广州市1991－2013年艾滋病相关死亡影响因素分析

目的 分析广州市艾滋病病毒感染者和艾滋病患者(HIV/AIDS)中艾滋病相关死亡的影响因素,为采取相应的措施提供依据。方法 利用国家艾滋病综合防治信息系统中1991－2013年广州市疫情资料,使用Cox风险比例模型分析艾滋病相关死亡的影响因素。结果 广州市HIV/AIDS病例中,报病时病程阶段为AIDS(HR=2.717,95%CI:2.039～3.621)、由医疗机构诊疗发现(HR=1.516,95%CI:1.159～1.981)、未接受过CD₄⁺T淋巴细胞检测(HR=4.866,95%CI:3.674～6.444)、符合治疗标准未治疗(HR=12.213,95%CI:8.467～17.616)、报病时年龄40岁以上的病例发生艾滋病相关死亡的风险更高。另外,不符合治疗标准而未治疗的病例发生艾滋病相关死亡的风险也高于接受抗病毒治疗的病例(HR=1.936,95%CI:1.145～3.272)。结论 及早发现HIV/AIDS病例,接受CD₄⁺T淋巴细胞检测和抗病毒治疗可降低HIV/AIDS的死亡风险,延长生存时间。     

湖北省荆州市1996-2021年HIV/AIDS病死率及其影响因素回顾性队列研究

目的 分析荆州市HIV/AIDS病死率及其影响因素。方法 资料来源于中国疾病预防控制信息系统的艾滋病综合防治信息系统,选取现住址为荆州市、确诊时年龄≥15岁、确诊时间为1996-2021年的HIV/AIDS作为研究对象。采用乘积极限法绘制死亡曲线,Cox比例风险回归模型识别死亡的影响因素。结果 HIV/AIDS共3 304例,随访16 091.5人年,死亡893例,病死率为5.5/100人年。HIV/AIDS确诊后1、5和10年的累积死亡概率分别为15.4%、25.0%和34.6%,参加抗病毒治疗者1、5和10年的累积死亡概率为6.9%、14.4%和23.7%,未参加抗病毒治疗者1、5和10年的累积死亡概率为68.0%、90.1%和98.7%。Cox比例风险回归模型分析结果显示,未参加抗病毒治疗者的死亡风险高于参加抗病毒治疗者（aHR=9.85,95%CI：8.19~11.85）;参加抗病毒治疗者死亡的危险因素包括男性（aHR=1.64,95%CI：1.29~2.08）、确诊时年龄≥60岁（aHR=3.52,95%CI：2.38~5.20）、注射吸毒/其他途径感染（aHR=2.38,95%CI：1.30~4.34）、医疗机构发现（aHR=1.53,95%CI：1.11~2.11）和首次CD4⁺T淋巴细胞（CD4）计数<50个/μl（aHR=2.58,95%CI：1.87~3.58）,死亡的保护因素是较高文化程度（高中/中专：aHR=0.64,95%CI：0.46~0.90;大专及以上：aHR=0.42,95%CI：0.24~0.73）。未参加抗病毒治疗者死亡的危险因素包括确诊时年龄较大（30~岁：aHR=2.32,95%CI：1.40~3.84;45~岁：aHR=2.61：95%CI：1.59~4.27;≥60岁：aHR=3.31,95%CI：2.01~5.47）、首次CD4计数较低（<50个/μl：aHR=10.47,95%CI：6.47~16.56;50~199个/μl：aHR=2.31,95%CI：1.08~4.94;200~349个/μl：aHR=2.35,95%CI：1.46~3.79）。结论 1996-2021年荆州市HIV/AIDS病死率较高,首次CD4计数、抗病毒治疗和确诊时年龄是影响HIV/AIDS死亡的主要因素,应进一步坚持扩大检测和“发现即治疗”政策,提升抗病毒治疗效果和HIV/AIDS生存率。     

