Introduktion: Trycksår är en vårdskada som kan uppstå i samband med kirurgiska ingrepp. Det medför ett stort lidande för patienten men även en kostnad för samhället. Alla patienter som opereras har en ökad risk att utveckla trycksår på grund av unika riskfaktorer som en operation medför. Därför har operationsteamet en särskild utmaning i att förebygga denna vårdskada.   Syfte: Syftet med studien var att undersöka vilka trycksårspreventiva åtgärder som operationsteamet använder.   Metod: Studien genomfördes som en observationsstudie med kvantitativ ansats. Operationsteam vid ett medelstort sjukhus i södra Sverige observerades.  Ett observationsprotokoll konstruerades för att fånga de åtgärder som operationsteamet använde. Totalt genomfördes 20 observationer.   Resultat: Operationsteamet tryckavlastade patientens hälar och bakhuvud. Patienten värmdes intraoperativt, personalen såg till att patienten inte låg med benen i kors eller låg på varmt underlag och anpassade  operationsbordet efter patientens behov. Flera möjliga trycksårsförebyggande metoder genomfördes inte alls eller i liten utsträckning. Operationsteamet repositionerade inte patienten varannan timme, instrument, personal och utrustning tilläts trycka på patienten och material fanns mellan patienten och den tryckavlastande madrassen.   Konklusion: Operationsteamet utnyttjade trycksårspreventiva åtgärder för att förhindra trycksår hos patienten. Dock fanns ett flertal trycksårsförebyggande åtgärder som sällan användes eller inte alls. / Introduction: Pressure ulcers are a common health problem that can be a complication in surgical procedures. It means a great suffering for the patient, but also a cost to society. The surgical team has a special challenge to prevent pressure ulcers that occur in the operating room. It´s because all patients who undergo surgery have an increased risk of developing pressure ulcers because of the unique risk factors that an operation means for the patient.   Aim: The purpose of this study was to investigate the methods that the surgical team use to prevent pressure ulcer in patients during surgery.   Method: The study was conducted as an observational study with quantitative approach. The study included 20 observations of surcial teams on a hospital in south Sweden. An observation protocol was created to capture the preventive methods the surgical team used.   Results: The surgical team depressurized the patients heels and occiput with pillows. The surgical team was warming the patient intraoperatively, made sure that the patient was not lying with legs crossed or laid on a warm surface. The staff adjusted the operating table to the patient's needs. Several possible methods to prevent pressure ulcers that was not used or rarely used, was also observed. The surgical team did not reposition the patient every two hours, equipment and staff were allowed to press against the patient and layers of material laid between the patient and the pressure ulcer preventing mattress.   Conclusion: The surgical team used pressure ulcer preventive methods to decrease the risks of pressure ulcer in the patients. However, there were a number of pressure ulcers prevention methods that were rarely used.

