The end-of-life needs of Aboriginal and immigrant communities: a challenge to conventional medical models

IntroductionConcerns have been raised internationally about the palliative care needs of migrants and First Nations people. This article presents insights from research investigating the end-of-life needs of Aboriginal and culturally and linguistically diverse people living in Western Sydney, Australia. This region has a large rapidly growing, and highly diverse population and on average low socioeconomic status. The research was guided by an advisory panel made up of representatives of supportive and palliative medicine, bereavement support, Aboriginal health, and multicultural health facilities. It aimed to generate findings to support the delivery of culturally sensitive services in the public health system.MethodThe multi-method design and the conduct of the research were informed by the literature on researching with marginalized groups which highlights the ethical considerations needed to avoid replicating past injustices. Qualitative data was generated from key informants and community focus groups.ResultsThe analysis revealed seven themes and some suggested solutions which were relevant across several themes. The seven themes were: the Need for trusted relationships; Talking about death and dying; Knowledge of key services; Decision-making and obtaining consent from the patient; Appropriate physical spaces; Cultural practices around EOL; and Language barriers.DiscussionWithin each theme a variety of cultural beliefs and practices were revealed that conflicted with mainstream medical systems, indicating the need for changes in such systems. ‘Compassionate Communities' was identified as a model to support the necessary changes

Practicing Feminist Materialisms:Pedagogy and Critique

Whether as a theoretical topic of inquiry or as a methodological platform for conducting research and developing teaching tools and assessment, feminist materialisms re-imagine the classroom experience through interdisciplinary and transversal learning and teaching practices. This workshop brought together a group of scholars interested in making fruitful connections between theories and methodologies of feminist materialism, with the aim to extend these connections into a volume of the &#8216;Teaching with Gender Series&#8217; published by AtGender. The focus of the workshop included clarification of what we understand by new/European feminist materialisms and material feminisms/pedagogies, as well as sharing the learning and teaching practices that we use and hope to develop in this context. Through this we aimed to make visible and palpable the materialities already at play in our (feminist) classrooms by taking into account the entangled human and more than human actors that emerge in pedagogical practice.Practicing Feminist Materialisms: Pedagogy and Critique, workshop, ICI Berlin, 29 November 2013 <https://doi.org/10.25620/e131129

'To see a world in a grain of sand...': thinking universality and specificity for a feminist politics of difference

Sexual difference has emerged in the last three decades as an enduring question for feminism. Drawing attention to the embodied nature of subjectivity, it enables feminists to counter the more insidious presumptions of universality and the phallocentric economy of knowledge production, and makes possible feminine expressions of subjectivity. At the same time, engaging the nature of difference has opened the way to a more detailed interrogation of identity, specifically the identity of ' woman' and 'the feminine' as categories of feminist analysis. However, tensions have emerged within this field over the concept of community, and how to motivate for political change on the basis of a common identity when the identity of woman is itself contested. In tracing these arguments, this thesis raises a number of considerations about the way difference is understood. It finds that a conceptual commitment to the specificity of the body as properly constitutive of the political can run the risk of sidelining, denigrating and presuming to excise what appears as universal, masculine, or phallocentric. In doing so, it potentially leaves aside a full political engagement with the generative and implicated nature of these terms in the formation of all identity. Consequently, questions around thought, universality, virtuality, and disembodiment may not be given full consideration, with the outcome that feminism may be foreclosing its political domain from important formative concerns. The primary aim of this thesis is to open these categories of analysis to question, to understand how they have been constructed in debates around difference, and to bring to light some of the assumptions which remain axiological to what properly constitutes feminist politics. Engaging Luce Irigaray's reading of divinity for community and identity, this thesis argues that if the implicated nature of identity is taken seriously then the organising categories fundamental to notions of political action and community become a general field of difference which exceeds the reach of feminist politics as it currently stands

What Matters in the End: Understanding the End-of-Life Needs of Culturally & Linguistically Diverse and Aboriginal Communities in Western Sydney Local Health District

What Matters in the End is the culmination of a three-year multi-method, multi-disciplinary research initiative investigating the end-of-life needs of culturally diverse people living in Western Sydney. The research was undertaken by the Western Sydney University Caring at End-of-Life Research Program in collaboration with Western Sydney Local Health District. We worked with participants from the Aboriginal community and from Arabic, Mandarin and Hindi speaking backgrounds, as well as healthcare professionals and people working in the end-of-life space, to find out what is needed in the service system and wider community to support culturally diverse people and their families at end-of life. The report provides details of the research design and findings as well as a comprehensive set of recommendations for the delivery of culturally appropriate and safe end-of-life and bereavement care

Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry

Background: COVID-19 has been associated with a broad range of thromboembolic, ischemic, and hemorrhagic complications (coagulopathy complications). Most studies have focused on patients with severe disease from high-income countries (HICs). Objectives: The main aims were to compare the frequency of coagulopathy complications in developing countries (low- and middle-income countries [LMICs]) with those in HICs, delineate the frequency across a range of treatment levels, and determine associations with in-hospital mortality. Methods: Adult patients enrolled in an observational, multinational registry, the International Severe Acute Respiratory and Emerging Infections COVID-19 study, between January 1, 2020, and September 15, 2021, met inclusion criteria, including admission to a hospital for laboratory-confirmed, acute COVID-19 and data on complications and survival. The advanced-treatment cohort received care, such as admission to the intensive care unit, mechanical ventilation, or inotropes or vasopressors; the basic-treatment cohort did not receive any of these interventions. Results: The study population included 495,682 patients from 52 countries, with 63% from LMICs and 85% in the basic treatment cohort. The frequency of coagulopathy complications was higher in HICs (0.76%-3.4%) than in LMICs (0.09%-1.22%). Complications were more frequent in the advanced-treatment cohort than in the basic-treatment cohort. Coagulopathy complications were associated with increased in-hospital mortality (odds ratio, 1.58; 95% CI, 1.52-1.64). The increased mortality associated with these complications was higher in LMICs (58.5%) than in HICs (35.4%). After controlling for coagulopathy complications, treatment intensity, and multiple other factors, the mortality was higher among patients in LMICs than among patients in HICs (odds ratio, 1.45; 95% CI, 1.39-1.51). Conclusion: In a large, international registry of patients hospitalized for COVID-19, coagulopathy complications were more frequent in HICs than in LMICs (developing countries). Increased mortality associated with coagulopathy complications was of a greater magnitude among patients in LMICs. Additional research is needed regarding timely diagnosis of and intervention for coagulation derangements associated with COVID-19, particularly for limited-resource settings.</p