Kommunal delegation - särskilt inom socialrätten

This thesis deals with municipal delegation and in particular the excercise of authority over individuals within the field of social law. Said exercise of authority primarily concerns compulsive preventive detention and applications for compulsory care under LVU. The thesis consists of a descriptive part where the applicable law regarding municipal delegation is investigated. Concepts covered include enforcement, decision making, layperson governance (lekmannastyre), local self-government and the rule of law. The essay examines what the legislative history says about the design of the regulation concerning delegation. In the discussion this paper evaluates existing law and points to a number of interesting points. The results of the survey are analyzed, finally, with the help of a protocol for the investigation of formal legal security. 150 years ago all tasks in municipalities were performed by laypeople. As the municipalities responsibilities has grown and more stringent requirements have been placed on municipal decision-making, municipalities have increasingly become servant organizations. Despite the fact that the Swedish municipalities employ more than 1 million people there is almost no mention of municipal public servants in municipal law. Instead of legislating the employees’ tasks, the legislator has opted to let the servants perform their duties on delegation by the municipal committees. The law names the committees as the responsible decision makers in most cases. The reason for this construction is that Sweden has an important principle of local self-government. This means that municipalities should be free to form their own organizations to suite their own needs. The thesis has found that local self-government is a very strong principle. It makes the rules on delegation is very permissive. There are no formal requirements. In the area of authority against the individual, however, the regulations are stricter. Delegation is in this case not permitted. Compulsory voting prevails. A case of official authority against the individual under LVU must always be examined by the administrative court. The legal survey concludes that delegation rules are properly secure, among other things because it is the collective that makes decisions. The theory is that the more people who make decisions, the better legal certainty we have. But it would have been more certain if the legislator was elaborate on what legal certainty is.Uppsatsen behandlar kommunal delegation och speciellt den myndighetsutövning mot enskild som sker på socialrättens område. Framförallt gäller myndighetsutövningen tvångsomhändertaganden och ansökan om tvångsvård enligt LVU. Uppsatsen består av en deskriptiv del där gällande rätt avseende kommunal delegation utreds. Begrepp som behandlas är bland annat ren verkställighet, beslut, lekmannastyrning, kommunal självstyrelse och rättssäkerhet. Uppsatsen undersöker vidare vad förarbetena säger om utformningen av delegationsregleringen. I diskussion utvärderar uppsatsen gällande rätt och pekar på ett antal intressanta punkter. Resultatet av undersökningen analyseras slutligen med hjälp av ett protokoll för undersökning av formell rättssäkerhet. För 150 år sedan utfördes alla uppgifter i kommunerna av förtroendevalda lekmän. Allteftersom kommunernas uppgifter har blivit fler och mer krav ställs på kommunalt beslutsfattande har kommunerna i ökande grad blivit tjänstemannaorganisationer. Trots att de svenska kommunerna anställer mer än 1 miljon personer förekommer de anställda nästan inte alls i kommunallagen. Istället för att lagfästa de anställdas arbete har lagstiftaren valt att låta tjänstemännen utföra sina uppgifter på delegation från de kommunala nämnderna. I lagen är det nämnden som står som ansvarig beslutsfattare i de flesta fall. Anledningen till denna konstruktion är att vi i Sverige har en viktig princip: det kommunala självstyret. Det innebär att kommunerna ska vara fria att utforma sina egna organisationer så som det passar dem bäst. I undersökningen konstateras att den kommunala självstyrelsen är en mycket stark princip. Den gör att reglerna om delegation är mycket tillåtande. Det saknas formkrav. På området för myndighetsutövning mot enskild är det däremot hårdare regler. Delegation är då inte tillåten. Röstplikt råder. Ett fall av myndighetsutövning mot enskild enligt LVU ska alltid prövas av förvaltningsdomstol. Rättssäkerhetsundersökningen kommer fram till att delegationsreglerna är rättssäkra bland annat på grund av att det är kollektivet som fattar beslut. Teorin är att ju fler som fattar beslut desto bättre rättssäkerhet har vi. Men det hade varit mer säkert om lagstiftaren uttalade hur han definierar rättssäkerhet

