Förutsättningarna för psykiatrisk vård oberoende av patientens vilja och patientens rättsskydd vid fattandet av vårdbeslutet

I arbetet analyseras de i mentalvårdslagen (1990/1116) stadgade förutsättningarna för psykiatrisk sjukhusvård oberoende av patientens vilja gällande myndiga patienter för vilka inte har utsetts en intressebevakare före fattandet av vårdbeslutet, samt bakgrunden till och en del av de svårigheter som förknippas med denna form av vård och härtill anknutet beslutsfattande. Problemen tillspetsas framförallt i situationer av intressekonflikt mellan patientens intressen respektive samhällets intressen. Utgångspunkten ligger främst i finländsk mentalvårdslagstiftning och rättspraxis, men för att på ett ändamålsenligt sätt kunna redogöra för bakgrunden till och förutsättningarna för dylikt förvaltningsrättsligt beslutsfattande görs även relevanta kopplingar till medicinska (psykiatriska) yrkesetiska riktlinjer och mentalvårdslagstiftning inom övriga Norden. Analysen omfattar även den Europeiska människorättsdomstolens praxis i fall som gäller frihetsberövande på basis av psykiatrisk vård, närmare bestämt artikel 5 (1)(e) i den europeiska människorättskonventionen. Patientens självbestämmanderätt, frihet och integritet är utgångspunkterna för alla slags vårdförhållanden. Dessa inbegriper bl.a. frivillighet och informerat samtycke då en person söker vård. Möjligheten att förordna en person till psykiatrisk vård oberoende av dennes vilja är ett lagstadgat undantag till dessa principer. Beslutsfattandet är bundet till strikta lagstadgade förutsättningar, vilkas bedömning kräver juridisk, men framförallt medicinsk kunskap, vilket också skapar gränser och utmaningar för de yrkespersoner som arbetar med dylika ärenden. Kombinationen av psykiatri, etik och juridik är nödvändig, men inte alltid enkel att göra, vilket märks inte minst på terminologin som tillämpas i mentalvårdslagstiftningen. I arbetet analyseras en del av den terminologi som tillämpas inom finsk och övrig nordisk mentalvårdslagstiftning. Syftet är att visa att definitionerna, tolkningarna, terminologin och synsättet på psykisk ohälsa som tillämpas inom den finländska mentalvårdslagstiftningen jämförelsevis kanske inte är de mest lämpliga eller tidsenliga. En annan svår uppgift, som framförallt lagstiftaren ställ(t)s inför, är utformningen av mentalvårdslagstiftning som är tillräckligt flexibel för att tillåta beaktande av särdragen i varje enskilt ärende, men som samtidigt är strikt nog för att förhindra godtycke och missbruk. En person som lider av allvarlig psykisk ohälsa befinner sig oftast i en ytterst utsatt position, och är ofta begränsat eller inte alls kapabel att göra en korrekt bedömning av sig själv och sin situation. Således sker den starka betoningen av patientens självbestämmanderätt på både gott och ont. Det är kanske inte alltid i en psykiatrisk patients bästa att få bestämma själv, vilket också är en av frågorna som omfattas av analysen i arbetet. Eftersom det psykiatriska vårdbeslutet till karaktären är ett (skriftligt) förvaltningsbeslut, skiljer det sig samtidigt från övrigt beslutsfattande inom vårdsektorn, vilket till största delen utgör faktisk förvaltningsverksamhet. För patienten innebär vårdbeslutet också ett administrativt frihetsberövande. Ingreppet i patientens grundläggande fri- och rättigheter är särskilt stort och upplevs ofta som mycket kränkande, och därför ställs särskilt strikta krav på iakttagande av det lagstadgade beslutsförfarandet och vårdförutsättningarna samt tillgodoseendet av patientens rättsskydd. Den offentliga hälso- och sjukvården är verksamhet som är underställd den offentliga förvaltningen, vilket innebär att de allmänna förvaltningsrättsliga rättsskyddsgarantierna är tillämpliga. I och med vårdbeslutets karaktär av förvaltningsbeslut, kan ändring i beslutet sökas genom besvär hos förvaltningsdomstolen. Dessa är också några av de frågor som behandlas i arbetet.

