Regular Family Research Articles

A significant silence: Single mothers and the current Israeli housing discourse

I investigate the place given to Israeli single mothers' families and their right to the city in current housing discourses and state decisions. I discuss their right to appropriation--to be in the city and to occupy and make use of urban space. I also focus on their right to “difference” – namely, to have their identity and their difficulty in obtaining and securing housing fully considered in policy processes, and not to be pushed out of the social and geographic center of the country. Following the 2011 nationwide protests, the Israeli government promoted housing reforms, and housing programs became a major issue for politicians and the media. However, I demonstrate that there has been silence regarding single mothers, evident in several ways. First, policy criteria and most discourses are gender neutral and refer only to 'single parents'. Second, the mothers are framed in two opposing, simplistic categories--either as part of the weakest population or conversely as regular middle-class families. Program decisions provide only partial solutions. They also require single mothers to choose between the right to occupy a house and to difference. Using this case, I exemplify how Israel’s current housing agenda subjects the right to the city to neoliberal ideas and the overall aims of the state.

Family satisfaction in Egyptian adult intensive care units: A mixed-method study

ObjectivesTo examine family members’ satisfaction in adult intensive care units. MethodologyThis is mixed-method research. Family members of critically ill patients responded to a structured questionnaire and then were interviewed using semi-structured interviews. Quantitative and qualitative data were analyzed separately and integrated during the discussion. SettingsSix adult intensive care units in university hospitals in Egypt. Main outcome measuresFamily satisfaction was assessed using the Critical Care Family Satisfaction Survey and field notes of the interviews. ResultsThe mean total satisfaction score was 12.8 ± 3.5, and comfort has the lowest subscale mean score: 2.07 ± 0.96. Multivariate regression analysis showed that family members’ satisfaction was positively associated with their ability to communicate with patients (B [95% confidence interval]: 2.1 [1.19 to 3.02]) and negatively with daily purchasing of medications and supplies (−2.41 [−3.23 to −1.59]), low economic status (−1.57 [−2.47 to −0.67]), and perceiving patient condition to be deteriorating (−0.99 [−1.93 to −0.04]). Content analysis of qualitative data revealed four themes: aspects of family care, aspects of patient care, organizational and administrative issues and environment. ConclusionsIn Egyptian adult intensive care units, regular family meetings, flexible visiting hours, shared decision-making, increasing staff-to-patient ratio and ensuring comfortable waiting rooms are promising strategies to enhance family satisfaction.

Predictive Control Charts (PCC): A Bayesian approach in online monitoring of short runs

Performing online monitoring for short horizon data is a challenging, though cost effective benefit. Self-starting methods attempt to address this issue adopting a hybrid scheme that executes calibration and monitoring simultaneously. In this work, we propose a Bayesian alternative that will utilize prior information and possible historical data (via power priors), offering a head-start in online monitoring, putting emphasis on outlier detection. For cases of complete prior ignorance, the objective Bayesian version will be provided. Charting will be based on the predictive distribution and the methodological framework will be derived in a general way, to facilitate discrete and continuous data from any distribution that belongs to the regular exponential family (with Normal, Poisson and Binomial being the most representative). Being in the Bayesian arena, we will be able to not only perform process monitoring, but also draw online inference regarding the unknown process parameter(s). An extended simulation study will evaluate the proposed methodology against frequentist based competitors and it will cover topics regarding prior sensitivity and model misspecification robustness. A continuous and a discrete real data set will illustrate its use in practice. Technical details, algorithms, guidelines on prior elicitation and R-codes are provided in appendices and supplementary material. Short production runs and online phase I monitoring are among the best candidates to benefit from the developed methodology.