SAMMANFATTNING   Bakgrund: Tidigare studier visar att patienter påverkas både fysiskt och psykiskt vid överflyttning från en miljö till en annan. Att överflyttas från den specialiserade, högteknologiska intensivvårdsavdelningen till en vårdavdelning kan skapa upplevelser och känslor av stress, oro, ångest, osäkerhet, depression, sömnstörningar, minnesbortfall, mardrömmar med mera. Syfte: Att utforska hur miljöns utformning för vårdandet påverkar patientens välbefinnande efter överflyttning från intensivvårdsavdelning till kirurgisk vårdavdelning. Metod: Syftet besvarades med hjälp av upprepade observationer med informella intervjuer av tre patienter som hade vårdats på en intensivvårdsavdelning och hade överflyttats till en kirurgisk vårdavdelning. Deduktiv innehållsanalys användes och utgick från en tidigare skapad modell av begreppet miljö. Resultat: Patienternas välbefinnande påverkades av miljön efter överflytten till den kirurgiska vårdavdelningen. Resultatet presenteras efter modellens kategorier atmosfär, omvärld, omgivning, medelpunkt och förhållande. Slutsats: Att överflyttas till en lägre vårdnivå som en vårdavdelning är en stor omställning för patienterna både fysiskt och psykiskt. Resultatet stödjer att det finns en kunskapslucka som består av skillnader i miljön, skillnader i sjuksköterskors kompetens och skillnader i kommunikationen mellan intensivvårdsavdelningar och vårdavdelningar. Det är viktigt att tydliga rutiner finns kring hur en intensivvårdspatient ska tas emot och vårdas vid överflyttningen till en vårdavdelning. För att miljöombytet inte ska bli för omfattande för patienten kan överflyttning först ske till en intermediärvårdsavdelning innan vidare överflyttning till en vårdavdelning sker. / ABSTRACT Background: Previous studies showed that patients are affected both physically and mentally when they transferring from one environment to another. To be transferred from the specialized, high-tech intensive care to a ward can create experiences and feelings of stress, worry, anxiety, insecurity, depression, sleep disorders, memory loss, and nightmares with more. Aim: The aim of this study was to explore how environmental design for care affects the patient's well-being after transfer from intensive care to the surgical ward. Method: The aim was answered with help from repeated observations with informal interviews with three patients who had been treated in an intensive care unit and had been transferred to a surgical ward. Deductive content analysis was used and was based on a previously created model. Result: The patients' well-being was affected by the environment after transfer to the surgical ward. The results are presented according to the categories atmosphere, entourage, surroundings, midpoint and relationship. Conclusion: Be transferred to a lower level of care as a ward is a big change for the patients both physically and psychologically. The result supports that there is a knowledge gap which consist of differences in the environment, differences in nurses' skills and differences in communication between intensive care units and wards. It is important that there are clear procedures on how an intensive care patient to be received and cared for at the transfer to a ward. To move from one environment to another should not be too extensive for the patient can first be transfer place to an Intermediate Care Facility before further transfer to a ward occurs.

As lesões ósseas são doenças raras, mas com um grande destaque, que afetam a região maxilofacial. Dentre elas podemos destacar as Lesões Centrais de Células Gigantes e as Lesões Fibro-Ósseas Benignas (Displasia Cemento-Ossificante, Fibroma Ossificante e Displasia Fibrosa). O presente estudo teve como objetivo descrever e analisar os dados encontrados nas fichas de encaminhamento clínico presentes no Serviço de Patologia Oral e Maxilofacial da Faculdade de Odontologia da Universidade de São Paulo. Foram avaliados 89.265 casos em um período que variou de 1950 até 2016, utilizando as categorias de gênero, idade, etnia, sintomatologia, hipótese diagnóstica e localização anatômica. Após as exclusões, os casos selecionados somavam 773 casos divididos em: 267 casos de Lesão Central de Células Gigantes, 231 casos de Displasia Cemento Ossificante, 142 casos de Fibroma Ossificante e 133 de Displasia Fibrosa. Os resultados do estudo estão de acordo com o que está descrito na literatura, exceto nos casos de Displasia Fibrosa que foi encontrado uma predileção maior sexo feminino do que o masculino, mesmo que a literatura expresse que não existe tal predileção. Já nos casos de Displasia Cemento-Ossificante, o presente estudo mostrou que a maior prevalência de idade é entre a 4ª e 5ª década de vida e não entre a 3ª e 4ª como encontrado na literatura. Os casos de Displasia Cemento-Ossificante, em relação à etnia dos pacientes, mostraram que a maioria dos pacientes encontrados pelos autores eram leucodermas