Quantifying Time Awake Posturographically

This thesis focuses on the issue of testing sleepiness quantitatively. The issue is relevant to policymakers concerned with traffic- and occupational safety; such testing provides a tool for safety legislation and -surveillance. The findings of this thesis provide guidelines for a posturographic sleepiness tester. Sleepiness ensuing from staying awake merely 17 h impairs our performance as much as the legally proscribed blood alcohol concentration 0.5 does. Hence, sleepiness is a major risk factor in transportation and occupational accidents. The lack of convenient, commercial sleepiness tests precludes testing impending sleepiness levels contrary to simply breath testing for alcohol intoxication. Posturography is a potential sleepiness test, since clinical diurnal balance testing suggests the hypothesis that time awake could be posturographically estimable. Relying on this hypothesis this thesis examines posturographic sleepiness testing for instrumentation purposes. Empirical results from 63 subjects for whom we tested balance with a force platform during wakefulness for maximum 36 h show that sustained wakefulness impairs balance. The results show that time awake is posturographically estimable with 88% accuracy and 97% precision which validates our hypothesis. Results also show that balance scores tested at 13:30 hours serve as a threshold to detect excessive sleepiness. Analytical results show that the test length has a marked effect on estimation accuracy: 18 s tests suffice to identify sleepiness related balance changes, but trades off some of the accuracy achieved with 30 s tests. The procedure to estimate time awake relies on equating the subject s test score to a reference table (comprising balance scores tested during sustained wakefulness, regressed against time awake). Empirical results showed that sustained wakefulness explains 60% of the diurnal balance variations, whereas the time of day explains 40% of the balance variations. The latter fact implies that time awake estimations also must rely on knowing the local times of both test and reference scores.

Very Low Birth Weight Infants as Young Adults : Focus on aspects of cognition, behavior and sleep

Major advances in the treatment of preterm infants have occurred during the last three decades. Survival rates have increased, and the first generations of preterm infants born at very low birth weight (VLBW; less than 1500 g) who profited from modern neonatal intensive care are now in young adulthood. The literature shows that VLBW children achieve on average lower scores on cognitive tests, even after exclusion of individuals with obvious neurosensory deficits. Evidence also exists for an increased risk in VLBW children for various neuropsychiatric disorders such as attention-deficit hyperactivity disorder (ADHD) and related behavioral symptoms. Up till now, studies extending into adulthood are sparse, and it remains to be seen whether these problems persist into adulthood. The aim of this thesis was to study ADHD-related symptoms and cognitive and executive functioning in young adults born at VLBW. In addition, we aimed to study sleep disturbances, known to adversely affect both cognition and attention. We hypothesized that preterm birth at VLBW interferes with early brain development in a way that alters the neuropsychological phenotype; this may manifest itself as ADHD symptoms and impaired cognitive abilities in young adulthood. In this cohort study from a geographically defined region, we studied 166 VLBW adults and 172 term-born controls born from 1978 through 1985. At ages 18 to 27 years, the study participants took part in a clinic study during which their physical and psychological health was assessed in detail. Three years later, 213 of these individuals participated in a follow-up. The current study is part of a larger research project (The Helsinki Study of Very Low Birth Weight Adults), and the measurements of interest for this particular study include the following: 1) The Adult Problem Questionnaire (APQ), a self-rating scale of ADHD-related symptoms in adults; 2) A computerized cognitive test battery designed for population studies (CogState®) which measures core cognitive abilities such as reaction time, working memory, and visual learning; 3) Sleep assessment by actigraphy, the Basic Nordic Sleep Questionnaire, and the Morningness-Eveningness Questionnaire. Actigraphs are wrist-worn accelerometers that separate sleep from wakefulness by registering body movements. Contrary to expectations, VLBW adults as a group reported no more ADHD-related behavioral symptoms than did controls. Further subdivision of the VLBW group into SGA (small for gestational age) and AGA (appropriate for gestational age) subgroups, however, revealed more symptoms on ADHD subscales pertaining to executive dysfunction and emotional instability among those born SGA. Thus, it seems that intrauterine growth retardation (for which SGA served as a proxy) is a more essential predictor for self-perceived ADHD symptoms in adulthood than is VLBW birth as such. In line with observations from other cohorts, the VLBW adults reported less risk-taking behavior in terms of substance use (alcohol, smoking, and recreational drugs), a finding reassuring for the VLBW individuals and their families. On the cognitive test, VLBW adults free from neurosensory deficits had longer reaction times than did term-born peers on all tasks included in the test battery, and lower accuracy on the learning task, with no discernible effect of SGA status over and above the effect of VLBW. Altogether, on a group level, even high-functioning VLBW adults show subtle deficits in psychomotor processing speed, visual working memory, and learning abilities. The sleep studies provided no evidence for differences in sleep quality or duration between the two groups. The VLBW adults were, however, at more than two-fold higher risk for sleep-disordered breathing (in terms of chronic snoring). Given the link between sleep-disordered breathing and health sequelae, these results suggest that VLBW individuals may benefit from an increased awareness among clinicians of this potential problem area. An unexpected finding from the sleep studies was the suggestion of an advanced sleep phase: The VLBW adults went to bed earlier according to the actigraphy registrations and also reported earlier wake-up times on the questionnaire. In further study of this issue in conjunction with the follow-up three years later, the VLBW group reported higher levels of morningness propensity, further corroborating the preliminary findings of an advanced sleep phase. Although the clinical implications are not entirely clear, the issue may be worth further study, since circadian rhythms are closely related to health and well-being. In sum, we believe that increased understanding of long-term outcomes after VLBW, and identification of areas and subgroups that are particularly vulnerable, will allow earlier recognition of potential problems and ultimately lead to improved prevention strategies.

