Book Review : "Statutory Will Applications : A practical Guide by Richard Williams and Sam McCullough"

The jurisdiction of Australian courts to make wills for those lacking testamentary capacity is relatively new, having been granted by legislation progressively enacted across the various states and territories between 1996 and 2010. Given increasing numbers of statutory will applications since the legislative reform, and a growing body of law, the publication of the specialist work, Statutory Will Applications: A Practical Guide, by Richard Williams and Sam McCullough, is timely and valuable. This work will be of great interest to those who act for individual clients, especially wills and estates practitioners, but also personal injury practitioners acting for incapacitated persons who have been awarded substantial damages.

Book Review : "Statutory will Applications in Australia : A Practical Guide by Richard Williams & Sam McCullough"

Although UK courts have, for many years, had power to make wills for those lacking testamentary capacity, this jurisdiction jurisdiction is relatively new in Australia, having been granted by legislation enacted between 1996 and 2010.

Estimating the burden of disease attributable to interpersonal violence in South Africa in 2000

Violence, previously considered a social issue, is now an acknowledged public health problem. It is defined as the intentional use of physical force or power, threatened or actual, against another person, against oneself, or against a group or community, that results in injury, death or deprivation.1 In this study we focus on exposure to the interpersonal type of violence, which includes acts of family violence and community violence. Family violence is further categorised by victim: child, intimate partner, or elder. Community violence occurs among unrelated individuals and includes sexual assault and rape by strangers as well as youth violence...

Starting with strengths : an Indigenous early years intervention

Aboriginal protocol usually links the right to tell a story with a declaration of involvement or connection to the story. I am Aboriginal . . . I am a woman, daughter, sister, aunty and wife. I am also a mother to three beautiful children aged 6, 4 and 2 years. To my children at this point in their lives, I am their provider, nurturer, teacher, cook, taxi driver, mediator, stylist, Elder, slave, and expert on all there is to know in the world. Being the centre of the universe to three impressionable young minds is a role that I cherish deeply, and I take the responsibilities of it very seriously. I love the job of parenting. As any parent would agree, it is the most challenging and difficult job of all, but the opportunity to bring a life into the world and shape and mould a little person into a big person brings rewards that no career can.

The First-Year Law Experience: A New Beginning

The first-year experience at university is a "purgatorial zone”. There is the shock of the new: navigating a new campus, choosing and enrolling in courses, locating classrooms, finding new friends and establishing new social networks, buying arm loads of textbooks, making sense of subject outlines, balancing work and study, completing multiple assignments on time. But there are also the growing pains associated with intellectual development. Not only must first-year students take responsibility for their own learning; they must also accept that there are no "right" or "wrong" answers or "good" or "bad" positions, but judgements they must make and defend through analysis, reasoning and argument: ... the student [must] shift from passivity to activity; [university] is no longer an environment in which professors have the sole responsibility to teach but, rather; one in which the student has an equal responsibility to learn. They [need] . .. to becom[e] critical thinkers who are, in the words of Richard Paul and Linda Elder, "self-directed, self-disciplined, self-monitored, and self-corrective".

Identification of 15 new psoriasis susceptibility loci highlights the role of innate immunity

To gain further insight into the genetic architecture of psoriasis, we conducted a meta-analysis of 3 genome-wide association studies (GWAS) and 2 independent data sets genotyped on the Immunochip, including 10,588 cases and 22,806 controls. We identified 15 new susceptibility loci, increasing to 36 the number associated with psoriasis in European individuals. We also identified, using conditional analyses, five independent signals within previously known loci. The newly identified loci shared with other autoimmune diseases include candidate genes with roles in regulating T-cell function (such as RUNX3, TAGAP and STAT3). Notably, they included candidate genes whose products are involved in innate host defense, including interferon-mediated antiviral responses (DDX58), macrophage activation (ZC3H12C) and nuclear factor (NF)-κB signaling (CARD14 and CARM1). These results portend a better understanding of shared and distinctive genetic determinants of immune-mediated inflammatory disorders and emphasize the importance of the skin in innate and acquired host defense. © 2012 Nature America, Inc. All rights reserved.

