Predicting Asthma Symptoms in Low-Income Children With Persistent Asthma: The Role of Medication Adherence, Depressive Symptoms and Behavior Problems

Rationale This study explored the relationships between child depressive symptoms and hopelessness, child behavior problems, caregiver depressive symptoms, adherence to Flovent and/or Singulair, and asthma symptoms in a low-income sample of children with persistent asthma. Methods Eighty-one children ages 6-11 were recruited from a primary care clinic (26%), an asthma clinic (46%), or the emergency room (28%) in an urban pediatric hospital. The child\u27s adherence to Flovent/and or Singulair was measured by electronic monitoring devices over a 14 day period. Caregivers and children were interviewed after the monitoring period about child depressive symptoms and hopelessness, child behavior problems, caregiver depressive symptoms, and child asthma symptoms. Results Mean daily adherence was 65% (range=14-100%, n=70) to Flovent and 80% (range=21-100%, n=39) to Singulair. Parent- and child-reported asthma symptoms were positively and significantly correlated. Parent-reported daytime asthma symptoms were negatively correlated with Flovent and Singulair adherence, and positively correlated with caregiver-reported child behavior problems and depressive symptoms. Child-reported daytime asthma symptoms were significantly and positively correlated with child-reported depressive symptoms and hopelessness. Caregivers\u27 self-reported depressive symptoms were positively correlated with caregiver-reported asthma symptoms for the child and negatively correlated with the child\u27s Flovent and Singulair adherence. Regression analyses will explore the contribution of mental health variables to the prediction of asthma symptoms over and above the contribution of medication adherence. Conclusions: Asthma treatment providers need to consider the impact of child and caregiver mental health on asthma morbidity, particularly in cases of poor medication adherence

Predicting Asthma Morbidity at Three Month Follow-Up Among Low-Income African American Children With Severe Persistent Asthma

RATIONALE: This study examines predicators of asthma morbidity among a sample of low-income children with severe persistent asthma. METHODS: Eighty-one children ages 6-11 were recruited from an urban pediatric hospital. Adherence to Flovent was measured by electronic monitoring devices over 14 days. Caregivers and children were then interviewed about child depressive symptoms and behavior problems, child asthma symptoms, caregiver depressive symptoms, and social support. Three months later caregivers were interviewed about their child\u27s asthma morbidity. RESULTS: Caregivers reported a mean score of 1.1 (baseline) and 1.3 (3 months) on an asthma symptom measure, corresponding to a few days of symptoms. At 3 months they reported a mean of 3.8 asthma symptom days (over 2 weeks) and 1.8 days missed from school (over 3 months). Steroid bursts or ED visits over 3 months were reported by a quarter of the sample. Asthma morbidity indices at 3 months were related to asthma symptoms at baseline. The number of asthma symptom days at 3 months was significantly and positively correlated with caregiver report of the child\u27s depressive symptoms at baseline. Flovent adherence and other psychosocial variables were not related to any of the morbidity indices. CONCLUSIONS: Asthma morbidity at follow up was primarily associated with morbidity at baseline, and not with adherence or most psychosocial variables. As data collection is underway, our analyses will be conducted on a larger sample to further investigate the role of psychosocial variables and adherence in predicting asthma morbidity

Validity of the Family Asthma Management System Scale with an Urban African-American Sample

Objective To examine the reliability and validity of the Family Asthma Management System Scale for low-income African-American children with poor asthma control and caregivers under stress. The FAMSS assesses eight aspects of asthma management from a family systems perspective. Methods Forty-three children, ages 8–13, and caregivers were interviewed with the FAMSS; caregivers completed measures of primary care quality, family functioning, parenting stress, and psychological distress. Children rated their relatedness with the caregiver, and demonstrated inhaler technique. Medical records were reviewed for dates of outpatient visits for asthma. Results The FAMSS demonstrated good internal consistency. Higher scores were associated with adequate inhaler technique, recent outpatient care, less parenting stress and better family functioning. Higher scores on the Collaborative Relationship with Provider subscale were associated with greater perceived primary care quality. Conclusions The FAMSS demonstrated relevant associations with asthma management criteria and family functioning for a low-income, African-American sample

Bureaucracy, Tax System, and Economic Performance

This paper investigates the consequences for government size, growth and welfare if a selfish bureaucracy provides a congested input. Alternative exogenous tax systems are introduced and numerical analyses are carried out. The welfare optimum is only met under very specific assumptions: proportional congestion, a tax system only consisting of distortionary taxes and a bureaucracy that maximizes the budget's growth rate. Otherwise the relative size of the public sector becomes suboptimally large thus inducing welfare losses. From a welfare economic point of view bureaucratic selfishness is worse than a suboptimal taxing regime that does not (completely) internalize the congestion externalities. Copyright 2006 Blackwell Publishing, Inc..

Judges and Taxes: Judicial Review, Judicial Independence and the Size of Government

The study investigates how judicial review of policy and judicial independence affect the relative size of government. Judicial oversight of policy is the authority of courts to check the legality of policy measures and annul measures which are incompatible with the constitution or are enacted without following the procedures laid down by the law. Using a model of constitutional political economy, where policy making is subject to judicial oversight, it is predicted that the relative size of the public sector decreases as judicial review and judicial independence increase. The theoretical predictions are tested in an international cross section sample of 52 countries. Controlling for the effects of real income, age dependency, openness of the economy, the legal origins of a country and other socio-political variables the results show that the checks and balances provided by the judiciary lead to a smaller relative size of taxes in the economy. Copyright Springer Science+Business Media, Inc. 2005size of government, taxation, judicial review, judicial independence,