140 Lessons From the Front Line: Communication is Key

IntroductionAs junior doctors, we very rarely receive formal teaching on communication after medical school, with telephone encounters and difficult conversations over technology being a vital yet missing part of our education. The COVID-19 pandemic has required us to adapt how we communicate with patients’ families due to hospital visiting restrictions. In an era where tragically deterioration and death have been much more commonplace, we looked to identify areas where junior doctors felt their communication skills could be improved, and implemented a teaching programme to deliver this.MethodsPre-teaching questionnaires were distributed to a range of grades of junior doctors working in University Hospital of Llandough, Cardiff. The questionnaires were distributed at the beginning of June 2020, after 3 months of working in pandemic conditions. A teaching session on telephone and video communication skills was delivered by a local palliative care consultant. Post-teaching, a repeat questionnaire was undertaken to assess response and identify key learning points.ResultsPre-teaching, 100% of the 22 respondents had had to participate in difficult conversations over the phone, 82% had had no formal phone based communication skills training and 81.82% felt some form of formal teaching would be helpful. Post-teaching, 12 junior doctors provided feedback with an average 37% increase in confidence to undertake difficult conversations. Key learning points from the session highlighted the importance of preparation, regularly updating the family to build trust and rapport, and integrating family updates via tele-communication into daily ward life.ConclusionsEducation around telephone communication skills is critical to enable us to adapt our skills in accordance with the demands of the pandemic, to continue to support relatives and to engage with technology with confidence. Increased preparation is required to navigate difficult conversations via technology, and successful communication requires clinicians to take responsibility for initiating regular family updates.

Oral Health Status and Patterns of Dental Service Utilization of Adolescents in Lesotho, Southern Africa.

This study aimed to characterize the best predictors for unmet dental treatment needs and patterns of dental service utilization by adolescents in the Kingdom of Lesotho, Southern Africa. A self-reported 40-item oral health survey was administered, and clinical oral examinations were conducted in public schools in Maseru from August 10 to August 25, 2016. Associations between psychosocial factors with oral health status and dental service utilization were evaluated using simple, bivariate, and multivariate regressions. Five hundred and twenty-six survey responses and examinations were gathered. The mean age of student participants was 16.4 years of age, with a range between 12 and 19 years of age. More than two thirds (68%; n = 355) of participants were female. The majority reported their quality of life (84%) and general health to be good/excellent (81%). While 95% reported that oral health was very important, only 11% reported their personal dental health as excellent. Three percent reported having a regular family dentist, with the majority (85%) receiving dental care in a hospital or medical clinic setting; only 14% had seen a dental professional within the previous two years. The majority of participants did not have dental insurance (78%). Clinical examination revealed tooth decay on 30% of mandibular and maxillary molars; 65% had some form of gingivitis. In multivariate analysis, not having dental education and access to a regular dentist were the strongest predictors of not visiting a dentist within the last year. Our results suggest that access to oral health care is limited in Lesotho. Further patient oral health education and regular dental care may make an impact on this population.

The role of family meal frequency in common mental disorders in children and adolescents over eight months of follow-up.

ObjectiveThis study evaluated the influence of family meal frequency on the occurrence of common mental disorders (CMD) in children and adolescents over eight months of follow-up.DesignData from this longitudinal study were derived from the PAAPAS—Parents, Students, Community Health Agents, and Teachers for Healthy Eating—community trial. CMD were evaluated using the General Health Questionnaire. Frequency of family meals (breakfast and dinner) was categorized as “breakfast and dinner regularly with the family”, “at least breakfast or dinner regularly with the family”, and “does not have any meal regularly with the family.” The effect of family meal frequency on CMD was analyzed using generalized estimation equations with log-binomial models for repeated measures.SettingThis study was conducted in public schools (N = 18) of Duque de Caxias, Rio de Janeiro, Brazil, in 2016.ParticipantsChildren (aged 9–11 years) and adolescents (aged 12–17 years) from the fifth and sixth grades (N = 2,743).ResultsThese findings suggested that regular family meals were a protective factor for mental health. The adjusted relative risk of CMD was 0.75 (95% confidence interval = 0.69–0.83) for those who had two family meals regularly and 0.87 (95% confidence interval = 0.77–0.97) for those who had only one regular family meal, compared to students who had no regular family meals.ConclusionsPotential strategies that educate and encourage families about the mental health benefits of eating regular meals together must be explored and implemented.