Ryhmäidentiteetin mittaaminen verkkoroolipelissä World of Warcraft

The objective of the study was to explore the dimensions of group identity in the guilds of World of Warcraft. Previous research shows that social interaction has an important role in playing games for many players. Social identities are an important aspect of self-concept and since group related cues are more salient than personal clues in computer-mediated communication, the social gaming experience was approached through group identity. In the study a new scale will be developed to measure the group identity in games. Secondary goal is to study how different guild attributes affect the group identity and third goal is to explore the connection between group identity and gaming experience and amount of play. Subjects were 1203 guild members and 106 players not in a guild. The data was gathered by an Internet survey which measured group identity with nine scales, gaming experience with three scales and guild attributes with four scales. Also various background data was gathered. The construct of group identity was analyzed with explorative factor analysis. The typical experiences of group identity was analyzed with cluster analysis and effects of guild attributes with multivariate analysis of covariance. As a result of the study a new scale was developed which measured group identity on six dimensions: self-stereotyping, public and private evaluation, importance, interconnection of self and others and awareness of content. Group identity was experienced strongest in elder middle-sized guilds that had formal rules and that emphasized social interaction. The players with strong group identity had more positive gaming experience and played World of Warcraft more per week than the players who were not in a guild or identified to guild weakly. This result encourages game developers to produce environments that enhance group identity as it seems to increase the enjoyment in games. As a whole this study proposes that group identity in guilds is constructed from the same elements as in traditional groups. If this is truly the case, guild membership may have similar positive effects on individual’s mental well-being as traditional positively evaluated group memberships have.

Genome-wide meta-analysis identifies five new susceptibility loci for cutaneous malignant melanoma

Thirteen common susceptibility loci have been reproducibly associated with cutaneous malignant melanoma (CMM). We report the results of an international 2-stage meta-analysis of CMM genome-wide association studies (GWAS). This meta-analysis combines 11 GWAS (5 previously unpublished) and a further three stage 2 data sets, totaling 15,990 CMM cases and 26,409 controls. Five loci not previously associated with CMM risk reached genome-wide significance (P < 5 × 10−8), as did 2 previously reported but unreplicated loci and all 13 established loci. Newly associated SNPs fall within putative melanocyte regulatory elements, and bioinformatic and expression quantitative trait locus (eQTL) data highlight candidate genes in the associated regions, including one involved in telomere biology.

Genome-wide association study identifies a new melanoma susceptibility locus at 1q21.3

We performed a genome-wide association study of melanoma in a discovery cohort of 2,168 Australian individuals with melanoma and 4,387 control individuals. In this discovery phase, we confirm several previously characterized melanoma-associated loci at MC1R, ASIP and MTAP-CDKN2A. We selected variants at nine loci for replication in three independent case-control studies (Europe: 2,804 subjects with melanoma, 7,618 control subjects; United States 1: 1,804 subjects with melanoma, 1,026 control subjects; United States 2: 585 subjects with melanoma, 6,500 control subjects). The combined meta-analysis of all case-control studies identified a new susceptibility locus at 1q21.3 (rs7412746, P = 9.0 x 10(-11), OR in combined replication cohorts of 0.89 (95% CI 0.85-0.95)). We also show evidence suggesting that melanoma associates with 1q42.12 (rs3219090, P = 9.3 x 10(-8)). The associated variants at the 1q21.3 locus span a region with ten genes, and plausible candidate genes for melanoma susceptibility include ARNT and SETDB1. Variants at the 1q21.3 locus do not seem to be associated with human pigmentation or measures of nevus density.

