Objectives To describe rates of Medicaid-funded services provided by orthodontists in Iowa to children and adolescents, identify factors associated with utilization, and describe geographic barriers to care. Methods We analyzed enrollment and claims data from the Iowa Medicaid program for a 3-year period, January 2008 through December 2010. Descriptive, bivariate, and multivariable logistic regression analyses were performed with utilization of orthodontic services as the main outcome variable. Service areas were identified by small area analysis in order to examine regional variability in utilization. Results The overall rate of orthodontic utilization was 3.1 percent. Medicaid enrollees living in small towns and rural areas were more likely to utilize orthodontic services than those living in urban areas. Children who had an oral evaluation by a primary care provider in the year prior to the study period were more likely to receive orthodontic services. Service areas with lower population density and greater mean travel distance to participating orthodontists had higher utilization rates than smaller, more densely populated areas. Conclusions Rural residency and increased travel distances do not appear to act as barriers to orthodontic care for this population. The wide variability of utilization rates seen across service areas may be related to workforce supply in the form of orthodontists who accept Medicaid-insured patients. Referrals to orthodontists from primary care dentists may improve access to specialty care for Medicaid enrollees.
Objective: This study aimed to identify the types of foods that constitute a vegan diet and establish patterns within the diet. Dietary pattern analysis, a key instrument for exploring the correlation between health and disease was used to identify patterns within the vegan diet. Design: A modified version of the EPIC-Norfolk food frequency questionnaire (FFQ) was created and validated to include vegan foods and launched on social media. Setting: UK participants, recruited online Participants: A convenience sample of 129 vegans voluntarily completed the FFQ. Collected data was converted to reflect weekly consumption to enable factor and cluster analyses. Results: Factor analysis identified four distinct dietary patterns including: 1) convenience, (22%); 2) health conscious, (12%); 3) unhealthy, (9%); and 4) traditional vegan (7%). Whilst two healthy patterns were defined, the convenience pattern was the most identifiable pattern with a prominence of vegan convenience meals and snacks, vegan sweets and desserts, sauces, condiments and fats. Cluster analysis identified three clusters, cluster one ‘convenience’ (26.8%), cluster two, ‘traditional’ (22%) and cluster 3 ‘health conscious’ (51.2%). Clusters one and two consisted of an array of ultra-processed vegan food items. Together, both clusters represent almost half of participants and yielding similar results to the predominant dietary pattern, strengthens the factor analysis. Conclusions: These novel results highlight a need for further dietary pattern studies with full nutrition and blood metabolite analysis in larger samples of vegans to enhance and ratify these results.
W alkability-the extent to which an area is supportive of walking-is a concept that emerged from the transportation literature and has been widely adopted in health research examining the impact of the built environment on physical activity and health outcomes. 1 Factors that make neighbourhoods more walkable include pedestrian amenities such as sidewalks, crosswalks, curb cuts and traffic lights; street connectivity; mixed-land use; and the presence of a variety of destinations within walking distance, features typically found in urban more than suburban neighbourhoods. 2-4 From a public health perspective, creating more walkable neighbourhoods might be expected to lead to a healthier environment by encouraging reduced car usage and therefore lower car emissions and air pollution, and also by increasing opportunities for active transportation (physically active modes of transportation, such as walking, biking, rollerblading, skateboarding), which could increase overall levels of physical activity and decrease obesity. 5-7 Although a significant amount of research has shown that adults living in urban neighbourhoods walk more and have a lower bodymass index (BMI) than their suburban counterparts, other studies have found that this association is not consistent in all urban neighbourhoods or with all demographic groups. 4,8,9 Very little research has examined the impact of neighbourhood design on activity levels in children and youth, and the few studies that have looked specifically at youth activity have also produced mixed findings. 10-13 A study of Belgian adolescents found that they were more likely to walk and bike in less walkable neighbourhoods than more walkable neighbourhoods. 14 Other studies have found that while boys are more active in neighbourhoods that are close to commercial areas and have connected streets, girls are more active in neighbourhoods with unconnected, curvilinear, low-traffic streets. 15,16 No consistent association has been established between children's BMI and neighbourhood design, but some research suggests that certain neighbourhood characteristics may be influential. For example, neighbourhood safety and access to parks, playgrounds, recreation centres and sidewalks were significantly associated with lower BMI in girls aged 10-11 years in a US study based on a survey conducted by the National Centre for Health Statistics. 17 Higher rates of overweight and obesity were found in both boys and girls
This paper presents initial results and conclusions from the National Evaluation of a Mileage-Based Road User Charge, a 2-year field study conducted by the University of Iowa Public Policy Center. The study, which evaluates technical feasibility and user acceptance of mileage-based charging as a potential replacement for the current motor fuel tax, was authorized by the 2005 Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users, which reauthorized federal transportation funding. This study is the first to examine road user charges on a national and multijurisdictional scale. Approximately 2,650 volunteers from 12 areas throughout the country participated in the study, which concluded in July 2010. The system mileage charges were totaled and apportioned to the federal, state, and local levels with the use of onboard computers installed in participants' vehicles. The onboard computers contained Global Positioning System (GPS) receivers with an associated geographic database to identify the taxing jurisdictions in which the vehicles traveled. The average participant drove approximately 9,000 mi during the study (the study totaled more than 21 million miles). Approximately 92.5% of all driven miles were successfully measured by both the GPS and the onboard diagnostics system (OBD-II). Of the miles driven without GPS, 6.9% could be reliably assigned to jurisdictions by using straightforward interpolation techniques. Approximately 0.6% of total miles driven could not be reliably assigned to a state or local jurisdiction. Participant attitudes regarding the system and the overall concept of mileage-based charging were assessed. At the end of the study, 71% had a highly or somewhat positive view, and 17% held a highly or somewhat negative view. Participants consistently (but to varying degrees) preferred audit ability, which consisted of receiving detailed monthly invoices, over maximum privacy protection.
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