Kohti elämäkerrallista toimijuutta terveyssosiaalityössä

In aiming to help service users cope with a major life change imposed by, for example, a serious chronic illness or a severe impairment, social workers in health and mental health often, although not always explicitly, take a biographical perspective. Biography, shaped over time through the interplay between human agency and social structure, seems a relevant concept for social work, which focuses on the relationship between the individual and society. The aim of my research was to make the biographical perspective in health social work more explicit and to suggest ways in which practitioners can take into account their clients’ past without sliding into the field of psychotherapy. The questions set for the summary article ask what applying the biographical perspective in health social work could imply, and whether this perspective is compatible with social work practice theory. The study positions itself within the field of research on theoretical frameworks and knowledge production for health social work practice. Six papers, published during the years 2007–2016, form the base for this thesis. The first sub-study was based on a survey exploring issues of knowledge and competence in health social work, and laid out the context for the biographical perspective in social work practice as presented in the other five sub-studies. Three of the sub-studies were conceptual and published within an educational curriculum in the EU research project INVITE. The last two sub-studies were empirical and use qualitative content analysis; one analyses a biographical research interview from a social work perspective, and the other presents an analysis of 16 social workers’ views on biographical approaches as expressed in their final essays of a course on the biographical perspective in social work practice. Drawing on the sub-studies and on additional literature, the summary article takes the conceptual analysis further by outlining biographically informed health social work practice using ideas, concepts and methods developed in biographical research. My research maintains that the biographical perspective in health social work practice can be expressed by the notion of supporting clients’ biographical agency. This idea provides a general perspective for viewing clients as not totally determined by their past but as biographical actors in their social world, with a future they can influence. It is argued that the general concept of supporting biographical agency can be used with most clients. In cases when biographical interviewing is indicated, it implies listening to clients’ life stories, encouraging their biographical work, and helping them reconstruct their biographical identity in the midst of a major life change. In this type of work, building trustful relationships is essential. I found the biographical perspective in social work practice to be compatible with several social work practice theories. The ethical issues in biographical approaches concern the interpretation of clients’ life stories and the risk of clients becoming stuck in their past. The conclusion of my research was that the biographical perspective, defined in terms of supporting clients’ biographical agency, can provide a useful framework for health social workers in a multidisciplinary environment. Further research is needed to examine the benefits and possible risks of biographical approaches and to explore, in particular, clients’ own experiences of such approaches.Mot biografiskt agentskap i socialt arbete inom hälso- och sjukvård I arbetet med att stödja personer som drabbats av en stor förändring i livet, orsakad av till exempel en allvarlig kronisk sjukdom eller en svår funktionsnedsättning, använder sig socialarbetare i hälso- och sjukvård ofta av ett mer eller mindre outtalat biografiskt perspektiv. Biografi, som skapas över tid i samspelet mellan individens egen vilja och den sociala omgivningen, framstår som ett relevant begrepp i socialt arbete, som fokuserar på relationen mellan individ och samhälle. Avsikten med min forskning har varit att göra det biografiska perspektivet i socialt arbete synligare så att socialarbetare på ett mer teoretiskt grundat sätt kan ta i betraktande sina klienters förflutna. Min undersökning är ett inlägg i diskussionen om teoretiska referensramar, arbetsmetoder och kunskapsproduktion i socialt arbete. Avhandlingen består av sex delstudier och en sammanfattande artikel. En delstudie handlar om socialarbetares syn på kunskap och kompetens i hälso- och sjukvård och de övriga fem delstudierna behandlar biografiska perspektiv och metoder från olika synvinklar relaterade till socialt arbete i allmänhet. I den sammanfattande artikeln förs en teoretisk-konceptuell diskussion kring hur biografiska perspektiv och metoder kan användas i det sociala arbete som utförs specifikt i hälso- och sjukvård. Diskussionen baseras på idéer, begrepp och metoder som utvecklats i biografisk forskning. Jag formulerar ett slags biografiskt paradigm som också relateras till formella praktikteorier i socialt arbete. Som ett resultat av min forskning ser jag att det biografiska perspektivet i socialt arbete kan sammanfattas i uttrycket ’att stödja klienters biografiska agentskap’. Idén innebär en helhetssyn som beaktar att klienter har ett förflutet, ett nu och en framtid, att de är biografiska