Greenwashing the Trans-Pacific Partnership: Fossil fuels, the environment, and climate change

There has been much controversy over the Trans-Pacific Partnership (TPP) – a plurilateral trade agreement involving a dozen nations from throughout the Pacific Rim – and its impact upon the environment, biodiversity, and climate change. The secretive treaty negotiations involve Australia and New Zealand; countries from South East Asia such as Brunei Darussalam, Malaysia, Singapore, Vietnam, and Japan; the South American nations of Peru and Chile; and the members of the 1994 North American Free Trade Agreement (NAFTA), Canada, Mexico and the United States. There was an agreement reached between the parties in October 2015. The participants asserted: ‘We expect this historic agreement to promote economic growth, support higher-paying jobs; enhance innovation, productivity and competitiveness; raise living standards; reduce poverty in our countries; and to promote transparency, good governance, and strong labor and environmental protections.’ The final texts of the agreement were published in November 2015. There has been discussion as to whether other countries – such as Indonesia, the Philippines, and South Korea – will join the deal. There has been much debate about the impact of this proposed treaty upon intellectual property, the environment, biodiversity and climate change. There have been similar concerns about the Trans-Atlantic Trade and Investment Partnership (TTIP) – a proposed trade agreement between the United States and the European Union. In 2011, the United States Trade Representative developed a Green Paper on trade, conservation, and the environment in the context of the TPP. In its rhetoric, the United States Trade Representative has maintained that it has been pushing for strong, enforceable environmental standards in the TPP. In a key statement in 2014, the United States Trade Representative Mike Froman insisted: ‘The United States’ position on the environment in the Trans-Pacific Partnership negotiations is this: environmental stewardship is a core American value, and we will insist on a robust, fully enforceable environment chapter in the TPP or we will not come to agreement.’ The United States Trade Representative maintained: ‘Our proposals in the TPP are centered around the enforcement of environmental laws, including those implementing multilateral environmental agreements (MEAs) in TPP partner countries, and also around trailblazing, first-ever conservation proposals that will raise standards across the region’. Moreover, the United States Trade Representative asserted: ‘Furthermore, our proposals would enhance international cooperation and create new opportunities for public participation in environmental governance and enforcement.’ The United States Trade Representative has provided this public outline of the Environment Chapter of the TPP: A meaningful outcome on environment will ensure that the agreement appropriately addresses important trade and environment challenges and enhances the mutual supportiveness of trade and environment. The Trans-Pacific Partnership countries share the view that the environment text should include effective provisions on trade-related issues that would help to reinforce environmental protection and are discussing an effective institutional arrangement to oversee implementation and a specific cooperation framework for addressing capacity building needs. They also are discussing proposals on new issues, such as marine fisheries and other conservation issues, biodiversity, invasive alien species, climate change, and environmental goods and services. Mark Linscott, an assistant Trade Representative testified: ‘An environment chapter in the TPP should strengthen country commitments to enforce their environmental laws and regulations, including in areas related to ocean and fisheries governance, through the effective enforcement obligation subject to dispute settlement.’ Inside US Trade has commented: ‘While not initially expected to be among the most difficult areas, the environment chapter has emerged as a formidable challenge, partly due to disagreement over the United States proposal to make environmental obligations binding under the TPP dispute settlement mechanism’. Joshua Meltzer from the Brookings Institute contended that the trade agreement could be a boon for the protection of the environment in the Pacific Rim: Whether it is depleting fisheries, declining biodiversity or reduced space in the atmosphere for Greenhouse Gas emissions, the underlying issue is resource scarcity. And in a world where an additional 3 billion people are expected to enter the middle class over the next 15 years, countries need to find new and creative ways to cooperate in order to satisfy the legitimate needs of their population for growth and opportunity while using resources