e não melanodermas como relata a literatura. Os resultados mostraram que mesmo em um centro de referência como o Serviço de Patologia Oral da Faculdade de Odontologia da Universidade de São Paulo, as lesões ósseas são raras e alguns fatores como idade em pacientes com Displasia Fibrosa e Displasia Cemento-Ossificante e etnia em pacientes com Displasia Cemento-Ossificante não correspondem ao encontrado na literatura mundial. / Bone lesions are rare but important diseases that affect the maxillofacial region. Among them we can highlight the Central Giant Cells Lesion and the Benign Fibro-Osseous Lesions (Cemento-Osseous Dysplasia, Ossifying Fibroma and Fibrous Dysplasia). The objective of this study was to describe and analyze the data found in the clinical referral forms present at the Oral and Maxillofacial Pathology Service of the Faculty of Dentistry of the University of São Paulo. We evaluated 89.265 cases in a period ranging from 1950 to 2016, using the categories of gender, age, ethnicity, symptomatology, diagnostic hypothesis and anatomical location. After the exclusions, the selected cases totaled 773 cases divided into 267 cases of Central Giant Cell Lesion, 231 cases of Cemento-Osseous Dysplasia, 142 cases of Ossyfing Fibroma and 133 cases of Fibrous Dysplasia. The results of the study are in agreement with what is described in the literature, except in the cases of Fibrous Dysplasia that a predilection was found greater female than the male, even if the literature expresses that there is no such predilection. In the cases of Cemento-Osseous Dysplasia, the present study showed that the highest prevalence of age is between the 4th and 5th decade of life and not between the 3rd and 4th as found in the literature. The cases of Cemento-Osseous Dysplasia, in relation to the ethnicity of the patients, showed that the majority of the patients found by the authors were white and not black as reported in the literature. The results showed that even in a reference center such as the Oral Pathology Service of the Faculty of Dentistry of the University of São Paulo, bone lesions are rare and some factors such as age in patients with Fibrous Dysplasia and Cement-Ossificante Dysplasia and ethnicity in patients with Cement-Ossific Dysplasia do not correspond to that found in the world literature.

As lesões ósseas são doenças raras, mas com um grande destaque, que afetam a região maxilofacial. Dentre elas podemos destacar as Lesões Centrais de Células Gigantes e as Lesões Fibro-Ósseas Benignas (Displasia Cemento-Ossificante, Fibroma Ossificante e Displasia Fibrosa). O presente estudo teve como objetivo descrever e analisar os dados encontrados nas fichas de encaminhamento clínico presentes no Serviço de Patologia Oral e Maxilofacial da Faculdade de Odontologia da Universidade de São Paulo. Foram avaliados 89.265 casos em um período que variou de 1950 até 2016, utilizando as categorias de gênero, idade, etnia, sintomatologia, hipótese diagnóstica e localização anatômica. Após as exclusões, os casos selecionados somavam 773 casos divididos em: 267 casos de Lesão Central de Células Gigantes, 231 casos de Displasia Cemento Ossificante, 142 casos de Fibroma Ossificante e 133 de Displasia Fibrosa. Os resultados do estudo estão de acordo com o que está descrito na literatura, exceto nos casos de Displasia Fibrosa que foi encontrado uma predileção maior sexo feminino do que o masculino, mesmo que a literatura expresse que não existe tal predileção. Já nos casos de Displasia Cemento-Ossificante, o presente estudo mostrou que a maior prevalência de idade é entre a 4ª e 5ª década de vida e não entre a 3ª e 4ª como encontrado na literatura. Os casos de Displasia Cemento-Ossificante, em relação à etnia dos pacientes, mostraram que a maioria dos pacientes encontrados pelos autores eram leucodermas e não melanodermas como relata a literatura. Os resultados mostraram que mesmo em um centro de referência como o Serviço de Patologia Oral da Faculdade de Odontologia da Universidade de São Paulo, as lesões ósseas são raras e alguns fatores como idade em pacientes com Displasia Fibrosa e Displasia Cemento-Ossificante e etnia em pacientes com Displasia Cemento-Ossificante não correspondem ao encontrado na literatura mundial. / Bone lesions are rare but important diseases that affect the maxillofacial region. Among them we can highlight the Central Giant Cells Lesion and the Benign Fibro-Osseous Lesions (Cemento-Osseous Dysplasia, Ossifying Fibroma and Fibrous Dysplasia). The objective of this study was to describe and analyze the data found in the clinical referral forms present at the Oral and Maxillofacial Pathology Service of the Faculty of Dentistry of the University of São Paulo. We evaluated 89.265 cases in a period ranging from 1950 to 2016, using the categories of gender, age, ethnicity, symptomatology, diagnostic hypothesis and anatomical location. After the exclusions, the selected cases