Pulmonary valve endocarditis caused by right ventricular outflow obstruction in association with sinus of valsalva aneurysm: a case report

<p>Abstract</p> <p>Background</p> <p>Right-sided infective endocarditis is uncommon. This is primarily seen in patients with intravenous drug use, pacemaker or central venous lines, or congenital heart disease. The vast majority of cases involve the tricuspid valve. Isolated pulmonary valve endocarditis is extremely rare. We report the first case of a pulmonary valve nonbacterial thrombotic endocarditis caused by right ventricular outlflow tract (RVOT) obstruction in association with a large sinus of Valsalva aneurysm.</p> <p>Case presentation</p> <p>A 60-year-old man with a six-week history of fever, initially treated as pneumonia and sinusitis with levofloxacin, was admitted to the hospital with a new onset of a heart murmur. An echocardiogram showed thickening of the pulmonary valve suggestive of valve vegetation. A dilated aortic root and sinus of Valsalva aneurysm measuring at least 6.4 cm were also identified. The patient was empirically treated for infective endocarditis with vancomycin and gentamycin for 28 days. Four months later, the patient underwent resection of a large aortic root aneurysm and exploration of the pulmonary valve. During the surgery, vegetation of the pulmonary valve was confirmed. Microscopic pathological examination revealed fibrinous debris with acute inflammation and organizing fibrosis with chronic inflammation, compatible with a vegetation. Special stains were negative for bacteria and fungi.</p> <p>Conclusion</p> <p>This is the first case report of a pulmonary valve nonbacterial endocarditis caused by RVOT obstruction in association with a sinus of Valsalva aneurysm. We speculate that jets created by the RVOT obstruction and large sinus of Valsalva aneurysm hitting against endothelium of the pulmonary valve is the etiology of this rare nonbacterial thrombotic endocarditis.</p

The risk for bacterial endocarditis in cirrhotic patients: a population-based 3-year follow-up study

[[abstract]]Background We noted only rare reports of cirrhotic patients with bacterial endocarditis (BE). There is insufficient data on the risk of BE in liver cirrhosis. This is the first national population-based study evaluating the risk of BE in cirrhotic patients. Methods We used the National Health Insurance Database, which is derived from the Taiwan National Health Insurance Program. The study cohort comprised 40 803 patients with cirrhosis and the comparison cohort consisted of 40 841 randomly selected subjects with a similar age and sex distribution. Results Of the total 81 644 patients, 192 (0.24%) experienced BE during the 3-year follow-up period, 121 patients from the study cohort (0.30% of the cirrhotic patients) and 71 patients from the comparison group (0.17% of non-cirrhotic patients) (p＜0.001). After adjusting for patient age, sex, and comorbid disorders, the Cox regression analysis showed that cirrhotic patients had a high risk of BE compared to non-cirrhotic patients during the 3-year follow-up period (hazard ratio 2.04, 95% confidence interval 1.61–2.44, p＜0.001). Conclusion We conclude that liver cirrhosis is a risk factor for the occurrence of BE.[[notice]]補正完畢[[incitationindex]]SCI[[booktype]]紙

Staphylococcus aureus Bacteraemia in a Tropical Setting: Patient Outcome and Impact of Antibiotic Resistance