in a manner that is sustainable for current and future generations. The TPP parties already represent a diverse range of developed and developing countries. Should the TPP become a free trade agreement of the Asia-Pacific region, it will include the main developed and developing countries and will be a strong basis for building a global consensus on these trade and environmental issues. The TPP has been promoted by its proponents as a boon to the environment. The United States Trade Representative has maintained that the TPP will protect the environment: ‘The United States’ position on the environment in the TPP negotiations is this: environmental stewardship is a core American value, and we will insist on a robust, fully enforceable environment chapter in the TPP or we will not come to agreement.’ The United States Trade Representative discussed ‘Trade for a Greener World’ on World Environment Day. Andrew Robb, at the time the Australian Trade and Investment Minister, vowed that the TPP will contain safeguards for the protection of the environment. In November 2015, after the release of the TPP text, Rohan Patel, the Special Assistant to the President and Deputy Director of Intergovernmental Affairs, sought to defend the environmental credentials of the TPP. He contended that the deal had been supported by the Nature Conservancy, the International Fund for Animal Welfare, the Joint Ocean Commission Initiative, the World Wildlife Fund, and World Animal Protection. The United States Congress, though, has been conflicted by the United States Trade Representative’s arguments about the TPP and the environment. In 2012, members of the United States Congress - including Senator Ron Wyden (D-OR), Olympia Snowe (R-ME), and John Kerry (D-MA) – wrote a letter, arguing that the trade agreement needs to provide strong protection for the environment: ‘We believe that a '21st century agreement' must have an environment chapter that guarantees ongoing sustainable trade and creates jobs, and this is what American businesses and consumers want and expect also.’ The group stressed that ‘A binding and enforceable TPP environment chapter that stands up for American interests is critical to our support of the TPP’. The Congressional leaders maintained: ‘We believe the 2007 bipartisan congressional consensus on environmental provisions included in recent trade agreements should serve as the framework for the environment chapter of the TPP.’ In 2013, senior members of the Democratic leadership expressed their opposition to granting President Barack Obama a fast-track authority in respect of the TPP House of Representatives Minority Leader Nancy Pelosi said: ‘No on fast-track – Camp-Baucus – out of the question.’ Senator Majority leader Harry Reid commented: ‘I’m against Fast-Track: Everyone would be well-advised to push this right now.’ Senator Elizabeth Warren has been particularly critical of the process and the substance of the negotiations in the TPP: From what I hear, Wall Street, pharmaceuticals, telecom, big polluters and outsourcers are all salivating at the chance to rig the deal in the upcoming trade talks. So the question is, Why are the trade talks secret? You’ll love this answer. Boy, the things you learn on Capitol Hill. I actually have had supporters of the deal say to me ‘They have to be secret, because if the American people knew what was actually in them, they would be opposed. Think about that. Real people, people whose jobs are at stake, small-business owners who don’t want to compete with overseas companies that dump their waste in rivers and hire workers for a dollar a day—those people, people without an army of lobbyists—they would be opposed. I believe if people across this country would be opposed to a particular trade agreement, then maybe that trade agreement should not happen. The Finance Committee in the United States Congress deliberated over the Trans-Pacific Partnership negotiations in 2014. The new chair Ron Wyden has argued that there needs to be greater transparency in trade. Nonetheless, he has mooted the possibility of a ‘smart-track’ to reconcile the competing demands of the Obama Administration, and United States Congress. Wyden insisted: ‘The new breed of trade challenges spawned over the last generation must be addressed in imaginative new policies and locked into enforceable, ambitious, job-generating trade agreements.’ He emphasized that such agreements ‘must reflect the need for a free and open Internet, strong labor rights and environmental protections.’ Elder Democrat Sander Levin warned that the TPP failed to provide proper protection for the environment: The TPP parties are considering a different structure to protect the environment than the one adopted in the May 10 Agreement, which directly incorporated seven multilateral environmental agreements into the text of past trade agreements. While the form is less important than the substance, the TPP must provide an overall level of environmental protection that upholds and builds upon the May 10 standard, including fully enforceable obligations. But many of our trading partners are actively seeking to weaken the text to the point of falling short of that standard, including on key issues like conservation. Nonetheless, 2015, President Barack Obama was able to secure the overall support of the United States Congress for his ‘fast-track’ authority. This was made possible by the Republicans and dissident Democrats. Notably, Oregon Senator Ron Wyden switched sides, and was transformed from a critic of the TPP to an apologist for the TPP. For their part, green political parties and civil society organisations have been concerned about the secretive nature of the negotiations; and the substantive implications of the treaty for the environment. Environmental groups and climate advocates have been sceptical of the environmental claims made by the White House for the TPP. The Green Party of Aotearoa New Zealand, the Australian Greens and the Green Party of Canada have released a joint declaration on the TPP observing: ‘More than just another trade agreement, the TPP provisions could hinder access to safe, affordable medicines, weaken local content rules for media, stifle high-tech innovation, and even restrict the ability of future governments to legislate for the good of public health and the environment’. In the United States, civil society groups such as the Sierra Club, Public Citizen, WWF, the Friends of the Earth, the Rainforest Action Network and 350.org have raised concerns about the TPP and the environment. Allison Chin, President of the Sierra Club, complained about the lack of transparency, due process, and public participation in the TPP talks: ‘This is a stealth affront to the principles of our democracy.’ Maude Barlow’s The Council of Canadians has also been concerned about the TPP and environmental justice. New Zealand Sustainability Council executive director Simon Terry said the agreement showed ‘minimal real gains for nature’. A number of organisations have joined a grand coalition of civil society organisations, which are opposed to the grant of a fast-track. On the 15th January 2013, WikiLeaks released the draft Environment Chapter of the TPP - along with a report by the Chairs of the Environmental Working Group. Julian Assange, WikiLeaks' publisher, stated: ‘Today's WikiLeaks release shows that the public sweetener in the TPP is just media sugar water.’ He observed: ‘The fabled TPP environmental chapter turns out to be a toothless public relations exercise with no enforcement mechanism.’ This article provides a critical examination of the draft Environment Chapter of the TPP. The overall argument of the article is that the Environment Chapter of the TPP is an exercise in greenwashing – it is a public relations exercise by the United States Trade Representative, rather than a substantive regime for the protection of the environment in the Pacific Rim. Greenwashing has long been a problem in commerce, in which companies making misleading and deceptive claims about the environment. In his 2012 book, Greenwash: Big Brands and Carbon Scams, Guy Pearse considers the rise of green marketing and greenwashing. Government greenwashing is also a significant issue. In his book Storms of My Grandchildren, the climate scientist James Hansen raises his concerns about government greenwashing. Such a problem is apparent with the TPP – in which there was a gap between the assertions of the United States Government, and the reality of the agreement. This article contends that the TPP fails to meet the expectations created by President Barack Obama, the White House, and the United States Trade Representative about the environmental value of the agreement. First, this piece considers the relationship of the TPP to multilateral environmental treaties. Second, it explores whether the provisions in respect of the environment are enforceable. Third, this article examines the treatment of trade and biodiversity in the TPP. Fourth, this study considers the question of marine capture fisheries. Fifth, there is an evaluation of the cursory text in the TPP on conservation. Sixth, the article considers trade in environmental services under the TPP. Seventh, this article highlights the tensions between the TPP and substantive international climate action. It is submitted that the TPP undermines effective and meaningful government action and regulation in respect of climate change. The conclusion also highlights that a number of other chapters of the TPP will impact upon the protection of the environment – including the Investment Chapter, the Intellectual Property Chapter, the Technical Barriers to Trade Chapter, and the text on public procurement.