aktörer i sin sociala värld och kan påverka sitt eget liv. Att stödja klienters biografiska agentskap innebär att uppmuntra deras biografiska arbete, ibland genom att lyssna på deras livsberättelser. Jag hävdar att alla klienter kan betraktas som biografiska aktörer medan biografiska metoder, såsom biografiska intervjuer, ska användas endast när det är befogat. Det biografiska perspektivet i socialt arbete befanns passa ihop med flera praktikteorier i socialt arbete. De etiska aspekterna av biografiska tillvägagångssätt gäller bland annat tolkningen av klienters livsberättelser och risken för att klienter ’fastnar’ i det förflutna. Ytterligare forskning behövs för att undersöka fördelar och eventuella risker med biografiska tillvägagångssätt och framför allt för att klarlägga klienternas egna erfarenheter av och synpunkter på sådana tillvägagångssätt.Pyrkiessään tukemaan terveydenhuollon asiakkaita vakavaan pitkäaikaissairauteen tai vaikeaan vammaan sopeutumisessa terveyssosiaalityöntekijät usein, toisinaan jopa huomaamattaan, käyttävät elämäkerrallista näkökulmaa. Elämäkerta, joka muotoutuu ajan myötä toimijuuden ja sosiaalisten rakenteiden välisessä vuorovaikutuksessa, vaikuttaisi olevan käyttökelpoinen käsite yksilön ja yhteiskunnan väliseen suhteeseen keskittyvässä sosiaalityössä. Tutkimukseni tavoite oli elämäkerrallisen näkökulman selventäminen niin, että terveyssosiaalityöntekijät voisivat tietoisemmin ottaa huomioon asiakkaittensa menneisyyttä siirtymättä kuitenkaan psykoterapeuttiseen työskentelyyn. Yhteenvetoartikkelini tutkimuskysymykset koskevat sitä, mitä elämäkerrallinen näkökulma voisi tarkoittaa käytännön sosiaalityössä ja miten tämä näkökulma sopii yhteen sosiaalityön käytäntöteorioiden kanssa. Tutkimus paikantuu terveyssosiaalityön teoreettisten viitekehysten ja tiedontuotannon kenttään. Vuosina 2007-2016 julkaistut kuusi artikkelia muodostavat väitöskirjan perustan. Ensimmäinen osajulkaisu käsittelee kyselyaineiston perusteella tietoa ja kompetenssia terveyssosiaalityössä ja luo keskustelupohjaa elämäkerralliselle lähestymistavalle, jota käsitellään viidessä muussa osajulkaisussa. Osajulkaisuista kolme ovat käsitteellisiä ja julkaistiin osana opetusaineistoa, joka tuotettiin EU tutkimusprojektissa INVITE – New Ways of Biographical Counselling in Vocational Rehabilitative Training. Kahdessa viimeisessä osajulkaisussa käsitellään aihetta empiirisesti käyttäen kvalitatiivista sisällönanalyysiä. Toisessa analysoidaan erästä elämäkerrallista tutkimushaastattelua sosiaalityön näkökulmasta ja toisessa analysoidaan 16 sosiaalityöntekijän ko. lähestymistapaa käsittelevän kurssin loppuesseitä siitä näkökulmasta, miten niissä arvioidaan elämäkerrallisen lähestymistavan hyötyä sosiaalityössä. Osajulkaisuihin ja lisäkirjallisuuteen nojaten teoreettis-käsitteellinen analyysi viedään yhteenvetoartikkelissa pidemmälle hahmottelemalla elämäkerrallista lähestymistapaa terveyssosiaalityössä. Tässä analyysissa käytän elämäkertatutkimuksessa kehitettyjä ajatuksia, käsitteitä ja menetelmiä. Tutkimukseni tuloksena tiivistän elämäkerrallisen lähestymistavan terveyssosiaalityössä käsitteeksi ’elämäkerrallisen toimijuuden tukeminen’. Tämä ajatus tarjoaa yleisen lähestymistavan asiakkaiden näkemiseksi ei täysin menneisyytensä määrittäminä vaan myös elämäkerrallisina toimijoina sosiaalisessa maailmassaan, jossa he voivat vaikuttaa omaan tulevaisuuteensa. Väitän, että elämäkerrallisen toimijuuden tukemisen käsitettä voidaan käyttää erilaisten asiakkaiden kanssa työskenneltäessä erityyppisissä keskusteluissa ja eripituisissa elämäkertahaastatteluissa. Asiakkaiden elämäkerrallisen toimijuuden tukeminen tarkoittaa heidän elämänkertomustensa kuuntelemista, elämäkerralliseen työskentelyyn rohkaisemista ja heidän vahvistamistaan elämäkerrallisen identiteetin jälleenrakentamisessa merkittävän elämänmuutoksen yhteydessä. Siinä työssä tarvitaan luottamuksellisen suhteen rakentamisen taitoa. Sosiaalityön elämäkerrallista lähestymistapaa todettiin voitavan hyvin käyttää usean sosiaalityön käytäntöteorian kanssa. Määritelmällisesti se sopii yhteen elämänkulkukeskeisen, narratiivisen, rekonstruktiivisen ja suhdeperustaisen sosiaalityön kanssa. Lähestymistapa todettiin myös olevan melko yhteensopiva voimavarasuuntautuneen, valtaistavan, eksistentiaalisen, psykodynaamisen, ekosysteemisen ja henkilökeskeisen sosiaalityön kanssa. Se ei kuitenkaan sovi ongelmanratkaisukeskeisiin tai käyttäytymisteoreettisiin lähestymistapoihin. Mutta erilaisia käytäntöteorioita voidaan yhdistää esimerkiksi moniteoreettisessa sosiaalityössä. Elämäkerrallisten lähestymistapojen eettiset näkökohdat koskevat muun muassa asiakkaiden elämänkertomusten tulkintaa ja heidän menneisyyteensä juuttumisen riskiä sekä heidän mahdollisia odotuksia psykoterapeuttisen avun saamiseksi. Tutkimukseni johtopäätöksenä esitän, että elämäkerrallinen lähestymistapa määriteltynä asiakkaiden elämäkerrallisen toimijuuden tukemisena voisi tarjota hyödyllisen teoreettisen kehyksen monitieteiseen terveyssosiaalityöhön. Lisää tutkimusta tarvitaan sosiaalityön elämäkerrallisten lähestymistapojen hyödyistä ja mahdollisista riskeistä. Erityisesti tulisi selvittää asiakkaiden omia kokemuksia tällaisten lähestymistapojen käytöstä. Avainsanat terveyssosiaalityö; elämäkerta; elämänkertomus; elämäkerrallinen lähestymistapa; elämäkerrallinen toimijuus; elämäkerrallinen työskentely; elämäkerrallinen identiteett

