Search

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.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.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.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.

OBJECTIVES: To date, only a few studies have attempted to study the processes by which community design and the built and social environments affect individual physical activity, especially in children. Qualitative enquiry is useful for exploring perceptions and decision-making, and to understand the processes involved in how people interact with their environments. This study used qualitative methods to gain insight into the pathways linking the neighbourhood environment with children's activity patterns. METHODS: Data were collected in semi-structured interviews with 24 child-parent dyads (children aged 10-14 years). Families lived in neighbourhoods ranging from lowest to highest median income and representing the three main design types found in Saskatoon - urban, semi-suburban and suburban. RESULTS: Parents and children underscored the importance of safe environments for children's physical activity: streets or paths they can cycle on without feeling threatened, parks and green spaces free of criminal activity, and neighbourhoods where people know each other and children have friends to play with. Although grid-pattern urban neighbourhoods with a high density of destinations may in principle promote active transportation, the higher levels of crime and traffic danger that tend to exist in these areas may hinder physical activity in children.CONOCLUSION: Understanding what facilitates activity in children is a complex endeavour. It requires understanding the barriers to physical activity present at the neighbourhood level as well as social and perceptual factors that act in interdependent ways to either promote or hinder children's physical activity. Language: en

As increasing amounts of intercity freight are transported by trucking firms, the possibility of constructing truck-only lanes along selected rural Interstate highways warrants consideration. On heavily traveled sections, there is potential for improvements in safety and productivity if such lanes were added. In this paper, we explore the conditions under which investment in truck-only lanes could be considered and what sorts of benefits may accrue to both occupants of passenger vehicles and to operators of heavy trucks. Then we examine the available evidence regarding the nature and magnitude of these benefits to gain insight into the willingness of highway users to pay for these lanes. We conclude that the willingness to pay for truck-only lanes on the part of occupants of passenger vehicles appear to be quite limited and that support for these lanes on the part of trucking firms is likely to depend upon their being allowed to operate longer-combination vehicles (LCVs) on them. Trucking firms could be assessed tolls to travel in truck-only lanes, with these tolls representing some fraction of the increased productivity gained through being allowed to operate LCVs. Finally, we pose several questions that would need to be answered before an investment in truck-only lanes might be considered along a given Interstate segment.