Computationally efficient likelihood inference in exponential families when the maximum likelihood estimator does not exist

In a regular full exponential family, the maximum likelihood estimator (MLE) need not exist in the traditional sense. However, the MLE may exist in the completion of the exponential family. Existing algorithms for finding the MLE in the completion solve many linear programs; they are slow in small problems and too slow for large problems. We provide new, fast, and scalable methodology for finding the MLE in the completion of the exponential family. This methodology is based on conventional maximum likelihood computations which come close, in a sense, to finding the MLE in the completion of the exponential family. These conventional computations construct a likelihood maximizing sequence of canonical parameter values which goes uphill on the likelihood function until they meet a convergence criteria. Nonexistence of the MLE in this context results from a degeneracy of the canonical statistic of the exponential family, the canonical statistic is on the boundary of its support. There is a correspondance between this boundary and the null eigenvectors of the Fisher information matrix. Convergence of Fisher information along a likelihood maximizing sequence follows from cumulant generating function (CGF) convergence along a likelihood maximizing sequence, conditions for which are given. This allows for the construction of necessarily one-sided confidence intervals for mean value parameters when the MLE exists in the completion. We demonstrate our methodology on three examples in the main text and three additional examples in an accompanying technical report. We show that when the MLE exists in the completion of the exponential family, our methodology provides statistical inference that is much faster than existing techniques.

Effectiveness of Psychoeducation Programme on Knowledge of Schizophrenia among Care Givers of the Patients with Schizophrenia, Admitted in Selected Hospital of SGR

Background: Schizophrenia is one of the commonly occurring disorders, often causing a high degree of disability to the patients, as well as being stressful to the caregivers. Many people are still unaware that there are effective treatments for schizophrenia. A combination of regular medication, family education and support reduce the relapse rate from 50% to 60%. Psychoeducation interventions provide information to patients and their families as well as provide the tools necessary to cope with the disorder. Aim: The study aimed to find the efficacy of psycho-education on knowledge regarding schizophrenia among care givers of patients by conducting pretest before intervention and posttest after intervention. Methods: Pre-experimental one group pre-test and posttest design was used for this study. The sample of 50 care givers were selected using purposive sampling technique consists of care givers of schizophrenia patients admitted in psychiatric ward. The study was conducted at the selected state govt. hospital IMHANS Srinagar J&K India. Data was collected using structured knowledge questionnaire. The researcher first explained the aim of the evaluation and invited family members to take part. After consenting to participate in the study, family members were assessed in group of twenty five. Result: mean knowledge score at pre-test was 8.94+5.101 and 27.66+1.814 at post test. There was significant difference in knowledge scores of pre-test and post-test p<0.001).There was no significant association between knowledge score and demographic variables. Conclusion: There was significant gain in knowledge score of care givers. The study concluded that psycho education was effective in increasing the knowledge of care givers of schizophrenia patients. Psycho education of the family members is the key to understand about the illness and provide better care to the patient.

Visitation Access to U.S. Nursing Homes: An Analysis of Facility Locations, Ratings, and Disparities

Research findings suggest that family visits to nursing home residents are important for countering depression, increasing residents’ well-being and quality of life (Miller, 2019; Durkin et al., 2014), maintaining physical function (Shankar et al., 2017), and improving general health (Parmenter et al., 2012). Presence by family can directly impact a resident’s care quality, since family members may take a role in monitoring their older relative’s status (Miller, 2019). Unfortunately, regular family visits to nursing homes may be difficult, or impossible, due to challenges that include distance, travel time, lack of transportation, and cost (Fields et al., 2019) (Miller, 2019). These same challenges may translate to socio-economic barriers for families, eliminating long-term-care as an option for older relatives (Ferraro et al., 2017), (Angel and Berlinger, 2018). This paper considers the issue of nursing home visitation access and examines related disparities through spatial and demographic analysis of 15,000+ US facilities monitored by the Centers for Medicare the Medicaid Services. Mathematical models are used to analyze facility and population data, using access measures adapted from the geography discipline (Lou and Wang, 2003; Paez et al., 2019). Analysis explores whether higher rated nursing homes are more likely to be closer to affluent populations, and whether socioeconomic status is a significant factor in overall access. Analysis reveals patterns of access disparity with respect to nursing home ratings and geographies. For example, proximity to higher rated facilities increases monotonically with median household income. Specific policy recommendations are discussed.

