EPOCHAL (Effects of Pollen on Cardiorespiratory Health and Allergic symptoms): Intake questionnaire (English and German)
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https://zenodo.org/record/7613528
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This questionnaire was developed for the EPOCHAL study (Effects of Pollen on Cardiorespiratory Health and Allergic symptoms). The study was sponsored and led by Swiss TPH in Basel, Switzerland and approved by the local ethics committee (Ethikkomission Nordwest- und Zentralschweiz EKNZ, project ID 2021-00151). Written informed consent was obtained from every participant prior to study inclusion.
This is the "intake questionnaire" which was administered once for each participant upon starting the study. It includes questions about the following topics:
1) Education
2) Employment
3) Allergy history: including allergies, previous testing, treatments and typical symptoms
4) Residential history
5) Medical history: including asthma, lung conditions, cardiac conditions, Covid-19, neurologic and psychiatric conditions, sleep conditions, recent surgeries and medication intake
6) Lifestyle: including physical activity, smoking habits, alcohol and caffeine intake, sleep habits
The questionnaire is also available in German under the same DOI.
Please note that this questionnaire was administered electronically on a tablet, and contains:
Form logic, which determines the relevance of some questions based on previous answers. Affected questions are typically shown in grey color.
Warnings (in large red font) and directions (in large grey font) to warn nurses against performance of spirometry measurements if contraindications were present. For example, when recent surgery was indicated in Topic #5.
本问卷为EPOCHAL研究(Effects of Pollen on Cardiorespiratory Health and Allergic Symptoms,即花粉对心肺健康与过敏症状的影响研究)研发而成。该研究由位于瑞士巴塞尔的瑞士热带与公共卫生研究所(Swiss TPH)发起并主导,已获得当地伦理委员会——瑞士西北与中部瑞士伦理委员会(Ethikkomission Nordwest- und Zentralschweiz EKNZ)批准,项目编号为2021-00151。所有受试者在纳入研究前均已签署书面知情同意书。
本问卷为入组问卷(intake questionnaire),每位受试者在研究启动时仅需完成一次填写,问卷涵盖以下主题:
1) 教育背景
2) 就业状况
3) 过敏史:包括过敏情况、既往检测史、治疗方案及典型症状
4) 居住史
5) 病史:包括哮喘、肺部疾病、心脏疾病、COVID-19、神经与精神疾病、睡眠障碍、近期手术史及用药情况
6) 生活方式:包括体育锻炼、吸烟习惯、饮酒与咖啡因摄入情况、睡眠习惯
本问卷的德语版本可通过相同的数字对象标识符(Digital Object Identifier,DOI)获取。
请注意,本问卷通过平板电脑以电子形式发放,包含以下内容:
表单逻辑:可根据受试者此前的作答判断部分问题的关联性,涉及的问题通常会以灰色显示。
警示信息(以红色大号字体呈现)与操作指引(以灰色大号字体呈现):若存在禁忌证,则提醒医护人员不得进行肺量测定法(spirometry)。例如,当第5项主题中提及近期手术史时,即需触发该提示。
创建时间:
2024-07-12



