Nutritional status of children with cerebral palsy attending rehabilitation centers.

AIM: To describe the nutritional status of children with cerebral palsy (CP) from rehabilitation and therapeutic centers in Argentina, and to analyze their risk of undernutrition based on their Gross Motor Function Classification System (GMFCS) level. METHOD: This was a cross-sectional study with data collected from 321 children (196 males, 125 females) with CP age 2 to 19 years (mean age 9y 3mo, SD 4y 5mo) from 17 rehabilitation and therapeutic centers in five Argentine provinces. Nutritional status was defined by height, weight, and body mass index for age z-scores using World Health Organization growth charts. Odds ratios were used to evaluate the association between GMFCS level and nutritional status. RESULTS: Of the children with CP studied, 52.4% were in GMFCS levels IV and V. Regarding the nutritional status, 41.7% were normal, 19.0% had moderate undernutrition, 33.9% severe undernutrition, 2.5% overweight, and 2.8% obese. When compared to those in GMFCS levels I to III, the odds of children in GMFCS levels IV and V having moderate undernutrition are four times greater and the odds of having severe undernutrition are 14 times greater. INTERPRETATION: There is a high prevalence of undernutrition associated with CP (GMFCS levels IV and V) among children in rehabilitation and therapeutic centers in Argentina. Risk of severe undernutrition increases with increased motor compromises.

Humanitarianism in surgery.

PURPOSE: Humanitarianism is by definition a moral of kindness, benevolence and sympathy extended to all human beings. In our view as surgeons working in underserved countries, humanitarianism means performing the best operation in the best possible circumstances with high income country (HIC) results and training in-country surgeons to do the same. Hernia Repair for the Underserved (HRFU), a not for profit organization, is developing a long term public health initiative for hernia surgery in Western Hemisphere countries. We report the progress of HRFUs methods to render humanitarian care. METHODS: In a collaborative effort, Creighton University and the Institute for Latin American Concern developed an outpatient surgery site for hernia surgery in Santiago, Dominican Republic. Based on this experience, we developed a sustainable care model by recruiting American and European Hernia Society expert surgeons, staff members they recommended, building relationships with local and industry partners, and selecting local surgeons to be trained in mesh hernioplasty. HRFU then extended the care model to other Western Hemisphere countries. RESULTS: Between 2004 and 2015, the HRFU elective hernia morbidity and mortality rates for 2052 hernia operations were 0.7 and 0%, respectively. This is consistent with outcomes from HICs and confirms the feasibility of a public health initiative based on the principles of the Preferential Option for the Poor. CONCLUSIONS: HRFU has recorded HIC morbidity and mortality rates for hernia surgery in low and middle income countries and has initiated a new surgical training model for sustainability of effect.