Testing a Point Null Hypothesis against One-Sided for Non Regular and Exponential Families: The Reconcilability Condition to P-values and Posterior Probability

Testing a Point Null Hypothesis against One-Sided for Non Regular and Exponential Families: The Reconcilability Condition to P-values and Posterior Probability

The awareness, visibility and support for young carers across Europe: a Delphi study

BackgroundAcross Europe, young carers (YCs) and their need for support receive limited attention in the media, policy and empirical research, even though, similar to adult carers, they also provide care to ill family members. The Delphi study, a qualitative research methodology, which provides the focus for this article, had the overall aim of exploring existing successful strategies to support YCs. Compared to YCs, even less is known about adolescent young carers (AYCs), a group that is in a critical life transition phase. The study forms part of an EU Horizon 2020 funded research project on AYCs aged 15–17 years old.MethodsA two-round Delphi study was conducted with 66 experts on YCs from 10 European countries. Topics included: (i) visibility and awareness-raising of YCs at local, regional, and national levels, (ii) current interventions to support YCs, and (iii) future strategies to support YCs.ResultsExperts reported a lack of visibility and awareness about YCs in general, and AYCs in particular. Although awareness is slowly increasing in most countries, with the UK ranked highest, experts acknowledged that it remains challenging to identify YCs in many countries. Furthermore, the level and type of support available for YCs differs, with most countries mainly offering support on a local level. Diverse views were expressed regarding future strategies to support YCs. Experts highlighted the importance of specific legislation to formalise the rights of YCs, and the issue of whether young people should be safeguarded from caregiving or if this should be considered part of regular family life. They also emphasised the relevance of available integrated support services for YCs, including schools, family, health and social care.ConclusionsIn most European countries, there is a lack of awareness and visibility on YCs. Identification of YCs is a crucial first step and there is need for a common definition of YCs, together with greater opportunities for young adults to identify themselves as YCs.

Formative Evaluation of Open Goals: A UK Community-Based Multi-Sport Family Programme.

Community parks provide opportunities for physical activity (PA) and facilitate social interactions. This formative evaluation assesses the implementation of ‘Open Goals’ (OG), a novel multi-sport programme aiming to increase family PA and community cohesion, delivered weekly by Liverpool Football Club’s charitable foundation to local parks in Liverpool, North West England. Three Open Goals parks were chosen for the evaluation settings. Formative evaluation measures included: System for Observing Play and Recreation in Communities (SOPARC) observations (n = 10), direct session observations (n = 8), semi-structured interviews with Open Goals coaching staff (n = 3), and informal feedback from families (n = 5) about their experiences of Open Goals. Descriptive statistics and thematic analysis were applied to quantitative and qualitative data, respectively. Within the three evaluation parks, Open Goals reached 107 participants from May–July 2019, through 423 session attendances. Fidelity of the programme was high (M = 69% of session content delivered as intended). Overall park use when OG was offered compared to when it was not offered was not statistically significant (p = 0.051), however, target area use was significantly increased (p = 0.001). Overall physical activity levels in parks were significantly (p = 0.002) higher when Open Goals was being offered, compared to when it was not. Coaches reported that engagement in OG positively affected family co-participation and children’s behavioural development. Contextual issues included environmental and social barriers to programme engagement, including the co-participation element of the programme and criticism of the marketing of OG. It is evident that community-based multi-sport PA programmes endorsed by professional football clubs are well positioned to connect with local communities in deprived areas and to encourage PA and community engagement. This study suggests that such programmes may have the ability to improve park usage in specific areas, along with improving physical activity levels among families, although further research is required. Effective marketing strategies are needed for promotional purposes. Upskilling of coaches in the encouragement of family co-participation may support regular family engagement in PA in local parks.

On the Metric Dimension of Generalized Tensor Product of Interval with Paths and Cycles

The concept of minimum resolving set for a connected graph has played a vital role in Robotic navigation, networking, and in computer sciences. In this article, we investigate the values of m and n for which P2⊗mPn and P2⊗mCn are connected and find metric dimension in this case. We also conclude that, for each m, we obtain a new regular family of constant metric dimension. We also give a basis for these graphs and presentation of resolving vector in general closed form with respect to the basis.