Blockchains and the state as parallel legal systems

Avhandlingen behandlar blockkedjans eventuella ställning som ett transnationellt rättssystem. Syftet är att undersöka huruvida blockkedjor och dess applikationer bör betraktas som rättssubjekt som faller under statlig jurisdiktion eller om de utgör självständiga rättssystem med jurisdiktion över sin egen verksamhet. Forskningen följer en rättsteoretisk samt rättssociologisk metod. Materialet består i huvudsak av rätts- och andra samhällsvetenskapliga artiklar samt tekniska och empiriska data angående blockkedjan Ethereums funktion och användning. I avhandlingen diskuteras statens suveränitet som koncept samt blockkedjeteknologins hot mot statens suveränitet. Det konstateras att blockkedjan och staten möjligtvis kommer att fungera som konkurrerande eller parallella normativa system i framtiden. Rättspluralismen presenteras därmed som ett fungerande ramverk för identifierandet och utvärderandet av icke-statliga rättssystem såsom blockkedjan. Avhandlingens forskningsfråga är huruvida blockkedjor kan betraktas som rättssystem. Luhmanns systemteori används som det främsta verktyget för besvarandet av forskningsfrågan. Blockkedjan Ethereum fungerar som föremål för analysen. Avhandlingen reflekterar även kring interna och externa rättsliga utmaningar som uppstår till följd av blockkedjans ställning som ett (framväxande) rättssyste

Radiographic and Ultrasonographic Findings in Three Surgically Confirmed Cases of Small Intestinal Ischemia Related to Mesenteric Volvulus or Intestinal Torsion in Dogs