四川省1991-2017年HIV/AIDS生存分析

目的 分析1991-2017年四川省HIV/AIDS生存时间及其影响因素。方法 运用回顾性队列研究方法,对全国艾滋病综合防治数据信息系统中1991-2017年四川省新报告的143 988例HIV/AIDS的资料,采用寿命表法计算生存概率,用Cox比例风险模型分析生存时间的影响因素。结果 143 988例HIV/AIDS中,30 420例死于艾滋病及相关疾病（21.1%）,平均生存时间为11.51年（95% CI：11.39~11.64）;多因素Cox比例风险模型分析结果显示,HIV/AIDS生存的相关影响因素包括性别（男比女：HR=1.35,95% CI：1.32~1.40）、文化程度（小学及以下比初中及以上：HR=1.15,95% CI：1.12~1.18）、民族（汉族比其他：HR=1.46,95% CI：1.41~1.52）、职业（农民比其他：HR=1.26,95% CI：1.22~1.29）、诊断时年龄（≥ 55岁比15~24岁：HR=3.18,95% CI：3.02~3.36）、诊断时疾病状态（艾滋病比HIV感染：HR=1.44,95% CI：1.39~1.48）、抗病毒治疗（ART）（接受ART者比未接受ART者：HR=0.20,95% CI：0.19~0.20）、首次CD₄⁺T淋巴细胞计数（CD₄）（>500个/μl比<200个/μl：HR=0.42,95% CI：0.40~0.45）。结论 1991-2017年四川省HIV/AIDS诊断后平均生存时间为11.51年。男性、小学及以下文化程度、汉族、农民、诊断时较大年龄、诊断时为艾滋病状态是HIV/AIDS生存的危险因素,接受ART、首次CD₄水平高是HIV/AIDS生存的保护因素。     

山东省抗病毒治疗HIV/AIDS生存状况及影响因素分析

目的 了解山东省抗病毒治疗HIV/AIDS的生存状况及影响因素。方法 运用Kaplan-Meier（K-M）法及累积发生函数（CIF）估算2003-2015年山东省抗病毒治疗HIV/AIDS的艾滋病相关死亡发生率、部分分布比例风险回归模型（F-G模型）分析生存状况及影响因素。结果 竞争风险存在时,K-M法计算艾滋病相关死亡累积发生率高于CIF。CIF估算5 593例治疗HIV/AIDS随访1、3、5、10年艾滋病相关死亡累积发生率分别为3.08%、4.21%、5.37%和7.59%。大专及以上文化程度（HR=0.40,95% CI：0.24~0.65）HIV/AIDS的艾滋病相关死亡发生危险较低,现住址在鲁西地区（HR=1.33,95% CI：1.01~1.89）、医疗机构检测发现（HR=1.39,95% CI：1.06~1.80）、治疗基线方案含NVP（HR=1.36,95% CI：1.03~1.88）、治疗基线临床症状Ⅲ/Ⅳ期（HR=2.61,95% CI：1.94~3.53）、诊断1年后接受随访（HR=2.02,95% CI：1.30~3.15）、诊断基线CD₄⁺T淋巴细胞计数（CD₄）≤ 200个/μl（HR=3.41,95% CI：2.59~4.59）、治疗基线CD₄ ≤ 350个/μl（HR=5.48,95% CI：2.32~12.72）的HIV/AIDS发生艾滋病相关死亡风险高。结论 竞争风险存在时,K-M法高估艾滋病相关死亡累积发生率,优选竞争风险模型进行生存分析;早诊断、及时随访、早治疗可降低HIV/AIDS艾滋病相关死亡。     