Care for care: Studio REV's strategies of engagement

The artists at Studio REV-, along with their allies in the broader non-profit sector, address domestic workers’ rights in the United States. As a social practice art project, NannyVan works to improve how information about domestic rights is disseminated to these workers, whether nannies, elder caregivers or others. As part of a larger project named CareForce, the NannyVan project shows an ethics of care by using design traces as tactics and transversal methods as strategies.

Hard Custom, Hard Dance : Social Organisation, (Un)Differentiation and Notions of Power in a Tabiteuean Community, Southern Kiribati

Hard Custom, Hard Dance: Social Organisation, (Un)Differentiation and Notions of Power in a Tabiteuean Community, Southern Kiribati is an ethnographic study of a village community. This work analyses social organisation on the island of Tabiteuea in the Micronesian state of Kiribati, examining the intertwining of hierarchical and egalitarian traits, meanwhile bringing a new perspective to scholarly discussions of social differentiation by introducing the concept of undifferentiation to describe non-hierarchical social forms and practices. Particular attention is paid to local ideas concerning symbolic power, abstractly understood as the potency for social reproduction, but also examined in one of its forms; authority understood as the right to speak. The workings of social differentiation and undifferentiation in the village are specifically studied in two contexts connected by local notions of power: the meetinghouse institution (te maneaba) and traditional dancing (te mwaie). This dissertation is based on 11 months of anthropological fieldwork in 1999‒2000 in Kiribati and Fiji, with an emphasis on participant observation and the collection of oral tradition (narratives and songs). The questions are approached through three distinct but interrelated topics: (i) A key narrative of the community ‒ the story of an ancestor without descendants ‒ is presented and discussed, along with other narratives. (ii) The Kiribati meetinghouse institution, te maneaba, is considered in terms of oral tradition as well as present-day practices and customs. (iii) Kiribati dancing (te mwaie) is examined through a discussion of competing dance groups, followed by an extended case study of four dance events. In the course of this work the community of close to four hundred inhabitants is depicted as constructed primarily of clans and households, but also of churches, work co-operatives and dance groups, but also as a significant and valued social unit in itself, and a part of the wider island district. In these partly cross-cutting and overlapping social matrices, people are alternatingly organised by the distinct values and logic of differentiation and undifferentiation. At different levels of social integration and in different modes of social and discursive practice, there are heightened moments of differentiation, followed by active undifferentiation. The central notions concerning power and authority to emerge are, firstly, that in order to be valued and utilised, power needs to be controlled. Secondly, power is not allowed to centralize in the hands of one person or group for any long period of time. Thirdly, out of the permanent reach of people, power/authority is always, on the one hand, left outside the factual community and, on the other, vested in community, the social whole. Several forms of differentiation and undifferentiation emerge, but these appear to be systematically related. Social differentiation building on typically Austronesian complementary differences (such as male:female, elder:younger, autochtonous:allotochtonous) is valued, even if eventually restricted, whereas differentiation based on non-complementary differences (such as monetary wealth or level of education) is generally resisted, and/or is subsumed by the complementary distinctions. The concomitant forms of undifferentiation are likewise hierarchically organised. On the level of the society as a whole, undifferentiation means circumscribing and ultimately withholding social hierarchy. Potential hierarchy is both based on a combination of valued complementary differences between social groups and individuals, but also limited by virtue of the undoing of these differences; for example, in the dissolution of seniority (elder-younger) and gender (male-female) into sameness. Like the suspension of hierarchy, undifferentiation as transformation requires the recognition of pre-existing difference and does not mean devaluing the difference. This form of undifferentiation is ultimately encompassed by the first one, as the processes of the differentiation, whether transformed or not, are always halted. Finally, undifferentiation can mean the prevention of non-complementary differences between social groups or individuals. This form of undifferentiation, like the differentiation it works on, takes place on a lower level of societal ideology, as both the differences and their prevention are always encompassed by the complementary differences and their undoing. It is concluded that Southern Kiribati society be seen as a combination of a severely limited and decentralised hierarchy (differentiation) and of a tightly conditional and contextual (intra-category) equality (undifferentiation), and that it is distinctly characterised by an enduring tension between these contradicting social forms and cultural notions. With reference to the local notion of hardness used to characterise custom on this particular island as well as dance in general, it is argued in this work that in this Tabiteuean community some forms of differentiation are valued though strictly delimited or even undone, whereas other forms of differentiation are a perceived as a threat to community, necessitating pre-emptive imposition of undifferentiation. Power, though sought after and displayed - particularly in dancing - must always remain controlled.