This case report describes the radiographic and ultrasonographic findings of three surgically confirmed cases of mesenteric volvulus or intestinal torsion in dogs. In all three cases, ultrasonographic findings included segmental ileus and absent or markedly reduced peristalsis of the affected small intestine, and partial loss of wall layering with increased overall echogenicity of the intestinal wall, but with normal to mildly increased wall thickening. No blood flow was detected in the affected small intestinal wall when assessed with colour Doppler. A moderate amount of peritoneal effusion was also detected with hyperechoic omental and mesenteric fat tissue throughout the peritoneal cavity. Few reports describe ultrasonographic findings of small intestinal ischemia in small animals. In all three cases presented here, ultrasound was helpful in demonstrating typical intestinal wall changes and helped to obtain the correct diagnosis of ischemic disease of the small intestine.Peer reviewe

Polymer-coated bioactive glass S53P4 increases VEGF and TNF expression in an induced membrane model in vivo

The two-stage induced-membrane technique for treatment of large bone defects has become popular among orthopedic surgeons. In the first operation, the bone defect is filled with poly(methyl methacrylate) (PMMA), which is intended to produce a membrane around the implant. In the second operation, PMMA is replaced with autograft or allograft bone. Bioactive glasses (BAGs) are bone substitutes with bone-stimulating and angiogenetic properties. The aim of our study was to evaluate the inductive vascular capacity of BAG-S53P4 and poly(lactide-co-glycolide) (PLGA)-coated BAG-S53P4 for potential use as bone substitutes in a single-stage induced-membrane technique. Sintered porous rods of BAG-S53P4, PLGA-coated BAG-S53P4 and PMMA were implanted in the femur of 36 rabbits for 2, 4 and 8 weeks. The expression of vascular endothelial growth factor (VEGF) and tumor necrosis factor alpha (TNF) in the induced membranes of implanted materials was analyzed with real-time quantitative polymerase chain reaction and compared with histology. Both uncoated BAG-S53P4 and PLGA-coated BAG-S53P4 increase expression of VEGF and TNF, resulting in higher amounts of capillary beds, compared with the lower expression of VEGF and less capillary beads observed for negative control and PMMA samples. A significantly higher expression of VEGF was observed for PLGA-coated BAG-S53P4 than for PMMA at 8 weeks (p <0.036). VEGF and TNF expression in the induced membrane of BAG-S53P4 and PLGA-coated BAG-S53P4 is equal or superior to PMMA, the "gold standard" material used in the induced-membrane technique. Furthermore, the VEGF and TNF expression for PLGA-coated BAG-S53P4 increased during follow-up.Peer reviewe

S53P4 bioactive glass scaffolds induce BMP expression and integrative bone formation in a critical-sized diaphysis defect treated with a single-staged induced membrane technique

Surgical management of critical-sized diaphyseal defects involves multiple challenges, and up to 10% result in delayed or non-union. The two-staged induced membrane technique is successfully used to treat these defects, but it is limited by the need of several procedures and bone graft. Repeated procedures increase costs and morbidity, while grafts are subject to donor-site complications and scarce availability. To transform this two-staged technique into one graft-independent procedure, we developed amorphous porous scaffolds sintered from the clinically used bioactive glass S53P4. This work constitutes the first evaluation of such scaffolds in vivo in a critical-sized diaphyseal defect in the weight-bearing rabbit femur. We provide important knowledge and prospects for future development of sintered S53P4 scaffolds as a bone substitute. Critical-sized diaphysis defects are complicated by inherent sub-optimal healing conditions. The two staged induced membrane technique has been used to treat these challenging defects since the 1980 & rsquo;s. It involves temporary implantation of a membrane-inducing spacer and subsequent bone graft defect filling. A single-staged, graft-independent technique would reduce both socio-economic costs and patient morbidity. Our aim was to enable such single-staged approach through development of a strong bioactive glass scaffold that could replace both the spacer and the graft filling. We constructed amorphous porous scaffolds of the clinically used bioactive glass S53P4 and evaluated them in vivo using a critical sized defect model in the weight-bearing femur diaphysis of New Zealand White rabbits. S53P4 scaffolds and standard polymethylmethacrylate spacers were implanted for 2, 4, and 8 weeks. Induced membranes were confirmed histologically, and their osteostimulative activity was evaluated through RT-qPCR of bone morphogenic protein 2, 4, and 7 (BMPs). Bone formation and osseointegration were examined using histology, scanning electron microscopy, energy-dispersive X-ray analysis, and micro-computed tomography imaging. Scaffold integration, defect union and osteosynthesis were assessed manually and with X-ray projections. We demonstrated that S53P4 scaffolds induce osteostimulative membranes and produce osseointegrative new bone formation throughout the scaffolds. We also demonstrated successful stable scaffold integration with early defect union at 8 weeks postoperative in critical-sized segmental diaphyseal defects with implanted sintered amorphous S53P4 scaffolds. This study presents important considerations for future research and the potential of the S53P4 bioactive glass as a bone substitute in large diaphyseal defects. Statement of significance Surgical management of critical-sized diaphyseal defects involves multiple challenges, and up to 10% result in delayed or non-union. The two-staged induced membrane technique is successfully used to treat these defects, but it is limited by the need of several procedures and bone graft. Repeated procedures increase costs and morbidity, while grafts are subject to donor-site complications and scarce availability. To transform this two-staged technique into one graft-independent procedure, we developed amorphous porous scaffolds sintered from the clinically used bioactive glass S53P4. This work constitutes the first evaluation of such scaffolds in vivo in a critical-sized diaphyseal defect in the weight-bearing rabbit femur. We provide important knowledge and prospects for future development of sintered S53P4 scaffolds as a bone substitute. (c) 2021 The Author(s). Published by Elsevier Ltd on behalf of Acta Materialia Inc. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )Peer reviewe

