”). This aim includes more than a decade (2002–2012) of comprehensive national transplant waitlist data (Scientific Registry of Transplant Recipients (SRTR)). The second aim will assess and define objective parameters of liver transplant patient frailty by measuring decline in lean core muscle mass (“sarcopenia”) using abdominal CT scans collected retrospectively at a single U.S. transplant center between 2006 and 2015. The relationship between these objective sarcopenia measures and subjective functional status assessed using the Karnofsky Functional Performance (KPS) scale are described and quantified. The third aim quantifies the extent to which poor functional status (KPS) pre-transplant is associated with worse post-transplant survival and includes national data on liver transplantations conducted between 2005 and 2014 (SRTR). The results of this dissertation will help providers in the assessment of frailty and subsequent risk of adverse outcomes and has implications for strategic clinical management in anticipation of surgery. This research will also to serve to inform national policy on the design of transplant center performance measures.