totaled 773 cases divided into 267 cases of Central Giant Cell Lesion, 231 cases of Cemento-Osseous Dysplasia, 142 cases of Ossyfing Fibroma and 133 cases of Fibrous Dysplasia. The results of the study are in agreement with what is described in the literature, except in the cases of Fibrous Dysplasia that a predilection was found greater female than the male, even if the literature expresses that there is no such predilection. In the cases of Cemento-Osseous Dysplasia, the present study showed that the highest prevalence of age is between the 4th and 5th decade of life and not between the 3rd and 4th as found in the literature. The cases of Cemento-Osseous Dysplasia, in relation to the ethnicity of the patients, showed that the majority of the patients found by the authors were white and not black as reported in the literature. The results showed that even in a reference center such as the Oral Pathology Service of the Faculty of Dentistry of the University of São Paulo, bone lesions are rare and some factors such as age in patients with Fibrous Dysplasia and Cement-Ossificante Dysplasia and ethnicity in patients with Cement-Ossific Dysplasia do not correspond to that found in the world literature.

<p>Resistenta bakterier är ett växande problem inom den svenska sjukvården. Extended spectrum ß-lactamases (ESBL) är bakterier som kan bilda enzymer som bryter ned antibiotika så att den på så sätt blir resistent. En av de stora anledningarna till spridning av resistenta bakterier är personalens brist på korrekt utförande av basala hygienrutiner. Syftet med studien var att undersöka hur sjukvårdspersonal på en infektionsavdelning tillämpar de riktlinjer för basala hygienrutiner som finns fastställda för personal inom hälso- och sjukvården. Data samlades in genom observationer på en infektionsavdelning på ett sjukhus i Mellansverige. Resultatet visade att följsamheten till basala hygienrutiner var mindre än hälften bland de två jämförda personalgrupperna. Resultatet visade hög följsamhet till handskanvändning vid vård av patienter som inte var ESBL-bärare, medan följsamheten var sämre vid vård av patienter med ESBL. Detta resultat visade på en signifikant skillnad, dvs. att personalen var bättre på att använda handskar vid vård av patienter som inte var bärare av ESBL. Resultatet visade att nära hälften av de observerade inte spritar händerna innan patientkontakt, vare sig det rör sig om en patient som är bärare av ESBL-bakterier eller inte. Det tyder på stora brister i följsamheten till hygienrutiner på den observerade infektionsavdelningen.</p> / <p>Resistant bacteria are an increasingly large problem within the Swedish health care system. Extended spectrum ß-lactamases (ESBL) are bacteria that produce enzymes capable of breaking down antibiotics, a characteristic which renders them resistant to antibiotics. One of the main causes for the spreading of resistant bacteria is low compliance to hand hygiene procedures.</p><p>The aim of this study was to examine how the health care workers of an infectious disease ward apply the hygiene guidelines that have been established for health care staff. Data was collected through observations in an infectious disease ward in Central Sweden. The results showed that compliance towards hand hygiene procedures was less than 50% within the two staff groups compared. It also showed good compliance to the guidelines for glove use when caring for patients not carrying ESBL, but less compliance when caring for patients with the infection. The difference was statistically significant, i.e. health care staff used gloves more often when caring for patients not carrying ESBL than they did with patients who were carriers. The results showed that that almost 50% of the observed health care workers did not use hand disinfection before contact with patients, whether these were ESBL carriers or not. This indicates that compliance to hand hygiene procedures is not as good as one could hope for.</p>

Resistenta bakterier är ett växande problem inom den svenska sjukvården. Extended spectrum ß-lactamases (ESBL) är bakterier som kan bilda enzymer som bryter ned antibiotika så att den på så sätt blir resistent. En av de stora anledningarna till spridning av resistenta bakterier är personalens brist på korrekt utförande av basala hygienrutiner. Syftet med studien var att undersöka hur sjukvårdspersonal på en infektionsavdelning tillämpar de riktlinjer för basala hygienrutiner som finns fastställda för personal inom hälso- och sjukvården. Data samlades in genom observationer på en infektionsavdelning på ett sjukhus i Mellansverige. Resultatet visade att följsamheten till basala hygienrutiner var mindre än hälften bland de två jämförda personalgrupperna. Resultatet visade hög följsamhet till handskanvändning vid vård av patienter som inte var ESBL-bärare, medan följsamheten var sämre vid vård av patienter med ESBL. Detta resultat visade på en signifikant skillnad, dvs. att