S53P4 bioactive glass scaffolds induce BMP expression and integrative bone formation in a critical-sized diaphysis defect treated with a single-stage d induce d membrane technique

Surgical management of critical-sized diaphyseal defects involves multiple challenges, and up to 10% result in delayed or non-union. The two-staged induced membrane technique is successfully used to treat these defects, but it is limited by the need of several procedures and bone graft. Repeated procedures increase costs and morbidity, while grafts are subject to donor-site complications and scarce availability. To transform this two-staged technique into one graft-independent procedure, we developed amorphous porous scaffolds sintered from the clinically used bioactive glass S53P4. This work constitutes the first evaluation of such scaffolds in vivo in a critical-sized diaphyseal defect in the weight-bearing rabbit femur. We provide important knowledge and prospects for future development of sintered S53P4 scaffolds as a bone substitute. Critical-sized diaphysis defects are complicated by inherent sub-optimal healing conditions. The two staged induced membrane technique has been used to treat these challenging defects since the 1980 & rsquo;s. It involves temporary implantation of a membrane-inducing spacer and subsequent bone graft defect filling. A single-staged, graft-independent technique would reduce both socio-economic costs and patient morbidity. Our aim was to enable such single-staged approach through development of a strong bioactive glass scaffold that could replace both the spacer and the graft filling. We constructed amorphous porous scaffolds of the clinically used bioactive glass S53P4 and evaluated them in vivo using a critical sized defect model in the weight-bearing femur diaphysis of New Zealand White rabbits. S53P4 scaffolds and standard polymethylmethacrylate spacers were implanted for 2, 4, and 8 weeks. Induced membranes were confirmed histologically, and their osteostimulative activity was evaluated through RT-qPCR of bone morphogenic protein 2, 4, and 7 (BMPs). Bone formation and osseointegration were examined using histology, scanning electron microscopy, energy-dispersive X-ray analysis, and micro-computed tomography imaging. Scaffold integration, defect union and osteosynthesis were assessed manually and with X-ray projections. We demonstrated that S53P4 scaffolds induce osteostimulative membranes and produce osseointegrative new bone formation throughout the scaffolds. We also demonstrated successful stable scaffold integration with early defect union at 8 weeks postoperative in critical-sized segmental diaphyseal defects with implanted sintered amorphous S53P4 scaffolds. This study presents important considerations for future research and the potential of the S53P4 bioactive glass as a bone substitute in large diaphyseal defects. Statement of significance Surgical management of critical-sized diaphyseal defects involves multiple challenges, and up to 10% result in delayed or non-union. The two-staged induced membrane technique is successfully used to treat these defects, but it is limited by the need of several procedures and bone graft. Repeated procedures increase costs and morbidity, while grafts are subject to donor-site complications and scarce availability. To transform this two-staged technique into one graft-independent procedure, we developed amorphous porous scaffolds sintered from the clinically used bioactive glass S53P4. This work constitutes the first evaluation of such scaffolds in vivo in a critical-sized diaphyseal defect in the weight-bearing rabbit femur. We provide important knowledge and prospects for future development of sintered S53P4 scaffolds as a bone substitute. (c) 2021 The Author(s). Published by Elsevier Ltd on behalf of Acta Materialia Inc. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )Peer reviewe