Background: Most information on invasive Staphylococcus aureus infections comes from temperate countries. There are considerable knowledge gaps in epidemiology, treatment, drug resistance and outcome of invasive S. aureus infection in the tropics. Methods: A prospective, observational study of S. aureus bacteraemia was conducted in a 1000-bed regional hospital in northeast Thailand over 1 year. Detailed clinical data were collected and final outcomes determined at 12 weeks, and correlated with antimicrobial susceptibility profiles of infecting isolates. Principal Findings: Ninety-eight patients with S. aureus bacteraemia were recruited. The range of clinical manifestations was similar to that reported from temperate countries. The prevalence of endocarditis was 14%. The disease burden was highest at both extremes of age, whilst mortality increased with age. The all-cause mortality rate was 52%, with a mortality attributable to S. aureus of 44%. Methicillin-resistant S. aureus (MRSA) was responsible for 28% of infections, all of which were healthcare-associated. Mortality rates for MRSA and methicillin-susceptible S. aureus (MSSA) were 67% (18/27) and 46% (33/71), respectively (p = 0.11). MRSA isolates were multidrug resistant. Only vancomycin or fusidic acid would be suitable as empirical treatment options for suspected MRSA infection. Conclusions: S. aureus is a significant pathogen in northeast Thailand, with comparable clinical manifestations and a similar endocarditis prevalence but higher mortality than industrialised countries. S. aureus bacteraemia is frequently associated with exposure to healthcare settings with MRSA causing a considerable burden of disease. Further studies are required to define setting-specific strategies to reduce mortality from S. aureus bacteraemia, prevent MRSA transmission, and to define the burden of S. aureus disease and emergence of drug resistance throughout the developing world. © 2009 Nickerson et al

“It is like working with a small satellite from the rest of the solar system” : A qualitative study regarding the meaning of the social network in adolescents’ treatment against substance use

The aim for this study was to examine how social workers perceive the social network’s function and involvement in an adolescent’s process toward changing a substance use. The study is based on seven qualitative interviews with social workers in Mini-Maria facilities, working with youths/adolescents in psychosocial substance use treatment. The interviews were analysed with a brief inspiration from the approach of thematic analysis. The ecological systems theory as well as a perspective on the theory of social capital were used for interpretation of the result. The overall conclusion is that adolescents’ networks have a large impact on their substance use treatment, both in terms of the outcome as well as the meaning to the adolescent itself. Parents of youths are frequently involved in the practical treatment, while friends rarely are, but they both form a central part regarding the process of change. The social capital is also of great importance since it is constructed within the different parts of the social network where the youth experiences support. Social capital can therefore be both constructive and destructive depending on the structure of those relationships

Pneumococcal vaccine responses in elderly patients with multiple myeloma, Waldenstrom’s macroglobulinemia, and monoclonal gammopathy of undetermined significance

AbstractBackgroundVaccination with the 23-valent pneumococcal polysaccharide vaccine (PPV) has been recommended for elderly patients with B cell malignancies and dysfunctions because of their enhanced susceptibility to pneumococcal infections. More recent recommendations advocate the use of conjugate pneumococcal vaccines.MethodsWe compared responses to single dose vaccination with either PPV or the 7-valent pneumococcal conjugate vaccine (PCV7) in fifty-six patients ⩾60 years with a diagnosis of multiple myeloma (n = 24), Waldenstrom’s macroglobulinemia (n = 15) and the non-malignant B cell disorder monoclonal gammopathy of undetermined significance (MGUS) (n = 17), and 20 age-matched controls. Serum was collected prior to vaccination and 4–8 weeks later, and analyzed for IgG antibody levels to pneumococcal serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F by ELISA. Functional antibody activity towards pneumococcal serotypes 4 and 14 was measured using an opsonophagocytic killing assay (OPA).ResultsAll patient groups had lower pre-vaccination IgG antibody and OPA titers to the investigated serotypes compared to the healthy controls. Following vaccination, myeloma patients responded with significant IgG titer increases to 1/7 serotypes and OPA titer increases to 1/2 serotypes. Corresponding IgG and OPA vaccine responses were 3/7 and 0/2 for Waldenstrom patients, 4/7 and 1/2 for MGUS patients, and 4/7 and 2/2 for the healthy controls, respectively. Notably high antibody levels without corresponding OPA titers were seen among a few myeloma patients indicating the presence of non-functional antibodies. Neither of the two vaccines elicited significantly higher serotype-specific IgG concentrations, OPA titers or antibody fold increases in any of the study groups. Hypogammaglobulinemia and ongoing chemotherapy were associated with poor vaccine responses in a multivariate analysis.ConclusionOur findings confirm that B cell malignancies and disorders among elderly patients are associated with suboptimal responses to pneumococcal vaccination. Single-dose PCV7 was not shown to be superior to PPV