personalen var bättre på att använda handskar vid vård av patienter som inte var bärare av ESBL. Resultatet visade att nära hälften av de observerade inte spritar händerna innan patientkontakt, vare sig det rör sig om en patient som är bärare av ESBL-bakterier eller inte. Det tyder på stora brister i följsamheten till hygienrutiner på den observerade infektionsavdelningen. / Resistant bacteria are an increasingly large problem within the Swedish health care system. Extended spectrum ß-lactamases (ESBL) are bacteria that produce enzymes capable of breaking down antibiotics, a characteristic which renders them resistant to antibiotics. One of the main causes for the spreading of resistant bacteria is low compliance to hand hygiene procedures. The aim of this study was to examine how the health care workers of an infectious disease ward apply the hygiene guidelines that have been established for health care staff. Data was collected through observations in an infectious disease ward in Central Sweden. The results showed that compliance towards hand hygiene procedures was less than 50% within the two staff groups compared. It also showed good compliance to the guidelines for glove use when caring for patients not carrying ESBL, but less compliance when caring for patients with the infection. The difference was statistically significant, i.e. health care staff used gloves more often when caring for patients not carrying ESBL than they did with patients who were carriers. The results showed that that almost 50% of the observed health care workers did not use hand disinfection before contact with patients, whether these were ESBL carriers or not. This indicates that compliance to hand hygiene procedures is not as good as one could hope for.

Efter andra världskriget ställdes Sverige inför en ekonomisk tillväxt och urbanisering vilket startade den tidsperiod som kallas rekordåren. En miljon bostäder byggdes på tio år och kritiserades tidigt för brister i miljön. Miljonprogrammet förde med sig en högre bostandard men kunde inte garantera en stimulerande utemiljö. Centrumanläggningen skulle istället förse invånarna med förnödenheter. Andersberg i Gävle är ett typiskt miljonprogramsområde som är under förnyelse. Syftet med studien är att undersöka om den pågående förnyelsen som bostadsbolaget Gavlegårdarna genomför är ett steg i rätt riktning mot en trivsam miljö eller om utemiljön är i behov av komplettering. Med hjälp av observationer och en inventering av miljön samt en enkätundersökning har det framkommit att grönytor, fler mötesplatser, upprustning och komfortabla detaljer som bänkar och grönska är vad som kan förbättras. Trots att miljonprogrammen förknippas med negativt rykte framkom det i studien att tryggheten är god i området samt att befolkningen generellt trivs. Studien visar även att de negativa egenskaper som miljonprogrammens miljö för med sig även är tillgångar. Det fortsatta arbetet i Andersberg bör succesivt förnyas med mindre komplement i utomhusmiljön, t.ex. med fler bänkar och en inbjudande gestaltning. Miljonprogrammen var en stor satsning, men det framtida arbetet måste ske succesivt med en involvering av invånarna. Inför framtida studier är ett arbete om hur invånare bättre kan involveras i planeringsprocessen ett viktigt komplement. / After the Second World War, Sweden was facing a strong economic growth and urbanization, which led to the time period of time called the record years. One million housing units were built in ten years. Shortcomings in the environments created were strongly criticized. The center facility was instead a facility that would provide residents with necessities. Today, central squares and common areas are in need of renovation to guarantee a stimulating environment. The Andersberg neighborhood in Sweden is typical for the so called Million homes programme and is currently undergoing renovation. The purpose of the study is to investigate whether the ongoing renewal created by the housing company Gavlegårdarna is a step in the right direction and if the outdoor environment in this community needs further development. An observation study of common space, environment, and a survey of residents was performed to investigate the area. The results revealed that common meeting places, such as green space, playground and the local square needs supervision and improved design. Although many of the Million homes programme have bad reputations, the results of this study indicated that perceived safety of residents is good, and overall satisfaction with the environment. Also the study indicates that the negative qualities of these areas can be assets. The Million programs was a big investment, however future environment improvements in Andersberg should take small steps such as adding more benches and improved site design. A study of citizen participation in the planning process in Andersberg would be an important follow-up to this study.