Why people select the outpatient clinic of medical centers: a nationwide analysis in Taiwan.

IntroductionIn contrast to other countries, Taiwan’s National Health Insurance (NHI) program allows patients to freely select the specialists and tiers of medical care facility without a referral. Some medical centers in Taiwan receive over 10,000 outpatients per day. In the NHI program, the co-payment was increased for high-tier facilities for outpatient visits in 2002, 2005, and 2017. However, the policies only mildly reduced the use of high-tier medical care facilities. The main purpose of this study was to evaluate the factors contributing to the patients’ selection of the outpatient clinic of medical centers without a referral.MethodsAn online anonymous survey was conducted by using the Google Forms platform utilizing a self-constructed questionnaire from September to October 2018. A nationwide sample in Taiwan was recruited using convenience sampling through social media. Based on a literature review and a focus group, 20 factors that may affect the choice of the outpatient institution were constructed. The associations between items that affect the patients selection of outpatient clinics were assessed using exploratory factor analysis. Principal axis factoring was performed to identify the major factors affecting the decision. Multiple logistic regression was performed to determine which factors satisfactorily explained “visiting the outpatient clinic of the medical center for an illness without a referral.”ResultsDuring the survey period, 5,060 people browsed the online survey, and 1,003 responded and completed the online questionnaire. Therefore, the response rate was 19.8%. A total of 987 valid responses was collected. Exploratory factor analysis revealed that three main factors, namely the “physician factor”, “image and reputation factor”, and “facility and medication factor”, affected the selection of outpatient clinics. A series of logistic regressions indicated that patients who reported that hospital facilities, high-quality drugs, and diverse specialties were very important were more likely to select the outpatient clinic of a medical center (OR = 2.218, 95% CI [1.514–3.249]). Patients who reported that physician factors were very important were less likely to select a medical center (OR = 0.717, 95% CI [0.523–0.984]). Patients who were previously satisfied with their experience of the primary clinics or had a regular family doctor were less likely to choose a medical center (OR = 0.509, 95% CI -0.435–0.595] and OR = 0.676, 95% CI [0.471–0.969]).ConclusionIn Taiwan, patients with good primary medical experience and regular family physicians had significantly lower rates by selecting the outpatient clinic of a medical center. The results of this study support that the key to establishing graded medical care is to prioritize the strengthening of the primary medical system.

Health-related quality of life and determinants in North-China urban community residents

BackgroundThe objectives of this study were to investigate the HRQoL of residents living in central urban areas (CUA) and developing neighborhoods (DN) areas of North-China and to examine the relationship between health conditions and the physical and mental components of quality of life.MethodsA stratified random sample was taken and health survey scoring system questionnaire SF-36 was used to conduct the HRQoL survey among community residents in the two selected districts in 10 cities. A general questionnaire was also administered with questions that collected general information, population demographic characteristics and health behaviours, social relationships and perception of life satisfaction.ResultsFive thousand eight hundred eighty-one questionnaires were returned from 6059 invitations with a effective response rate of 97%. The residents in DN had a higher score of physical function, role limitation due to physical problems and vitality than those living in CUA. The prevalence of several chronic diseases was lower in DN’s residents than CUA’s residents. Age, presence/absence of chronic diseases, leisure time exercise, regular daily routine, sleep quality, appetite, family and social relationships and life satisfaction were significant determinants of HRQoL.ConclusionsResidents living in newly developed neighborhoods in China while keeping some habits and lifestyles of their original rural communities are healthier in terms of chronic diseases and HRQoL. Together with other risk factors chronic diseases are an important determinant on HRQoL. Several healthy habits and behaviors such as having a regular daily routine and exercising during leisure time improved HRQoL in Chinese urban communities. Targeted policies of public health based on these findings can better the health-related quality of life.

