Health Questionnaire

The purpose of this checklist is to gather together the information required to make a detailed assessment of compliance with the Working Time Regulations. In support of this endeavor the regulations also provide a sample health questionnaire for those about to embark on night work (or already engaged in it), which is reproduced below. 

The purpose of this questionnaire is to ensure that you are suited to working at night. All the information you provide will be kept confidential. 

Chronic chest disorders, especially if night-time symptoms are troublesome (Yes/No) Any medical condition requiring medication to a strict timetable (Yes/No) 

Any other health factors that might affect fitness at woric (Yes/No) 

If you have answered yes to any of the above, you may be asked to see a doctor or nurse for further assessment. 

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Trial endpoints need to be given particular consideration in the elderly. For example, health questionnaires that include practical outcomes. 

Polybrominated Biphenyls. The Michigan Department of Community Health (MDCH), together with the Centers for Disease Control and Prevention (CDC) and three other federal agencies, began a major study to assess the health effects of PBBs after the Michigtm contamination episode. A health questionnaire and blood samples were collected from people affected by the feed contamination incident. MDCH had the responsibility to analyze several thousand samples for PBB from 1975 to 1978. MDCH continues contact with this cohort, updates health questionnaires, and collects blood samples to be analyzed (MDCH 2002). 

Responses to a health questionnaire mailed to men who were still living in 1984. 

Computer analyses of the 22-page health questionnaire, which elicited information on some 150 different diseases or symptoms, produced no evidence of unusual patterns of illness or other disorders. Cancer incidence was within normal limits for this population."... 

Trial endpoints need to be given particular consideration in the elderly. For example, health questionnaires that include practical outcomes, such as ability to walk further or rise unaided from a chair, may be more appropriate in the elderly than measures of surrogate dynamic effects. 

Goldberg, D. (1978). Manual of the General Health Questionnaire. Windsor, UK NFER-Nelson. 

Because most healthcare workers wear the very light disposable half-mask respirator, recommend that a health questionnaire be the initial step in the evaluation process. Refer to OSHA 29 CFR 1910.134 paragraph e for guidance on medical evaluation. Appendix B of the Standard contains a sample medical questionnaire. If results from this evaluation are essentially normal, the employee can be cleared for respirator wear. Further evaluation, possibly including a directed physical examination and/or spirometry, should be considered in cases in which potential problems are suggested on the basis of the questionnaire results. 

TNA, WO195/15070, Porton Note No. 173, The Volunteer Personality. Responses to a Modified CorneU Medical Index Health Questionnaire , November i960. 

Sexual function There was a clear association between a-adrenoceptor antagonists and ejaculatory dysfunction (pain/discom-fort) in an observational study in Spanish men with benign prostatic hyperplasia and/or lower urinary tract symptoms [106 ]. The presence and severity of symptoms were assessed using the male sexual health questionnaire there was an 83% prevalence of ejaculatory dysfunction in patients taking a-adrenoceptor antagonists. Most cases of ejaculatory dysfunction were mild and severe dysfunction occurred in only 4% of cases. Although the adverse effects on sexual function were seen with all of the a-adrenoceptor antagonists, alfuzosin was associated with better ejaculatory function than tamsulosin, terazosin, or doxazosin. 

In order to obtain a clear representation of the data, we first created several groups of panelists on the basis of the answers they gave to each question in the health questionnaire. Then, for each of these groups, we measured the percentages of LOG and NOG subjects. The statistical difference between each group was assessed by tests. 

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