Viljan visar vägen till identiteten : Berättelsetyper och teman i livsberättelser av kvinnliga teologer i Svenskfinland

Forskningens utgångspunkt var att tillföra information om kvinnliga teologers liv i Svenskfinland under en period då kyrkan hade omdefinierat sin syn på kvinnor som präster. Till forskningens intresseområden hörde frågan om hur situationen hade påverkat kvinnors motivation att välja teologiska studier och yrken samt hur situationen hade inverkat på kvinnliga teologer i arbetslivet. Forskningens uppgift är att ur ett identitetsperspektiv undersöka målgruppens egna skildringar av livet som kvinnlig teolog i Svenskfinland. Forskningsfrågan delades in i två delfrågor: 1)Hur har kvinnliga teologer kommit att välja studier, yrken och arbetsplats? 2)Vad har kvinnliga teologer upplevt i sina studier och arbetsliv? Forskningens material samlades in hösten 2003 genom en förfrågan per brev och genom en tidningsnotis i tidningen Kyrkpressen. Materialet bestod av livsberättelser som kvinnliga teologer i olika yrkesgrupper hade skrivit utgående ifrån rubriken ”Mitt liv som kvinnlig teolog i Svenskfinland”. Cirka 250 kvinnor hade avlagt teologisk examen på svenska i Finland. Antalet personer som deltog i undersökningen med sin livsberättelse var 27. Materialet analyserades kvalitativt och induktivt med en narrativ analys som tog fasta på teman och berättelsetyper i olika livsskeden: val av studier, studietid, val av karriär och erfarenheter från arbetslivet. Analysresultatet var att studievalets beskrivning kunde tolkas som en valsituation där egenskaper jämfördes med yrkesrollen, som en socialisationsprocess, som ett alternativ till tidigare studieinriktning eller som en process där kvinnoprästdiskussioner, intresse för teologi och teologuppgifter fick informanten att välja teologin. Teman från studietiden handlade om studiers fördröjning, om yrkesinriktning, om studier som förberedelse för arbetslivet och om kvinnoprästdiskussionens inverkan på yrkesinriktningen. Val av arbetsplatser och yrken beskrevs utgående ifrån kvinnliga teologers förändrade position, moderskapets inverkan på karriären, en strävan att hitta en arbetsplats som passade informanten, erfarenheter från en enda arbetsplats och karriärsbyte. Lektorer tog fasta på välsignelseaktens betydelse, kyrkoherdens stora inflytande på arbetets karaktär samt hur situationen förändrades då kvinnor tilläts bli präster. För en del präster innebar prästrollen att andra människor betonade att de var kvinnor. Några informanter hade behov av stöd både från Borgå stifts ledning och från andra kvinnliga präster under den första tiden med kvinnliga präster. Till en början upplevdes ledningens stöd inte alltid som tillräckligt men det förbättrades med tiden. Informanterna berättade inte så mycket om läraryrket. Inom forskning verkade teologtiteln vara naturlig, medan informanter med erfarenhet av annat än teologyrken ibland hade stött på reaktioner på sitt yrkesval eller sin arbetsroll. Finlandssvenskheten upplevdes av olika informanter både som tryggt och inskränkt. Eventuella kontakter till finska stift upplevdes positivt även om det egna sammanhanget upplevdes som viktigt. Trivsel på arbetsplatsen orsakades av subjektiva belöningar och i en del fall av att arbetet motsvarade informantens yrkesinriktning. Att vara kvinnlig teolog innebar ibland att informantens yrkesval tolkades av andra som ett ställningstagande för någon ideologi i kvinnoprästfrågan.

