EPOCHAL (Effects of Pollen on Cardiorespiratory Health and Allergic symptoms): Intake questionnaire (English and German)
Authors/Creators
- 1. Swiss Tropical and Public Health Institute
Contributors
- 1. Swiss Tropical and Public Health Institute
Description
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.
Notes
Files
EPOCHAL_Intake Questionnaire_v3_EN_22.10.2021.pdf
Files
(13.9 MB)
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