沈阳市15~30岁学生HIV/AIDS患者抗病毒治疗相关因素分析

目的 探讨沈阳市学生HIV/AIDS患者抗病毒治疗（ART）的影响因素。方法 横断面调查获得2007-2015年沈阳市艾滋病治疗定点医院（中国医科大学附属第一医院）15~30岁学生HIV/AIDS患者ART相关信息,多因素logistic回归模型探讨ART的影响因素。结果 2007-2015年该医院共收治15~30岁学生HIV/AIDS患者146例,占累计治疗HIV/AIDS患者的6.1%（146/2 379）。患者均为男性,男男性行为传播途径占93.2%（136/146）,HIV延迟诊断率[诊断时CD₄⁺T淋巴细胞计数（CD₄）≤ 350个/μl]为52.7%（77/146）,患者中ART的构成比为67.1%（98/146）。多因素logistic回归分析显示,HIV诊断年份（aOR=1.21,95%CI：1.02~1.44）、年龄24~30岁（aOR=8.15,95%CI：1.46~45.52）和延迟诊断（aOR=2.22,95%CI：1.05~4.71）是学生HIV/AIDS患者ART的独立影响因素。结论 HIV诊断时间越晚、年龄越大及延迟诊断可能增加学生HIV/AIDS患者的ART比例。。     

山东省2017-2021年HIV感染者艾滋病相关死亡的影响因素分析

目的 分析山东省HIV感染者艾滋病相关死亡的影响因素，为降低死亡风险及延长生存时间提供参考。方法 研究对象为2017-2021年山东省HIV感染者，采用Cox比例风险回归模型分析艾滋病相关死亡及确证1年内死亡的影响因素。结果 2017-2021年山东省报告的14 700例HIV感染者中，发生艾滋病相关死亡351例，占2.4%（351/14 700）。多因素Cox比例风险回归模型分析结果显示，HIV感染者艾滋病相关死亡的危险因素包括文化程度为初、高中/中专（aHR=1.37，95%CI：1.01~1.84）、样本来源自医疗机构（aHR=1.61，95%CI：1.22~2.12）、病程为艾滋病期（aHR=9.86，95%CI：6.86~14.19）、未检测基线CD4⁺T淋巴细胞（CD4）（aHR=3.93，95%CI：2.69~5.75）、抗病毒治疗（ART）时间<6个月（aHR=3.46，95%CI：2.42~4.93）和未ART（aHR=1.45，95%CI：1.02~2.07）、末次CD4<200个/μl（aHR=3.51，95%CI：2.18~5.65）和末次CD4未检测（aHR=10.58，95%CI：6.15~18.19）、末次病毒载量（VL）值为50~999拷贝数/ml、≥1 000拷贝数/ml和未检测（aHR=2.59，95%CI：1.07~6.26；aHR=9.50，95%CI：5.60~16.12；aHR=15.33，95%CI：8.91~26.36）；HIV感染者确证1年内发生艾滋病相关死亡风险较高的因素包括样本来源自医疗机构（aHR=1.68，95%CI：1.19~2.36）、病程为艾滋病期（aHR=10.60，95%CI：7.13~15.75）、基线CD4未检测（aHR=3.71，95%CI：2.34~5.90）、ART时间<6个月（aHR=4.30，95%CI：2.85~6.49）和未ART（aHR=2.05，95%CI：1.35~3.13）、末次CD4<200个/μl（aHR=5.45，95%CI：2.04~14.60）和末次CD4未检测（aHR=20.95，95%CI：7.69~57.04）、末次VL值为50~999、≥1 000拷贝数/ml和未检测（aHR=15.21，95%CI：2.54~91.21；aHR=42.93，95%CI：9.64~191.20；aHR=61.35，95%CI：13.85~271.77）。结论 扩大检测覆盖面，促进早发现和早治疗，加强对HIV感染者的定期随访和检测，掌握病程进展并进行精准管理和治疗，对降低HIV感染者病死率和延长生存时间有重要作用。     

