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6. Kid’s questionnaire

6.1. SOME EXPLANATIONS TO FILLING THE QUESTINNAIRE IN.

6.1.1. The questionnaire is filled in by parents.

6.1.2. Don’t be scared of its size. The questions are quite simple. There are not so many of them as it seems.

6.1.3. If you want t answer positively click the appropriate square or circle with the left mouse button. If you want to answer negatively or not sure about it, give no answer.

6.1.4. If some section doesn’t refer to you child skip it. For example: your child is 3. That means that you don’t need to fill in the section about marks and behavior at school.

6.1.5. If there are a few eligible answers click all of them.

 

6.2. SOME EXPLANATIONS TO THE QUERTIONS OF THE QUESTIONNAIRE.

6.2.1. The questionnaire includes some private questions. Can I fill in the questionnaire anonymously?
Yes, you can. You are allowed to make up the kid’s last name instead of writing the real one. You’re also allowed not to write your phone number. But you should give your E-mail by all means.

6.2.2. Why are there so many questions devoted to psychological state of the kid in the questionnaire?
Because it influences asthma course drastically. Any doctor can confirm that fact.

6.2.3. Why are there so many questions about the same information with different formulations in different sections?
That helps to exclude loss or twist of the information.

6.2.4. Why don’t you need to inspect the kid? Why do you ask only about hormonal medications? Maybe the questionnaire was made by a bad doctor? Or maybe he disrespects his colleagues?
Let me insure you that I deeply respect my colleagues no matter in what country they work. I’m sure that they have done everything possible based on analyses results. I’m sure they have prescribed lots of various meds for your child.
My task is to do what they haven’t done. And I will base my work on practices which appeared 1000 year before first labs and modern pills, and my own explorations.
I could ask you to inspect your child again in a lab, to see an allergist, immunologist, pulmonologist etc., but I don’t want to waste your time and money.

6.3. THE QUESTIONNAIRE

6.3.1 Kid’s name and last name:

6.3.2 City, region, country:

6.3.3 Your E-mail:

6.3.4 Your phone number:

6.3.5 Kid’s gender:

 Male Female

6.3.6 Kid’s age (full years and months):

6.3.7 Kid’s height in cm:

6.3.8 Kid’s weight in kg:

6.3.9 How long is the kid sick? (years and months):

6.3.10 Number of attacks in last 30 days:

6.3.11 Average length of an attack:

6.3.12 How the attack stops:

 With medications Without medications

6.3.13 Period between attacks:

 Easy breathing Hard breathing

6.3.14 Hormonal addiction:

 The kid takes hormonal medications The kid doesn’t take hormonal medications

6.3.15 During the last year your kid’s asthma:

 Turned to severe form Was stable Turned to a mild form

6.3.16 How many times was the kid hospitalized with asthma:

6.3.17 Has your kid ever been allergic to:

 Blooming flowers pollen Medications Preventive vaccines Insects bites Food Cosmetics

6.3.18 Write down medications you kid is or has ever been allergic to:

6.3.19 Write down food you kid is or has ever been allergic to:

6.3.20 Write down allergens your kid is positive due to lad tests:

6.3.21 Write down diseases (except for asthma), traumas, operations your kid had:

6.3.22 Eyes color:

 Green, blue, gray Hazel

6.3.23 Hair color:

 Blonde Light brown Brown Black

6.3.24 Write down diseases (except for asthma) you kid suffers at the moment:

6.3.25 Click characteristics which refer to your kid:

 Unreasonable changes in mood Mood is almost always adequate Nervous Steady Whiney Laughing Kind Lovesome Cruel Evil Grumpy Obedient Stubborn Scraggly Accurate Communicative Silent Close Reserved Reasonable Irresponsible Disciplined Arrogant Boastful Squeamish Plodding Restless Curious Talkative

6.3.26 Your kid’s attitude to other family members:

 Warm Usual Cold

6.3.27 Your kid is stressed:

 In the family Outside (at school, in the street)

6.3.28 Kid’s marks at school in math:

 Average Below average Above average

6.3.29 Kid’s marks at school in physics:

 Average Below average Above average

6.3.30 Kid’s marks at school in biology:

 Average Below average Above average

6.3.31 Kid’s marks at school in literature:

 Average Below average Above average

6.3.32 Kid’s marks at school in drawing:

 Average Below average Above average

6.3.33 Kid’s marks at school in singing:

 Average Below average Above average

6.3.34 Kid’s marks at school in physical training:

 Average Below average Above average Group with less physical load Released from PT classes Attends sport sections Doesn’t like sports

6.3.35 Kid drinks:

 More than his peers The same as his peers Less than his peers

6.3.36 Attitude to meat:
(here and further there can be a few answers to the questions describing his tastes, for example if the kid loves some food but it makes him feel bad).

 Likes Indifferent Dislikes Feels bad

6.3.37 Attitude to fish:

 Likes Indifferent Dislikes Feels bad

6.3.38 Attitude to seafood:

 Likes Равнодушен Не любит Бывает плохо

6.3.39 Attitude to eggs:

 Likes Indifferent Dislikes Feels bad

6.3.40 Attitude to bread:

 Likes Indifferent Dislikes Feels bad

6.3.41 Attitude to cereals:

 Likes Indifferent Dislikes Feels bad

6.3.42 Attitude to vegetables:

 Likes Indifferent Dislikes Feels bad

6.3.43 Attitude to fruits:

 Likes Indifferent Dislikes Feels bad

6.3.44 Attitude to chocolate:

 Likes Indifferent Dislikes Feels bad

6.3.45 Attitude to sugar:

 Likes Indifferent Dislikes Feels bad

6.3.46 Attitude to salt:

 Likes Indifferent Dislikes Feels bad

6.3.47 Attitude to milk:

 Likes Indifferent Dislikes Feels bad

6.3.48 Attitude to coffee:

 Likes Indifferent Dislikes Feels bad

6.3.49 Attitude to tea:

 Likes Indifferent Dislikes Feels bad

6.3.50 Attitude to coca-cola:

 Likes Indifferent Dislikes Feels bad

6.3.51 Attitude to juices:

 Likes Indifferent Dislikes Feels bad

6.3.52 Attitude to alcohol (including beer):

 Likes Indifferent Dislikes Feels bad

6.3.53 Attitude to fat food:

 Likes Indifferent Dislikes Feels bad

6.3.54 Attitude to fried food:

 Likes Indifferent Dislikes Feels bad

6.3.55 Attitude to smoked food:

 Likes Indifferent Dislikes Feels bad

6.3.56 Attitude to sour:

 Likes Indifferent Dislikes Feels bad

6.3.57 Write down some information which is not asked by the questionnaire but is important to understand physical and psychological features of the kid: