The Importance of Bureaucratic Oversight Mechanisms: The Case of the Inspector General

Inspectors General (IG) have been playing an extraordinary role in exposing fraud, waste and abuse as well as promoting efficiency in federal agencies. This year will be the 30th anniversary of the 1978 Inspector General Act (P. L. 95-452.) So, this is the perfect time to evaluate the strengths and weaknesses of Inspectors General through a systematic evaluation of their interventions

Global Ethics and Corruption Measurement Issues in Latin America: The Cases of Colombia and Honduras

Current international organizations focus more on measuring corruption rather than ethics, integrity or transparency in government. Even Transparency International (TI) does not actually measure “transparency” but corruption itself. More critical, those measurements may not be considering government efforts to prevent public corruption at the national and local level. For instance, according to TI’s Corruption Perceptions Index (CPI), during the last decade the phenomenon of corruption in Latin America and the Caribbean countries has remained low-moderate, reaching ratings between 4 and 5 within the CPI rating scale, which includes values between 1 (more corruption) and 10 (less corruption). However, CPI scores may be ignoring specific data from the situation at the local government level. Moreover, CPI scores may have been seriously ignoring socio-political factors that affect corruption perceptions in society, as in the case of Colombia, or extreme poverty, such as in the case of Honduras. In order to escape a trap in which transparency efforts enhance the image of more affluent democracies while only appearing to confirm negative perceptions of societies in a developing stage, the author proposes the creation or improvement of “active transparency” practices at the local government level. This will transform citizens into key actors instead of just receptors of laws and anticorruption programs designed by government. Hence, this paper first discusses the problem with corruption and transparency measurement in the Latin

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Protein Quality and Sensory Perception of Hamburgers Based on Quinoa, Lupin and Corn

The need for partial or total substitution of animal protein sources by vegetable sources of high protein quality with good sensory acceptance is a promising alternative. The objective was to develop a hamburger with vegetable protein using a mixture design based on quinoa (Chenopodium quinoa Willd.), Peruvian Andean corn (Zea mays) and Andean lupine (Lupinus mutabilis Sweet). The design of these mixtures allowed obtaining eleven formulations, three of which were selected for complying with the amino acid intake for adults recommended by FAO. Then, a completely randomized design was applied to the selected samples plus a commercial product. Proximal composition was measured on a dry basis (protein, fat, carbohydrates, and ash), calculation of the Protein Digestibility Corrected Amino Acid Score (PDCAAS) and a sensory analysis was carried out using the Check-All-That-Apply (CATA) method with acceptability in 132 regular consumers of vegetarian products. Protein, fat, carbohydrate, and ash contents ranged from 18.5&ndash;24.5, 4.1&ndash;7.5, 65.4&ndash;72.1 and 2.8&ndash;5.9%, respectively. The use of Andean crops favored the protein content and the contribution of sulfur amino acids (SAA) and tryptophan from quinoa and lysine and threonine from lupin. The samples with Andean crops were described as easy to cut, soft, good, healthy, legume flavor, tasty and light brown, however the commercial sample was characterized as difficult to cut, hard, dark brown, uneven color, dry and grainy. The sample with 50% quinoa and 50% lupin was the most acceptable and reached a digestibility of 0.92. It complied with the lysine, threonine, and tryptophan intake, with the exception of SAA, according to the essential amino acid pattern proposed by the Food and Agriculture Organization of the United Nations

Characteristics and Factors Associated With Antihypertensive Medication Use in Patients Attending Peruvian Health Facilities

INTRODUCTION : Hypertension is a very common disease worldwide, and medication is needed to prevent its short-term and long-term complications. Our objective was to determine the characteristics and factors associated with antihypertensive medication use in patients attending Peruvian health facilities. MATERIALS & METHODS: We performed a multicenter, cross-sectional study with secondary data. We obtained self-reported antihypertensive medication from patients attending health facilities in 10 departments of Peru. We looked for associations of the antihypertensive treatment according to sociopathological factors and obtained p values using generalized linear models. RESULTS: Of the 894 patients with hypertension, 61% (547) were women and 60% (503) were on antihypertensive treatment, of which 82% (389) had monotherapy and 52% (258) had recently taken their medication. Antihypertensive treatment was positively correlated with the patient's age (adjusted prevalence ratio [aPR]: 1.01; 95% confidence interval [CI]: 1.007 to 1.017; p value < 0.001), diabetes (aPR: 1.31; 95% CI: 1.11 to 1.55; p value = 0.001) and cardiovascular disease (aPR: 1.38; 95% CI: 1.26 to 1.51; p value < 0.001). Conversely, the frequency of antihypertensive treatment decreases with physical activity (aPR: 0.80; 95% CI: 0.70 to 0.92; p value = 0.001). CONCLUSION: Patients who have comorbidities and advanced age are more likely to be on antihypertensive treatment. In contrast, patients with increased physical activity have a lower frequency of antihypertensive treatment. It is important to consider these factors for future preventive programs and to improve therapeutic compliance

Characteristics and factors associated with antihypertensive medication use in patients attending peruvian health facilities

Introduction Hypertension is a very common disease worldwide, and medication is needed to prevent its short-term and long-term complications. Our objective was to determine the characteristics and factors associated with antihypertensive medication use in patients attending Peruvian health facilities. Materials & Methods We performed a multicenter, cross-sectional study with secondary data. We obtained self-reported antihypertensive medication from patients attending health facilities in 10 departments of Peru. We looked for associations of the antihypertensive treatment according to sociopathological factors and obtained p values using generalized linear models. Results Of the 894 patients with hypertension, 61% (547) were women and 60% (503) were on antihypertensive treatment, of which 82% (389) had monotherapy and 52% (258) had recently taken their medication. Antihypertensive treatment was positively correlated with the patient's age (adjusted prevalence ratio [aPR]: 1.01; 95% confidence interval [CI]: 1.007 to 1.017; p value < 0.001), diabetes (aPR: 1.31; 95% CI: 1.11 to 1.55; p value = 0.001) and cardiovascular disease (aPR: 1.38; 95% CI: 1.26 to 1.51; p value < 0.001). Conversely, the frequency of antihypertensive treatment decreases with physical activity (aPR: 0.80; 95% CI: 0.70 to 0.92; p value = 0.001). Conclusion Patients who have comorbidities and advanced age are more likely to be on antihypertensive treatment. In contrast, patients with increased physical activity have a lower frequency of antihypertensive treatment. It is important to consider these factors for future preventive programs and to improve therapeutic compliance