Effects of vatinoxan in dogs premedicated with medetomidine and butorphanol followed by sevoflurane anaesthesia : a randomized clinical study

Publisher Copyright: © 2022 The Author(s)Objective: To investigate effects of vatinoxan in dogs, when administered as intravenous (IV) premedication with medetomidine and butorphanol before anaesthesia for surgical castration. Study design: A randomized, controlled, blinded, clinical trial. Animals: A total of 28 client-owned dogs. Methods: Dogs were premedicated with medetomidine (0.125 mg m−2) and butorphanol (0.2 mg kg−1) (group MB; n = 14), or medetomidine (0.25 mg m−2), butorphanol (0.2 mg kg−1) and vatinoxan (5 mg m−2) (group MB-VATI; n = 14). Anaesthesia was induced 15 minutes later with propofol and maintained with sevoflurane in oxygen (targeting 1.3%). Before surgical incision, lidocaine (2 mg kg−1) was injected intratesticularly. At the end of the procedure, meloxicam (0.2 mg kg−1) was administered IV. The level of sedation, the qualities of induction, intubation and recovery, and Glasgow Composite Pain Scale short form (GCPS-SF) were assessed. Heart rate (HR), respiratory rate (fR), mean arterial pressure (MAP), end-tidal concentration of sevoflurane (FE′Sevo) and carbon dioxide (PE′CO2) were recorded. Blood samples were collected at 10 and 30 minutes after premedication for plasma medetomidine and butorphanol concentrations. Results: At the beginning of surgery, HR was 61 ± 16 and 93 ± 23 beats minute−1 (p = 0.001), and MAP was 78 ± 7 and 56 ± 7 mmHg (p = 0.001) in MB and MB-VATI groups, respectively. No differences were detected in fR, PE′CO2, FE′Sevo, the level of sedation, the qualities of induction, intubation and recovery, or in GCPS-SF. Plasma medetomidine concentrations were higher in group MB-VATI than in MB at 10 minutes (p = 0.002) and 30 minutes (p = 0.0001). Plasma butorphanol concentrations were not different between groups. Conclusions and clinical relevance: In group MB, HR was significantly lower than in group MB-VATI. Hypotension detected in group MB-VATI during sevoflurane anaesthesia was clinically the most significant difference between groups.Peer reviewe

Cytokeratin 5 determines maturation of the mammary myoepithelium

At invasion, transformed mammary epithelial cells expand into the stroma through a disrupted myoepithelial (ME) cell layer and basement membrane (BM). The intact ME cell layer has thus been suggested to act as a barrier against invasion. Here, we investigate the mechanisms behind the disruption of ME cell layer. We show that the expression of basal/ME proteins CK5, CK14, and alpha-SMA altered along increasing grade of malignancy, and their loss affected the maintenance of organotypic 3D mammary architecture. Furthermore, our data suggests that loss of CK5 prior to invasive stage causes decreased levels of Zinc finger protein SNAI2 (SLUG), a key regulator of the mammary epithelial cell lineage determination. Consequently, a differentiation bias toward luminal epithelial cell type was detected with loss of mature, alpha-SMA-expressing ME cells and reduced deposition of basement membrane protein laminin-5. Therefore, our data discloses the central role of CK5 in mammary epithelial differentiation and maintenance of normal ME layer.Peer reviewe

Rahapelaaminen puheeksi : Puheeksiotto, tunnistaminen ja lyhytneuvonta

Rahapelaaminen on Suomessa hyvin yleistä. Osalle pelaajista se aiheuttaa talouteen, ihmissuhteisiin ja terveyteen liittyviä ongelmia. Riskipelaamisen ja rahapeliongelman varhainen tunnistaminen on tästä syystä tärkeää. Mitä aikaisemmin ongelma huomataan, sitä vähäisemmäksi haitat jäävät ja pelaaja saa avun ongelmasta toipumiseen. Tämä tukiaineisto tarjoaa ammattilaisille toimintamallin rahapelaamisen puheeksi ottamiseen, ongelman tunnistamiseen ja lyhytneuvontaan.Pelihaitat - tukiaineistoTämän julkaisun korvaa uusi, muutettu painos osoitteessa: http://urn.fi/URN:ISBN:978-952-343-679-4</a

Surgical treatment of chronic acromioclavicular joint dislocation with autogenous tendon grafts

Peer reviewe