Keskiluokkainen kulutuseetos 1920–1950-luvuilla syntyneiden suomalaisten kulutuskerronnassa

Tutkielmassa tarkastellaan suomalaista kulutuskulttuuria ja sen muuttumista kulutuskerronnan kautta. Aineisto koostuu 39 iäkkään, 1920–1950-luvuilla syntyneen, suomalaisen kuluttajaelämäkerroista, jotka kerättiin kirjoituskilpailulla. Tutkielmassa analysoidaan informanttien kulutukseen ja rahankäyttöön liittämiä hyveitä sekä sitä, millaisista kulutuseetoksista hyveet kertovat. Elämäkertojen erittelyyn ja tulkintaan on sovellettu lähiluentaa. Analyysin avulla on rakennettu tulkinta keskiluokkaisesta kulutuseetoksesta. Tutkimuksen teoreettinen viitekehys pohjautuu kulutuksen normatiivisia merkityksiä, kulutuseetoksia ja keskiluokkaisuutta käsitteleviin tutkimuksiin. Tulkintaa ohjaa lisäksi ymmärrys tutkittavan sukupolven elämänkulusta suomalaisen kulutusyhteiskunnan kehityksen näkökulmasta. Tutkittavan sukupolven elämän aikana kotitalous on kehittynyt agraarisen yhteiskunnan omavaraisesta tuotantoyksiköstä vauraan yhteiskunnan kulutukseen ja sosiaaliseen uusintamiseen keskittyväksi instituutioksi. Palkkatyöläisyys, vapaa-aika ja kulutusmahdollisuudet ovat lisääntyneet, ja yhteiskuntaa leimaa keskiluokkaistuminen. Elämäkerroista löytyvät säästäväisyyden ja vaatimattomuuden hyveet kertovat talonpoikaisen kulutueetoksen olevan edelleen keskeinen kulutuseetos, mutta niukkuuden hyveellistämisen lisäksi kulutuskerronnasta löytyy myös modernimpia tapoja suhtautua kulutukseen. Tulkitsen kuluttajaelämäkerroista löytyvien järkevyyden, tavallisuuden ja työnteon hyveiden kertovan keskiluokkaisuudesta. Hyveellinen kuluttaminen on keskiluokkaisessa kulutuseetoksessa talonpoikaista kulutuseetosta sallivampaa. Se määrittyy niukan kuluttamisen sijaan kohtuullisen ja tavallisen kuluttamisen hyveellistämiseksi. Keskiluokkaisessa kulutuseetoksessa on hyväksyttävää nauttia kohtuudella ja järkevästi omalla työllä ansaitusta vaurastumisesta. Talonpoikaisesta kulutuseetoksesta poiketen keskiluokkainen kulutuseetos hyväksyy kulutuksesta saatavan nautinnon. Sanonta ”ensin työ, sitten huvi” kuvaa keskiluokkaisen kulutuseetoksen tapaa suhtautua vaurastumisen mukanaan tuomaan kulutuskulttuuriin ja sen nautintoihin.