This thesis consists of four papers that are related to commonly used propensity score-based estimators for average causal effects. The first paper starts with the observation that researchers often have access to data containing lots of covariates that are correlated. We therefore study the effect of correlation on the asymptotic variance of an inverse probability weighting and a matching estimator. Under the assumptions of normally distributed covariates, constant causal effect, and potential outcomes and a logit that are linear in the parameters we show that the correlation influences the asymptotic efficiency of the estimators differently, both with regard to direction and magnitude. Further, the strength of the confounding towards the outcome and the treatment plays an important role. The second paper extends the first paper in that the estimators are studied under the more realistic setting of using the estimated propensity score. We also relax several assumptions made in the first paper, and include the doubly robust estimator. Again, the results show that the correlation may increase or decrease the variances of the estimators, but we also observe that several aspects influence how correlation affects the variance of the estimators, such as the choice of estimator, the strength of the confounding towards the outcome and the treatment, and whether constant or non-constant causal effect is present. The third paper concerns estimation of the asymptotic variance of a propensity score matching estimator. Simulations show that large gains can be made for the mean squared error by properly selecting smoothing parameters of the variance estimator and that a residual-based local linear estimator may be a more efficient estimator for the asymptotic variance. The specification of the variance estimator is shown to be crucial when evaluating the effect of right heart catheterisation, i.e. we show either a negative effect on survival or no significant effect depending on the choice of smoothing parameters.   In the fourth paper, we provide an analytic expression for the covariance matrix of logistic regression with normally distributed regressors. This paper is related to the other papers in that logistic regression is commonly used to estimate the propensity score.

Background: Examinations with the intent to assess neurological functions and level of conciousness are common in neurocritical care, but the effect on the patient is not entirely researched. Aim: The purpose of this study was to describe the patient’s situation at the neurological wake-up test concerning the environment, nursing interventions and the possibility given the patient to become awake, and if these conditions affect the outcome of the wake-up test. Methods: A quantitative observational study took place at a neurocritical care unit, where 20 patients were observed from interruption of sedation to the neurological assessment, which was performed by a neurosurgeon or a specialized critical care registered nurse. Nursing interventions, environmental factors and physiological parameters were documented. Result: Twelve intervention varieties to control patients’ physiological parameters were used. CPP &gt; 80 mmHg was found in 90 % of observations. Adjustment of the patient’s body position was found in 45 % of observations. The patients were considered sufficiently awake for the neurological assessment in 74 % of observations. The level of consciousness at the point of the neurological assessment was different depending on if it took place in the mornings, performed by neurosurgeons or in the afternoon, performed by nurses. The patients were not agitated and 60 % of patients appeared pain-free. Conclusion: The observed patients were given good conditions concerning environmental factors and nursing interventions for a neurological wake-up test with a fair neurological assessment. NWT as a method didn´t generally cause the observed patients discomfort, such as pain or agitation. / Bakgrund: Undersökningar för att avgöra neurologisk funktion och medvetandegrad är vanliga inom neurointensivvården, men hur