北京市1995-2015年艾滋病病例诊断后生存时间与影响因素分析

目的 分析1995-2015年北京市HIV感染者/AIDS患者（HIV/AIDS）诊断后生存时间及影响因素。方法 运用回顾性队列研究方法,对1995-2015年中国艾滋病综合防治信息系统中报告的12 874例HIV/AIDS的数据资料进行分析,应用寿命表法计算生存率,采用Cox比例风险模型分析生存时间的相关因素。结果 12 874例HIV/AIDS中,303例（2.4%）死于艾滋病及相关疾病,接受抗病毒治疗9 346例（72.6%）。平均生存时间为226.5个月（95% CI：223.0~230.1）,1、5、10、15年生存率分别为98.2%、96.4%、93.2%、91.9%。Cox比例风险模型分析结果显示,艾滋病死亡风险较高的因素包括诊断时为艾滋病患者（比HIV感染者,HR=1.439,95% CI：1.041~1.989）;异性传播（比同性传播,HR=1.646,95% CI：1.184~2.289）;现有或曾有配偶（比未婚,HR=2.186,95% CI：1.510~3.164）;诊断时年龄≥ 60岁（比≤ 30岁,HR=6.608,95% CI：3.546~12.316）;诊断后首次CD₄⁺T淋巴细胞计数（CD₄）<350个/μl（比≥ 350个/μl,HR=8.711,95% CI：5.757~13.181）;未抗病毒治疗（比抗病毒治疗,HR=18.223,95% CI：13.317~24.937）。结论 1995-2015年北京市HIV/AIDS诊断后的平均生存时间为226.5个月。诊断为HIV感染、同性传播、未婚、≤ 30岁、首次CD₄ ≥ 350个/μl、接受抗病毒治疗的HIV/AIDS生存时间较长。相反,诊断为AIDS、异性传播、现有或曾有配偶、年龄≥ 60岁、CD₄<350个/μl、未抗病毒治疗的死亡风险较高。     

河南省2008-2015年15岁及以上HIV/AIDS生存状况回顾性队列研究

目的 了解河南省HIV感染者/AIDS患者（HIV/AIDS）确诊AIDS后生存状况及其影响因素。方法 从国家艾滋病综合防治信息系统下载河南省相关数据库，筛选出2008-2015年间确诊为AIDS且≥15岁患者，进行回顾性研究。结果 纳入25 525例研究对象，观察期内病死率为24.9%，其中接受高效抗反转录病毒治疗（HAART）为14.4%。治疗比例从2008年的72.1%上升到2015年的92.8%，同期病死率从21.2%下降到4.1%，其中接受HAART者从9.2%下降到2.6%。多因素分析显示，确诊AIDS时CD₄⁺T淋巴细胞（CD₄）计数<50个/μl的患者死亡风险大（aHR=2.45）；接受HAART的患者死亡风险低（aHR=0.13）。在接受HAART患者中，有复方磺胺甲恶唑（TMP-SMZ）服用史的患者死亡风险低（aHR=0.76）；确诊AIDS时CD₄计数50~个/μl组和<50个/μl组死亡风险高（aHR值分别为1.26和1.97）；基线CD₄计数50~个/μl、<50个/μl组死亡风险高（aHR值分别为1.44和1.84）。结论 抗病毒治疗是影响HIV/AIDS生存时间的重要因素，加强HIV/AIDS的CD₄检测，尽早纳入HAART，同时及时开展TMP-SMZ预防治疗，是减少患者AIDS相关疾病死亡的有效途径。     

