Asiakkaan autonomiaako rakentamassa? : tapaustutkimus kunnallisesta kotipalvelusta asiakkaan suoriutumisen tukijana

Tutkimuksen tarkoituksena on analysoida kunnallista kotipalvelua asiakkaan näkökulmasta osana hyvinvointivaltiollista sosiaalipalvelujärjestelmää. Asetelmallisesti kyseessä on tapaustutkimus, jossa tarkastelen, miten kunnallinen kotipalvelu todellistuu yhden kunnan joidenkin kotipalveluasiakkaiden elämismaailmassa. Metodisesti on kysymys grounded¬-teorian mukaisesta lähestymistavasta. Tutkimukseni primaariaineistona ovat kotipalveluasiakkaiden haastattelut, joiden avulla rakennan kuvan asiakkaiden elämänprosesseista nousevista elämäntilanteista, joissa kunnallinen kotipalvelu viime kädessä todellistuu. Sekundaariaineistona ovat kunnallista kotipalvelua koskevat juridis-hallinnolliset asiakirjat, joiden avulla kehystän tutkimukseni päänäyttämön yhteiskunta-, kunta- ja toimeenpanojärjestelmän tasoilla. Tutkimukseni asiakkaiden suoriutumista vaikeuttavat monet eri tekijät: sosiaaliset suhteet eivät jousta, fyysinen tila on heikentynyt, ulkoiset resurssit ovat puutteelliset ja sisäiset voimavarat ehtyvät. Suoriutumista vaikeuttavat tekijät vaihtelevat asiakaskohtaisesti ja samankin asiakkaan kohdalla eri ajankohtina. Suoriutumisen vaikeuduttua tutkimukseni kotipalveluasiakkaiden toimintaa ohjaavaksi pyrkimykseksi tulee halutun elämäntavan puolustaminen ja legitimointi suhteessa kunnalliseen kotipalveluun, koska subjektiivista oikeutta kunnalliseen kotipalveluun ei ole. Kunnallisesta kotipalvelusta muodostuu tutkimukseni kotipalveluasiakkaille halutun elämäntavan toteuttamisen väline. Kunnallinen kotipalvelu tuottaa tutkimukseni asiakkaille suoriutumisen perusrakenteita: praktisia työsuorituksia ja puhuntaa, jotka tukevat todellisuuden ja identiteetin rakentamista, kun ennalta-arvaamattomat elämäntapahtumat vaikeuttavat suoriutumista. Kunnallisen kotipalvelun toimeenpanossa kohtaavat hyvinvointivaltiolliset juridis¬hallinnolliset ja yksilölliset asiakkaiden subjektiiviset tarpeentulkinnat. Tutkimukseni asiakkaille eri lähtökodista nousevat tarpeiden tulkinnat näyttäytyvät kotipalveluavun erilaisina niukkuuksina ja sen käsittelyinä; kunnallista kotipalveluapua ei saa silloin, kun sitä tarvitsisi, kodinhoitajien työtehtävät on rajattu, kodinhoitaja vaihtuu usein ja uhkana on kotipalvelumaksujen nousu ja avun määrän supistuminen. Hyvinvointivaltiollisena juridis-hallinnollisena järjestelmänä kunnallinen kotipalvelu muodostaa monikehyksisen ja -liikkeisen kokonaisuuden, joka laitospalveluiden vaihtoehtona tuottaa hoito-, hoiva- ja huolenpitopalveluita kotiin osana muita sosiaalipalve¬luita.The aim of the study is to analyse the loca1 home-help service from a client’s point of view as a part of social service system in a welfare state. The research design is a case study in which I investigate how the loca1 home-help service manifests itself in some home-help service recipients' everyday life in one municipality. The methodological approach to the issue is done in accordance with that used in grounded theory. The study is based on the primary data from the interviews given by the home-he1p service recipients. With the help of these interviews I construct a vision of the conditions the clients live in due to the processes of their lives. Ultimately, the local home-help service does manifest itself in these particular conditions of life. The secondary data of the study consists of judicial and administrative documents with the help of which I provide a setting for the main scene of the study on the level of social, municipal and executive systems. Coping forms a viewpoint combining different levels and dimensions of the loca1 home help service. There are lots of different factors that make coping difficult for the clients in the study: social relationships are far from flexible, physical condition is failing, external resources are poor and the internal ones will he exhausted. The factors making coping difficult vary among the clients. This holds even for one and the same client at times in the course of his life. After having started to face difficulties in coping, the most essential thing that starts to conduct the home-help service recipients' action is the aim to defend an legitimate the desired way of life in relation to the loca1 home-help service, because there is no subjective right to that service. The loca1 home-help service turns into a means with the help of which the home-help service recipients of the study may fu1fill the desired way of life. The loca1 home-help service provides the clients in the study with such basic structures for coping as a series of practical performances and talk, which support for building up reality and identity when unforeseen events in life make coping difficult. In the implementation of the loca1 home-help service, the judicial and administrative assessments of needs and the individual subjective ones of the clients will meet. The different starting points for assessing the needs of the clients in the study seem to provide different sorts of inadequate services and decision-making on them; one does not receive he1p from the loca1 home-help service when in urgent need of it; the duties of the home he1pers are clearly defined; the home helper on duty will often he some other worker time after time; there is a threat of an increase in the charges and a decrease in the amount of help available. The loca1 home-help service as a judicial and administrative system in a we1fare state forms a multimobile whole with a multiple setting which, as an alternative to institutional services, provides people living in their own homes with caring services as a part of other social services