Större frihet - bättre lokalt anpassad service? : Förvaltningsreformer och kommunernas service för utvecklingsstörda 1994-2000

In the beginning of the 1990s the legislation regarding the municipalities and the system of central government transfers were reformed in Finland. This resulted in a move from detailed governmental control to increased municipal autonomy. The purpose of this decentralization was to enable the municipalities to better adapt their administration and service supply to local needs. The aim of this study was to explore the effects of the increased municipal autonomy on the organization of services for people with intellectual disabilities. Did the increased autonomy cause the municipalities to alter their service supply and production and did the services become more adapted to local needs? The data consists of statistical information on service use and production, and also of background data such as demographics, economics and political elections on 452 municipalities in Finland from the years 1994 and 2000. The methods used are cluster analysis, discriminant analysis and factor analysis. The municipalities could be grouped in two categories: those which offered mainly one kind of residential services and others which had more varied mixes of services. The use of institutional care had decreased and municipalities which used institutional care as their primary form of service were mostly very small municipalities in 2000. The situation had changed from 1994, when institutional care was the primary service for municipalities of all sizes. Also the service production had become more differentiated and the municipalities had started using more varied ways of production. More municipalities had started producing their own services and private production had increased as well. Furthermore, the increase in local autonomy had opened up possibilities for local politics to influence both the service selection and methods of production. The most significant motive for changes in the service structure was high unemployment and an increasing share of elderly people in the population, particularly in sparsely populated areas. Municipalities with a low level of resources had made more changes in their service organization while those with more resources had been able to carry on as before. Key words: service structure, service for people with intellectual disabilities, municipalities, contingency theory, New Public Management

Short- and long-term consequences of food resources on Ural owl Strix uralensis reproduction

Life-history theory states that although natural selection would favour a maximisation of both reproductive output and life-span, such a combination can not be achieved in any living organism. According to life-history theory the reason for the fact that not all traits can be maximised simultaneously is that different traits compete with each other for resources. These relationships between traits that constrain the simultaneous evolution of two or more traits are called trade-offs. Therefore, during different life-stages an individual needs to optimise its allocation of resources to life-history components such as growth, reproduction and survival. Resource limitation acts on these traits and therefore investment in one trait, e.g. reproduction, reduces the resources available for investment in another trait, e.g. residual reproduction or survival. In this thesis I study how food resources during different stages of the breeding event affect reproductive decisions in the Ural owl (Strix uralensis) and the consequences of these decisions on parents and offspring. The Ural owl is a suitable study species for such studies in natural populations since they are long-lived, site-tenacious, and feed on voles. The vole populations in Fennoscandia fluctuate in three- to four-year cycles, which create a variable food environment for the Ural owls to cope with. The thesis gives new insight in reproductive costs and their consequences in natural animal populations with emphasis on underlying physiological mechanisms. I found that supplementary fed Ural owl parents invest supplemented food resources during breeding in own self-maintenance instead of allocating those resources to offspring growth. This investment in own maintenance instead of improving current reproduction had carry-over effects to the following year in terms of increased reproductive output. Therefore, I found evidence that reduced reproductive costs improves future reproductive performance. Furthermore, I found evidence for the underlying mechanism behind this carry-over effect of supplementary food on fecundity. The supplementary-fed parents reduced their feeding investment in the offspring compared to controls, which enabled the fed female parents to invest the surplus resources in parasite resistance. Fed female parents had lower blood parasite loads than control females and this effect lasted until the following year when also reproductive output was increased. Hence, increased investment in parasite resistance when resources are plentiful has the potential to mediate positive carry-over effects on future reproduction. I further found that this carry-over effect was only present when potentials for future reproduction were good. The thesis also provides new knowledge on resource limitation on maternal effects. I found that increased resources prior to egg laying improve the condition and health of Ural owl females and enable them to allocate more resources to reproduction than control females. These additional resources are not allocated to increase the number of offspring, but instead to improve the quality of each offspring. Fed Ural owl females increased the size of their eggs and allocated more health improving immunological components into the eggs. Furthermore, the increased egg size had long-lasting effects on offspring growth, as offspring from larger eggs were heavier at fledging. Limiting resources can have different short- and long-term consequences on reproductive decisions that affect both offspring number and quality. In long-lived organisms, such as the Ural owl, it appears to be beneficial in terms of fitness to invest in long breeding life-span instead of additional investment in current reproduction. In Ural owls, females can influence the phenotypic quality of the offspring by transferring additional resources to the eggs that can have long-lasting effects on growth.