2010年全国新报告HIV感染者/AIDS病例生存时间及其相关因素分析

目的 分析全国2010年新报告HIV感染者/AIDS病例（HIV/AIDS）生存时间及影响因素。方法 使用艾滋病综合防治数据信息系统截至2015年12月31日的病例报告历史卡片和随访定时数据库,筛选出2010年新报告HIV/AIDS并整理出随访结局数据,以寿命表法计算其生存率,采用Kaplan-Meier法拟合不同状态下的生存曲线,Cox比例风险模型分析HIV/AIDS生存时间的影响因素。结果 40 335例HIV/AIDS中,11 975例因艾滋病及相关疾病死亡;截至观察终点时,中位生存时间为63.1（95%CI：63.0~63.2）个月,1年和5年生存率分别为81.2%和69.9%;多因素Cox比例风险模型分析结果显示,艾滋病死亡的风险随年龄增加而增加,25~34、35~44、45~54和≥55岁组因艾滋病死亡的风险分别是15~24岁组的1.41倍（95%CI：1.29~1.54）、1.90倍（95%CI：1.74~2.07）、2.24倍（95%CI：2.04~2.46）和2.81倍（95%CI：2.57~3.08）;HIV/AIDS首次检测CD₄^＋T淋巴细胞（CD₄）值≥500个/μl是CD₄值<200个/μl 的0.12倍（95%CI：0.11~0.13）;接受抗病毒治疗者是未接受治疗者的0.11倍（95%CI：0.10~0.12）。结论 确诊时年龄、确诊时CD₄值水平、是否接受抗病毒治疗是HIV/AIDS生存时间的主要影响因素,应及早进行艾滋病检测、接受抗病毒治疗,以延长HIV/AIDS生存时间。     

云南省德宏州艾滋病病毒感染者/艾滋病患者阴性配偶HIV新发感染研究

目的 了解云南省德宏州艾滋病病毒感染者/艾滋病患者(HIV/AIDS)阴性配偶HIV新发感染率及其危险因素。方法 2009年2月至2014年12月,在HIV/AIDS的阴性配偶中建立前瞻性队列,每年随访一次,进行问卷调查及HIV检测。结果 至2014年12月,共纳入研究对象2091例,其中1692例研究对象至少随访一次,34例研究对象新发感染HIV,累计观察时间为5494.52人年, HIV新发感染率为0.62/100人年。2009-2010、2011-2012、2013-2014年HIV新发感染率分别为0.79/100人年、0.62/100人年、0.47/100人年。Cox回归分析显示,HIV新发感染的危险因素为不坚持使用安全套(HR=4.64,95%CI:1.89~11.40,P=0.001);与阴性配偶入组时间相比,HIV/AIDS开始抗病毒治疗时间晚一年以上(HR=3.70,95%CI:1.44~9.49,P=0.007),HIV/AIDS未进行抗病毒治疗(HR=3.62,95%CI:1.14~11.51,P=0.029)。结论 德宏州HIV/AIDS阴性配偶中HIV新发感染率相对较低。仍需在阴性配偶人群中进一步宣传坚持使用安全套的重要性,并尽早对HIV/AIDS进行抗病毒治疗。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Fatigue and health in a seafaring population

Background Occupational fatigue is relatively common withinthe general population and has been linked to reduced performance,injury and longer term ill-health. Despite growing acknowledgementof this problem in the maritime sector, little research hasbeen conducted into the risk factors, prevalence and consequencesof seafarers' fatigue. Aims To examine the prevalence of fatigue among seafarers, identifypotential risk factors and assess possible links with poor performanceand ill-health. Methods Cross-sectional questionnaire survey of seafarers workingin the offshore oil support, short-sea and deep-sea shippingindustries. A number of tools were used including the fatiguesubscale of the profile of fatigue-related symptoms, the CognitiveFailures Questionnaire, the General Health Questionnaire andthe SF36 General Health scale. Results In all, 1855 questionnaires were completed giving anoverall response rate of 20%. Fatigue symptoms were associatedwith a range of occupational and environmental factors, manyunique to seafaring. Reporting a greater number of risk factorswas associated with greater fatigue [e.g. OR = 2.53 (1.90–3.35)for those with three or four risk factors and OR = 9.54 (6.95–13.09)for those with five or more risk factors]. There was also astrong link between fatigue and poorer cognitive and healthoutcomes, with fatigue the most important of a number of riskfactors, accounting for 10–14% of the variance. Conclusions Seafarers' fatigue could impact on safety withinthe industry and may be linked to longer term individual ill-health.It can only be addressed by considering how multiple factorscombine to contribute to fatigue.