Multimodal exponential families of circular distributions with application to daily peak hours of PM2.5 level in a large city

In this paper, we propose two multimodal circular distributions which are suitable for modeling circular data sets with two or more modes. Both distributions belong to the regular exponential family of distributions and are considered as extensions of the von Mises distribution. Hence, they possess the highly desirable properties, such as the existence of non-trivial sufficient statistics and optimal inferences for their parameters. Fine particulates (PM2.5) are generally emitted from activities such as industrial and residential combustion and from vehicle exhaust. We illustrate the utility of our proposed models using a real data set consisting of fine particulates (PM2.5) pollutant levels in Houston region during Fall season in 2019. Our results provide a strong evidence that its diurnal pattern exhibits four modes; two peaks during morning and evening rush hours and two peaks in between.

1612-P: Liver Enzyme Is Associated with Future Remission from Impaired Fasting Glucose to Normal Fasting Glucose: The Kansai Healthcare Study

Prediabetes is a key risk for type 2 diabetes and its remission to normal glucose regulation has been shown to prevent or delay the onset of diabetes. However, which factors play roles in remission is not fully understood. We prospectively examined the relationships between liver enzymes at baseline and future remission from impaired fasting glucose (IFG) to normal fasting glucose (NFG). We included 3334 middle-aged Japanese men with IFG and not taking diabetic medications at baseline. They were followed for up to 11 years. IFG was defined as fasting plasma glucose level 100-125 mg/dL and HbA1c <6.5%. Remission to NFG was defined as fasting plasma glucose level <100 mg/dL detected two times consecutively at the annual checkup. Those who had developed diabetes before they achieved remission to NFG were not counted as remission. Cox proportional hazard models were used to estimate hazard ratios (HRs) for achieving remission to NFG. Alanine transaminase (ALT) and aspartate transaminase (AST) were divided into the following quartiles: 5-19, 20-26, 27-37, and ≥38 IU/L for ALT; 11-19, 20-23, 24-29, and ≥30 IU/L for AST. A total of 1224 subjects remitted to NFG during 19780 person-years. Incidence rates per 1000 person-years for quartiles 1, 2, 3, and 4 of ALT/AST were 81/65, 62/67, 56/60, and 49/56, respectively. In a multiple-adjusted model that included age, fasting plasma glucose, body mass index, smoking status, regular physical exercise, alcohol consumption, and family history of diabetes, HRs of future remission to NFG for quartiles 2, 3, and 4 of ALT were 0.84 (95% CI, 0.72-0.99), 0.84 (0.72-0.99), and 0.82 (0.69-0.97), respectively, compared to quartile 1. In the same model except AST was substituted for ALT, HRs of those for quartiles 2, 3, and 4 of AST were 1.04 (0.89-1.22), 1.02 (0.87-1.20), and 1.02 (0.87-1.21), respectively, compared to quartile 1. In conclusion, elevated ALT was inversely associated with future remission from IFG to NFG, but AST was not. Disclosure I. Shibata: None. K.K. Sato: None. M. Shibata: None. H. Koh: None. S. Uehara: None. K. Oue: None. H. Kambe: None. M. Morimoto: None. T. Hayashi: None.

Meenoostahtan Minisiwin: First Nations Family Justice "Pathways to Peace"