Spam – Spim – Spit. En marknadsrättslig undersökning av marknadsföring via nya kommunikationstekniker

I boken behandlas nya kommunikationstekniker och olika marknadsföringsmetoder som har uppkommit till följd av den tekniska utvecklingen. Marknadsföring via de nya kommunikationskanalerna har givit upphov till vissa olägenheter för mottagarna. Olägenheterna som mottagarna förorsakas vid marknadsföring via de nya teknikerna kan delas in i tre kategorier; 1) meddelandet förorsakar kostnader för mottagaren, 2) meddelandet hindrar mottagaren samt 3) meddelandet upplevs vara påträngande och utgöra ett intrång i mottagarens privatliv. Under de senaste åren har det förekommit hektiska lagstiftningsåtgärder på många håll i världen. Såväl enskilda stater, nationella myndigheter samt internationella organisationer har utarbetat regler om marknadsföring via de nya teknikerna. En av kärnfrågorna i regleringen är huruvida man skall ha ett system med ”opt-in” eller ”opt-out”. En opt-in-lösning innebär att marknadsföraren måste inhämta mottagarens samtycke på förhand, medan en opt-out-lösning innebär att det är tillåtet att sända marknadsföring om inte mottagaren motsatt sig detta. Enligt gällande lagstiftning faller marknadsföring via följande tre tekniker under opt-in: automatiserade uppringningssystem, telefax samt e-post. Det huvudsakliga syftet med avhandlingen är att utreda om nuvarande opt-in-lista är tillräckligt omfattande med beaktande av de olägenheter som marknadsföring via de nya teknikerna förorsakar, eller om den bör utvidgas. I genomgången av marknadsföring via nya tekniker har marknadsföring via bl.a. följande tekniker undersökts: Internet (www-sidor), reklamfönster, reklambanner, e-post, mobiltelefon, telefax, bloggar, RSS, Instant Messaging samt Internettelefoni. Vid sidan av nya tekniker har även vissa ”traditionella” marknadsföringsmetoder undersökts, i syfte att utreda huruvida även de bör falla in under en opt-in-lösning. De traditionella marknadsföringsmetoder som ingår i avhandlingen är hemförsäljning, telemarketing, TV- och radioreklam samt adresserad och oadresserad direktreklam. En annan central del i avhandlingen är frågan hur påföljdssystemet vid överträdelser av opt-in-bestämmelserna bör utformas. Hur skall de enskilda mottagarna få ersättning för de kostnader de åsamkats av marknadsföringen? Är det dags att införa straffskadestånd i Finland? Hög tid att även Finland får grupptalan? Kan tvisterna avgöras virtuellt via domstolar on-line eller ODR?