Geriatrisen lääkehoidon koulutustarpeet perusterveydenhuollossa - Moniammatillisen täydennyskoulutuksen suunnittelu LOST-alueen kotihoidon henkilöstölle

Sosiaali- ja terveysministeriön 2006 julkaiseman vanhustyön ja geriatrisen lääkehoidon kehittämistä koskevan selvityksen yhtenä tärkeänä huolenaiheena oli iäkkäiden lääkehoidon useat epäkohdat, kuten iäkkäitä hoitavien hoitajien lääkeosaamiseen liittyvät puutteet ja ongelmat. Yksi keino parantaa iäkkäitä hoitavien eri tahojen lääkehoito-osaamista on täydennyskoulutus, johon kaikilla sosiaali- ja terveydenhuollon ammattiryhmillä on oikeus ja velvollisuus. Täydennyskoulutuksella pystytään myös kehittämään organisaatioiden toimintaa ja tuottamaan uusia, parempia palveluita. Tutkimuksessa selvitettiin Lohjan, Siuntion, Inkoon ja Karjalohjan muodostaman sosiaali- ja terveydenhuollon yhteistoiminta-alueen LOSTin kotihoidon yksiköiden iäkkäiden lääkehoitoihin liittyviä koulutustarpeita. Tämän tutkimuksen avulla syvennettiin samalle tutkimusryhmälle tehdyn kyselytutkimuksen tuloksia. Tutkimusaineistona käytettiin LOST-alueen kotihoidon yksiköiden hoitajille (n=150) farmaseutin lopputyönä tehtyä kyselyaineistoa sekä työntekijöille (n=6) ja esimiehille (n=6) tehtyjä erillisiä ryhmäkeskusteluja. Lisäksi näkökulman laajentamiseksi ja moniammatillisuuden korostamiseksi aineistona käytettiin kotihoidon asiakkaita hoitavien lääkärien (n=4) teemahaastatteluja. Kyselyaineistosta analysoitiin erikseen sairaanhoitajien, lähihoitajien ja kodinhoitajien koulutustarpeet. Samat asiat nousivat esille kunkin ammattiryhmän tuloksissa. Tärkeimpinä lääkehoito-osaamiseen liittyvinä teoreettisina koulutettavina asioina kyselystä nousivat esille iäkkäiden farmakokinetiikka ja lääkkeiden käyttöön liittyvät erityispiirteet, lääkkeiden vaikutukset, lääkkeiden haittavaikutukset sekä lääkkeiden yhteisvaikutukset ja yhteensopivuus. Lisäksi teoreettisista taidoista nousi hoitotyön etiikkaan liittyvät tarkkuus ja huolellisuus työssä. Käytännön taidoista tärkeimpinä koulutettavina aiheina kyselystä nousivat asiakkaiden lääkehoidon ja voinnin seuranta, lääkkeiden jakaminen sekä lääkkeiden annosteluun liittyen se, että annostellaan oikeaa lääkettä ja vahvuutta, oikea annos ja oikeaan aikaan sekä oikeat antotavat. Ryhmäkeskusteluista ja lääkärien teemahaastatteluista haettiin syvempää ymmärrystä kyselyn tuloksiin. Yksi tärkeimmistä tämän laadullisen tutkimuksen löydöksistä oli kotihoidon yhteistyöhön liittyvät epäkohdat. Lääkehoitojen toteuttamista ja seurantaa voitaisiin tulosten perusteella parantaa lääkärien ja kotihoidon hoitajien yhteisellä koulutuksella. Tärkeimpiä sairauksia tai oireita, joihin hoitajat toivoisivat yhteisiä toimintakäytäntöjä, ovat diabetes, sydän- ja verisuonisairaudet, kipu, muistisairaudet sekä psyykensairaudet. Lisäksi koulutusaiheiksi tutkimuksesta nousivat iäkkäiden lääkehoidon erityispiirteet, lääkkeiden antoreitit ja lääkemuodot. Kyselyn sekä ryhmäkeskustelujen ja lääkärien teemahaastattelujen tuloksista tehtiin lopuksi synteesi, jonka lopputuloksena LOST-alueen kotihoidon hoitohenkilöstölle sekä kotihoidon lääkäreille koottiin yhteinen tarvelähtöinen täydennyskoulutussuunnitelma. Suunnitelma tehtiin aineistosta nousseiden koulutusaiheiden pohjalta, eikä siihen lisätty aiheita tutkimuksen ulkopuolelta.