Community justice initiatives are now common in Canada, both for young offenders and in adult criminal cases; there are only a few examples of alternative methods for dealing with justice issues in the area of mandated child welfare services. The initiative outlined in this paper represents one of the most comprehensive family justice initiatives in First Nations Child and Family Services in Canada. Meenoostahtan Minisiwin: First Nations Family Justice offers a new way of addressing conflict in child and family matters, outside of the regular Child and Family Services (CFS) and court systems. It incorporates the traditional peacemaking role that has existed for centuries in Northern Manitoba Cree communities, alongside contemporary family mediation. The program brings together family, extended family, community members, Elders, social workers and community service providers in the resolution of child protection concerns through the use of properly trained Okweskimowewak (family mediators). The Okweskimowewak’s role involves assisting participants to articulate their personal ‘truth’ (dabwe) and to hear and respect the dabwe of others; to create a safe and nurturing context by addressing inherent power imbalances; to explore the root causes of family conflict in order to address the long term best interests of children; and to facilitate innovative and collaborative planning outcomes for families. The program was developed by the Awasis Agency of Northern Manitoba, a mandated First Nations Child and Family Services agency, although it receives its services mandate from the Manitoba Keewatinowi Okimakanak (MKO) Exectuive. It is jointly funded by the Aboriginal Justice Strategy of Justice Canada and the Manitoba Department of Family Services and Housing. Overall direction for the program is provided by the First Nations Family Justice Committee, a sub-committee of the MKO Exectuive Director of Awasis Agency, and representative chiefs of the MKO region. The program currently employs a Program Coordinator, two full time regional Okweskimowewak, two full time community-based Okweskimowewak and an administrative assistant. Since its inception in 1999, the program has received referrals involving more than seven hundred families, including well over 1900 children and 1500 volunteer participants. Services have been provided in seventeen First Nation communities in Northern Manitoba as well as in Thompson, Winnipeg, The Pas, and Gillam. The Meenoostahtan Minisiwin program responds to all aspects of mandated child welfare, as well as other situations where the best interests of children are in jeopardy. These have included mediating care placement arrangements; child-parent conflicts; family-agency or family-agency-system conflicts; assisting in the development of service plans in neglect and abuse cases; advocating on behalf of families attempting to access services; family violence; larger community-wide conflicts; and working to address systemic problems which impact the lives of First Nations children and families. We believe that by establishing processes which focus on restoring balance and harmony within families and communities, we are working towards an overall increase in the health and wellness of community members. And you who would understand justice,
 How shall you, unless you
 Look upon all deeds In the fullness of light?
 Only then shall you know that the erect
 And the fallen are but one
 man standing in
 The twilight between the
 Night of his pigmy-self
 And the day of his god-self.
 K. Gibran

Daily life in National Disability Insurance Scheme times: Parenting a child with Down syndrome and the disability politics in everyday places

Social inclusion for people with disability is bound up with experiences of place in everyday life. In Australia, the inclusion agenda has been recently propelled by the National Disability Insurance Scheme which promotes – and funds – the full inclusion of people with disability so that their lives are conducted in everyday settings. This article addresses what lies between the aspirational policy principles of full inclusion and the experience of family life with a young child who has Down syndrome. Through auto-ethnographic inquiry, a series of vignettes describe my own encounters in everyday places such as shops, childcare centres and public swimming pools. I focus on ‘sense of place’ which is generated through everyday practices and can shape individual identity and belonging. Using ideas from feminist poststructuralism and critical disability studies, I argue that ableist discourses on disability are produced by people in everyday places through their attitudes, actions and expectations, disrupting regular family life and imposing oppressive modes of subjectivity upon children with intellectual disability and their parent-carers. In response, parents of children with intellectual disability are challenged to undertake the political labour of everyday disability advocacy. It is important for social work to recognise that this labour can become a significant part of the contemporary parent-carer role.

Use of the health care system by Ontario First Nations people with diabetes: a population-based study.

First Nations people in Ontario have an increased prevalence of diabetes compared to other people in the province. This study examined use of health care services by First Nations people with diabetes and other people with diabetes in Ontario. Using linked health administrative databases, we identified all people in Ontario with diabetes as of Apr. 1, 2014. We identified First Nations people using the Indian Register. We looked at outcomes from Apr. 1, 2014, to Mar. 31, 2015. We determined the proportion of people with a regular family physician and their continuity of care with that physician. We also examined visits with specialists for diabetes care, hospital admissions for ambulatory-care-sensitive conditions, and emergency department visits for hypo- or hyperglycemia. There were 1 380 529 people diagnosed with diabetes in Ontario as of Apr. 1, 2014, of whom 22 952 (1.7%) were First Nations people. First Nations people were less likely to have a regular family physician (85.3% v. 97.7%) and had lower continuity of care with that physician (mean score for continuity of care 74.6 v. 77.7) than other people in Ontario. They were also less likely to see specialists. First Nations people were more likely to be admitted to hospital for ambulatory-care-sensitive conditions (2.4% v. 1.2%) and to have an emergency department visit for hypo- or hyperglycemia (1.5% v. 0.8%). Disparities were particularly marked for those living in First Nations communities. First Nations people with diabetes in Ontario had poorer access to and use of primary care than other people with diabetes in the province. These findings may help explain continued disparities in the rates of complications related to diabetes.