Personporträttet som tidningsgenre : En närläsningsstudie med fokus på innehållsliga teman, berättarkonventioner och kön

The thesis The portrait interview as a newspaper genre. A qualitative close reading focussing on topical motifs, conventions of narration, and gender defines the portrait interview as a newspaper genre and analyses how the personalities in the portraits are constructed textually. The main body of material consists of 107 portrait interviews in two morning newspapers, Dagens Nyheter (published in Stockholm, Sweden) and Hufvudstadsbladet (published in Swedish in Helsinki, Finland), during two one-week periods (week 46/1999 and week 38/2002). There is also complementary material of 59 portraits from four magazines. The study is carried out within the research traditions of journalistic genre studies, gender and journalism, and critical text analysis. It is comprised of a qualitative close reading focussing on content (topical motifs or themes), conventions of narration, and gender. The methods used to carry out the study are qualitative close reading and quantitative content analysis. The analysis identifies the stylistic elements that differentiate the portrait genre from other journalistic genres, as well as from the autobiographical genre, and explores what opportunities and limitations these elements present for the inclusion of even more women protagonists in the portrait genre. The portrait interview is an exception from the critical mission of journalism in general, with its position as a genre of politeness. Since a typical characteristic of the portrait interview genre is that it pays tribute to the protagonist, the genre reveals the kind of personalities and lives that are seen as admirable in society. Four levels of portrait interview are defined: the prototype portrait, the pure portrait, the hybrid portrait and the marginal portrait. The prototype is a raw version of a portrait that fulfils the criteria but may be lacking in content and stylistics. The pure portrait does not lack these qualities and resembles an ideal portrait. The hybrid is a borderline case which relates to another genre or is a mixture between the portrait and some other genre, most commonly the news genre. The marginal portrait does not fulfil the criteria, and can therefore be seen as an inadequate portrait. For example, obituaries and caricatures are excluded if the protagonist s voice is never quoted. The analysis resulted in three factors that in part help to explain why the portrait interview genre has somewhat more female protagonists than journalistic news texts do in general. The four main reasons why women are presented somewhat more in the portrait genre than in other journalistic genres are: (i) women are shown as exceptions to the female norm when, for example, taking a typical male job or managing in positions where there are few women; (ii) women are shown as representing female themes ; (iii) use of the double bind as a story-generating factor; and (iv) the intimisation of journalism. The double bind usually builds up the narration on female ambiguity in the contradiction between private and public life, for example family and career, personal desire and work. The intimisation of journalism and the double bind give women protagonists somewhat more publicity also because of the tendency of portrait interviews to create conflicts within the protagonist, as an exception to journalism in general where conflicts are created or seen as existing between, for example, persons, groupings or parties. Women protagonists and their lives create an optimal narration of inner conflicts originating in the double bind as men are usually not seen as suffering from these conflicts. The analysis also resulted in gendered portrait norms: The feminine portrait norm and the masculine portrait norm or more concretely, professional life and family life as expectation and exception. Women are expected to be responsible parents and mediocre professionals, while men are expected to be professionals and in their free time engaging fathers. Key words: journalism, genre, portrait interview, gender, interview, newspaper, women s magazine.

Stor Anna, Liten Anna och tio andra personporträtt : Om innehållsliga och språkliga mönster i en mediegenres kvinnobeskrivningar