patienten påverkas av undersökningarna är relativt utforskat. Syfte: Studiens syfte var att beskriva förhållandena kring patienten vid neurologiskt wake-up test med avseende på miljö, åtgärder som utförs och möjligheten patienten ges att bli tillräckligt vaken, samt om dessa förhållanden påverkar utfallet i wake-up-testet. Metod: En kvantitativ observationsstudie genomfördes på en neurointensivvårdsavdelning, där 20 patienter observerades från sederingsstopp till bedömning av neurologisk status, vilken utfördes av neurokirurg eller intensivvårdssjuksköterska. Omvårdnadsåtgärder, miljöfaktorer och fysiologiska parametrar dokumenterades. Resultat: Tolv varianter av omvårdnadsåtgärder användes för att hålla patienternas fysiologiska parametrar inom gränsvärden. Högt CPP &gt; 80 mmHg förekom i 90 % av observationerna och den omvårdnadsåtgärd som noterades vid flest observationer var justering av patientens kroppsposition (45 %). Vid 74 % av bedömningarna av neurologisk status ansågs patienten ha hunnit vakna tillräckligt mycket. Vakenhetsgraden vid bedömning av neurologisk status skilde sig åt beroende på om bedömningen utfördes på morgon av läkare eller på eftermiddag av intensivvårdssjuksköterska. Patienterna var inte agiterade och bedömdes vid 60 % av observationerna inte visa tecken på smärta innan bedömning av neurologisk status. Slutsats: Patienterna i studien gavs goda förutsättningar med avseende på miljö och omvårdnadshandlingar för ett neurologiskt wake-up test med rättvisande bedömning av neurologisk status. För de observerade patienterna var NWT en metod som generellt sett inte verkade orsaka obehag som smärta eller agitation.

Introduction: In 2007 Ontario implemented a grade 8 quadrivalent human papillomavirus (qHPV) vaccination program targeting the virus that causes cervical cancer. Despite being 6 years post-implementation, few post-licensure studies have assessed the safety of the qHPV vaccine in this adolescent population. Since autoimmune disorders are often targeted for post-marketing surveillance by regulatory agencies, it is important to assess the risk of developing an autoimmune disorder post-qHPV vaccination. Objectives: The objectives of this thesis were to assess the risk for developing an autoimmune disorder following qHPV vaccination, assess for effect modification by the presence of predisposing risk factors, identify the period of highest risk and explore the risk for individual autoimmune disorders. Methods: A population-based retrospective cohort of girls eligible for Ontario’s qHPV vaccination program was identified using population-based databases. The risk of autoimmune disorders following qHPV vaccination was ascertained using the self-controlled case series method. Results: The risk of developing a new autoimmune disorder, adjusted for age, seasonality, concurrent vaccines and infections was 1.28 (95% CI: 0.87 – 1.89), and this association was independent of a history of immune-mediated disorders (p=0.39). The risk was not increased during days 7-24 post-vaccination (adjusted RR = 0.87, 95% CI: 0.43 – 1.74), but appeared to increase thereafter (adjusted RR = 1.36, 95% CI: 0.77 – 2.41 and RR = 1.62, 95% CI 0.94 – 2.78 respectively, for days 25 – 42 and days 43 – 60), although these differences were non-significant. The risk may be increased for certain disorders including Bell’s palsy (RR = 2.30, 95% CI: 0.67 – 7.95), systemic autoimmune rheumatic disorders (RR = 1.84, 95% CI: 0.42 – 8.02), Hashimoto’s disease (RR = 1.39, 95% CI: 0.46 – 4.22), and juvenile rheumatoid arthritis (RR = 1.31, 95% CI: 0.83 – 2.08), although none of these associations were statistically significant. Conclusion: This thesis demonstrated that no statistically significant increased risk for autoimmune disorders following qHPV vaccination was detected. However, there remains some uncertainty about the safety of the qHPV vaccine for a subset of the autoimmune disorders. The results from this analysis need to be pooled with those of other studies to confirm whether these are true safety signals. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2014-04-23 22:30:41.428