Streptococcus pneumoniae Capsular Serotype 19F Is More Resistant to C3 Deposition and Less Sensitive to Opsonophagocytosis than Serotype 6B▿

The polysaccharide capsule is a major virulence mechanism of Streptococcus pneumoniae, shielding the bacterium from phagocytes. Capsule types may differ in their abilities to resist immune defense. Antibody-mediated complement activation and opsonophagocytosis are crucial in protection against pneumococcus. Conjugate vaccine trials suggest imperfect protection against 19F. We have previously shown that significantly more anti-19F than anti-6B antibody is needed for killing in the opsonophagocytic assay (OPA). In this study, we explored whether the amount of C3 deposited on serotype 6B and 19F pneumococcal strains reflects their sensitivity to opsonophagocytosis. We compared clinical 6B and 19F nasopharyngeal, middle ear, and blood isolates as well as reference OPA strains (n = 16) for their sensitivity to opsonophagocytosis and C3 deposition. Sixfold anticapsular antibody concentrations were required for 50% opsonophagocytic killing of 19F compared to that of 6B strains. Serotype 19F was more resistant to C3 deposition than 6B. Complement deposition and opsonophagocytosis were dependent on the concentration of anticapsular antibodies. Differences between pneumococcal serotypes in antibody-mediated protection may partly be explained by the abilities of the capsules to resist complement deposition. These findings support previous studies suggesting that higher antibody concentrations to the capsular polysaccharide are needed for protection against disease caused by serotype 19F than that caused by 6B

PTCD1 Is Required for 16S rRNA Maturation Complex Stability and Mitochondrial Ribosome Assembly

Summary: The regulation of mitochondrial RNA life cycles and their roles in ribosome biogenesis and energy metabolism are not fully understood. We used CRISPR/Cas9 to generate heart- and skeletal-muscle-specific knockout mice of the pentatricopeptide repeat domain protein 1, PTCD1, and show that its loss leads to severe cardiomyopathy and premature death. Our detailed transcriptome-wide and functional analyses of these mice enabled us to identify the molecular role of PTCD1 as a 16S rRNA-binding protein essential for its stability, pseudouridylation, and correct biogenesis of the mitochondrial large ribosomal subunit. We show that impaired mitoribosome biogenesis can have retrograde signaling effects on nuclear gene expression through the transcriptional activation of the mTOR pathway and upregulation of cytoplasmic protein synthesis and pro-survival factors in the absence of mitochondrial translation. Taken together, our data show that impaired assembly of the mitoribosome exerts its consequences via differential regulation of mitochondrial and cytoplasmic protein synthesis. : Perks et al. engineered intron-exon boundaries using CRISPR/Cas9 to conditionally knock out Ptcd1 in mice. The RNA-binding protein PTCD1 is essential for heart function and regulates the stability and maturation of the 16S rRNA. PTCD1 is required for mitoribosome biogenesis, mitochondrial function, and coordinated nuclear transcription. Keywords: RNA, cardiomyopathy, regulatory RNAs, RNA-seq, mitochondrial ribosome, RNA-binding proteins, mitochondria, mitochondrial gene expression, ribosome biogenesi

Observations of climate impacts of cutover peatland afforestation, and peatland forest restoration, in Finland

Non peer reviewe