The aim of this licentiate thesis is to analyse how femininity is constructed in twelve portrait interviews of women in the dailies Dagens Nyheter (Stockholm) and Hufvudstadsbladet (Helsinki) in September 1996, and to explore the portrait interview as a media genre. The qualitative analysis has a feminist and constructionist perspective and is connected to critical text analysis. It was carried out on two levels: first, femininity is identified on the linguistic level by choice of words, and second on the level of content (topical motifs/themes). The portrait interview as a genre constitutes a third dimension in the analysis: The aim is not towards the identification of femininity, but rather towards the identification of the portrait interview a relatively unexplored media genre. References (Swedish: omtal) to the principal character (or protagonist) are traced mainly through reference chains which consist of names, pronouns and substantive phrases. The interviewees were referred to by their full names in Dagens Nyheter (with the exception of the oldest and youngest interviewees, both of whom were mainly referred to by their first names), while the style of reference varied more in Hufvudstadsbladet. The position of the principal character was also analysed through her relation in the text to minor characters from her working life and from her private life. These minor characters maintained their subordinate positions in all of the portraits except that of the youngest principal character, in which the subsidiary voices became at least as strong as the voice of the principal character. Three frequently-recurring topical motifs occurred in the portraits: The first involved explanations for the principal character s success divided into three categories, agent, affect and ambition, the second concerned using journeys or trips as symbols for turning points in life, and the third referred to the ambiguity in the contradiction between private (family/other private life) and public (work) life. This ambiguity is connected to the portrait interview as a text type (genre) which features conclusions at the end of portraits, which in turn is characteristic of reportage. However, the analysis showed that the conclusions of the portrait interviews often also included elements of ambiguity. This was evident in the contradictions be14 tween private and public life that arose in the portrait interviews that focused on these two spheres. The portraits that focused on the principal character s public life showed ambiguity on a more general level concerning questions about being a woman and having a profession, and they often ended with a description of some details of her private life. The women in the portraits were all constructed as being successful, in terms of having achieved direct success, reflective success or success in the form of life wisdom. The women of direct success were described as ambitious individuals with no sidetracks on their life paths, while those of reflective success were described as active heroines who had received help from different agents, who could use their affects as enriching ingredients in life, but who in the end had control over their own lives (life stories). The elderly women were constructed as having achieved life wisdom and their portraits were focused upon the past. The portrait interview as a genre is characterised by journalistic freedom (in relation to the more strict news genre), by a now room (Swedish nurum ) where the journalist meets the principal character (usually via spoken dialogue that she or he transforms into written text to be read by a mass-media audience) and by the relatively closed structure of the portrait. The portrait is relatively independent in relation to the news genre and in relation to the context of what has previously been written, what is being written at the time and what will be written in the future the principal character does not need to belong to the newspaper s usual gallery of actors. Furthermore, the principal character is constructed as being independent in relation to the subsidiary characters and other media actors. The conflict is within the principal character herself and within her life story, unlike the news genre in which equal actors are in conflict with each other. The portrait is also independent in relation to the news lifespan; the publishing timetable is not as strict as in the news genre, but is still dependent on the factors initiating the portrait. The enclosures consist of a raw analysis of two of twelve portrait interviews and of copies of all portraits.

Diabetesassocierade autoantikroppar hos barn med nydiagnostiserad typ 1 diabetes i relation till demografiska och kliniska faktorer

Syftet med studien var att undersöka sambanden mellan de diabetesassocierade autoantikropparna ICA, IAA, GADA, IA-2A och klinisk manifestation, HLA-genotyp, släktanamnes samt demografiska faktorer såsom ålder och kön hos finländska barn under 15 år med nydiagnostiserad typ 1 diabetes. Analyserna baserades på ett utdrag ur det finländska pediatriska diabetesregistret (2257 barn). Antikroppsfrekvenserna fastställdes utgående från halterna i serum. Alla barn HLA-genotypades och indelades i DR3- och DR4-positiva. Småbarnen (?5 år) hade ofta 3-4 positiva antikroppar. Äldre barn hade färre autoantikroppar men en allvarligare metabolisk dekompensering vid diagnostillfället. Diabetisk ketoacidos var vanligare hos flickor. I gruppen med endast en positiv autoantikropp var IA-2A-barnen oftare acidotiska, i övrigt påverkade inte antikroppsprofilen den kliniska bilden. Högriskgenotypen DR4/non-DR3 var associerad med IA-2A, som verkar fungera som en markör för betacelldestruktion. Det omfattande patientmaterialet gav stöd åt tidigare rapporter om samband mellan autoantikroppar och ålder, kön samt genotyp. Den allvarligare metaboliska dekompenseringen hos äldre barn tyder på att de inte diagnostiseras lika snabbt som småbarn.

Sångöversättning – någonstans mellan respekt och slagkraft

Abstract (Song translation. Balancing between respect and hit capacity): The article discusses song translation by posing questions relevant to the study, practice, and assessment of translating/translated song: Is song translation really translation? Do non-singable translations count? Can we distinguish between free and faithful song translation? Are there untranslatable (aspects of) songs? etc. Three song translations between Finnish and Swedish are analyzed in the discussion: one made for a booklet to a recording, which in spite of the evident documentary purpose is fairly singable, one that is a national transplantation, which moves the sung story to the target country but even so is fairly faithful, and one that is considered respectful to its source, became a target culture hit, but perhaps because of the subtle changes in content. Changes can be seen as caused by a particular translation brief, as manipulations negotiating a cultural difference, or as examples of how (liberally) the craft of song translation is exercised. An amateur translation of the same song, made by the article’s author, is deemed dysfunctional for having put emphasis merely on semantic accuracy and rhymes, neglecting other aspects of the craft. The article suggests that singability is a relative concept, that stylistic/intertextual values matter a great deal in song and exert significant influence on song translation, and that source and target attentions in this area can be discussed as a much variable vacillation between a stance of respect and an aim for hit capacity.

Översättningsforskning och framtidsskapande proaktivitet

Abstract (Translation studies and the possibility of future-creating proactivity): Translation researchers often and quite eagerly emphasise the practice-orientedness and usefulness of their field of knowledge as well as the proactive impact which their findings have or will have on modern translation practice. This article adopts, however, a critical view of that kind of a goal for proactive action within translation studies, and advocates a different conception and facet of proactivity. Hence, the question of future-orientedness of translation research is approached and explored from two vantage points: first, from the three Peircean modalities, namely possibility (may-be), (f)actuality (actually-is), and tendenciality (must-be or shouldbe)and second, from a futures semiotic view, according to which a future can be invented, made, or discovered.

SFL och översättningsforskning

Abstract (SFL and translation studies): In this paper, the study of translation is seen as a study of texts and discourses. It is argued that systemic-functional linguistics gives both a theoretical framework to discuss variation in text and variation in situational and cultural context, as well as an analytical toolkit to use to compare texts with each other. The same systemic-functional framework can hence be used to analyse both directly written texts and translations.

Mig eller mej, själ eller sjel? Problem och lösningar vid transkription av svenska sångtexter

Abstract (Mig or mej, själ or sjel? Problems and solutions in the transcription of Swedish song texts): In this article I am pointing out and discussing problems and solutions concerning phonetic transcription of Swedish song texts. My material consists of 66 Swedish songs phonetically transcribed. The transcriptions were published by The Academy of Finnish Art Song in 2009. The first issue was which level of accuracy should be chosen. The transcriptions were created to be clear at a glance and suitable for the needs of interpretation of non Swedish speaking singers. The principle was to use as few signs and symbols as possible without sacrificing accuracy. Certain songs were provided with additional information whenever there was a chance of misinterpretation. The second issue was which geographic variety of the language should be visible in the transcription, Standard Swedish or Finland-Swedish? The songs in the volume are a selection of well-known works that are also of international interest. Most were composed by Jean Sibelius (1865–1957), a substantial number of whose songs were based on poems written by Finland’s national poet, Johan Ludvig Runeberg (1804–1877). Thus I chose to use the variety of Swedish language spoken in Finland, in order to reflect the cultural origin of the songs. This variety differs slightly from the variety spoken in Sweden both on prosodic and phonetic level. In singing, the note-text gives the interpretor enough information about prosody. The differences concern mostly the phonemes. A fully consequent transcript was, however, difficult to make, due to vocal requirement. So, for example, in an unstressed final syllable the vowel was often indicated as a central vowel, which in singing is given a more direct emphasis than in a literal pronunciation, even if this central vowel does not occur in spoken Finland-Swedish.

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.