Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access |
Article copyright, the authors; Journal compilation copyright, J Endocrinol Metab and Elmer Press Inc |
Journal website http://www.jofem.org |
Editorial
Volume 7, Number 1, February 2017, pages 1-4
Data Collection and the Questionnaires for the Effective Use of Biobank for Metabolic Disorders
Tables
1. Basic data Age, year of birth, sex, dominant arm (right or left) |
2. Anthropometric data Body height (cm), body weight (kg), abdominal circumference (cm), systolic and diastolic blood pressure (mm Hg), heart rate (beats/min), grip strength (kg) |
3. The questionnaires about body weight Did your body weight change? Yes or no If you answered “yes” A. How did your body weight change? You (gained or lost) ___ kg in ___ (weeks, months, years) |
4. The questionnaires about diabetes Were diabetes or hyperglycemia pointed out to you? Yes or no If you answered “yes” A. When were you told that your plasma glucose was high? (day/month/ year) or at the age of ___ years old B. Why did you know that your plasma glucose was high? a) Medical checkup b) When you visited hospital because you have symptoms of diabetes. c) When you visited hospital because you have other diseases. What are other diseases? d) Other reasons |
5. The questionnaires about symptoms Do you have the following symptoms? ・Thirsty ・General fatigue ・Chest pain or chest discomfort during exercise ・Drink plenty of water ・Get tired easily ・Palpitation or short of breath ・Frequent urination ・Edema of face and/or limbs ・Amenorrhea ・Increased or decreased appetite ・Numbness in toe and/or planta ・Erectile dysfunction ・Foot pain ・Scratches are difficult to heal ・Cramp ・Skin ulcer ・Weight gain or loss ・Athlete’s foot ・Depression ・Decreased visual acuity ・Sensitivity to cold or cool limbs ・Insomnia or sleep disorder ・Taste disorder ・Constipation or diarrhea ・Other symptoms |
6. The questionnaires about the treatment for diabetes Did or do you receive the treatment for diabetes? Yes or no If you answered “yes” A. Did or do you take oral anti-diabetic drugs? The date of start and cessation of the drugs, and the name of drugs which you used B. Were or are you treated by insulin The date of start and cessation of insulin, and the name of insulin which you used C. Only exercise therapy a) What kind of exercise? b) How long do you exercise? c) How often do you exercise? D. Only diet therapy a) How is your diet therapy? b) How much calorie do you take a day? E. Did you receive nutritional education? Yes or no If you answered “yes” a) salt ___ g a day, protein ___ g day, potassium ___ mg a day F. Did you experience the admission to hospital to receive the treatment or education for diabetes? Yes or no If you answered “yes” a) The name of hospital, the date of admission |
7. The questionnaires about familial history of diabetes Do you have the relatives with diabetes? Yes or no If you answered “yes” A. Who grandfather, grandmother, father, mother, brother, sister B. The treatment for diabetes Only diet or exercise therapy, oral anti-diabetic drugs, insulin C. Diabetic complication Hemodialysis, blindness, gangrene or amputation of lower limb, cerebral infarction, angina or myocardial infarction, cerebral hemorrhage, other complications |
1. The questionnaires about the medical checkup Regular medical checkup, the medical checkup for cancer |
2. For females, the questionnaires about menstruation, pregnancy and delivery A. Do you have menstruation? Yes or no B. Did you experience pregnancy and/or delivery? If you answered “yes” Did you have medical problems during pregnancy? a) pregnancy-induced hypertension b) hyperglycemia and/or urinary glucose during pregnancy c) other medical problems during pregnancy C. How much was your child’s body weight at birth? |
3. The questionnaires about allergy A. Do you have allergy? Yes or no If you answered “yes” B. What are you allergic to? ・Milk ・Soy ・Egg ・Pollen ・Mackerel ・Mite ・Soba ・Crab ・Wheat ・Shrimp ・Other foods C. Do you have atopic dermatitis? Yes or no D. Do you have drug allergy? Yes or no If you answered “yes” a) The name of drug b) Symptoms due to drug allergy |
4. The questionnaires about the current and past treatment for other diseases ・Hypertension ・Hyperuricemia and/or gout ・Pollinosis ・Arrhythmia ・Renal diseases ・Depression ・Angina ・Bronchial asthma ・Myocardial infarction ・Tuberculosis ・Adrenal insufficiency ・Hyperlipidemia ・Cerebral infarction ・Rheumatoid arthritis ・Chronic hepatitis ・Peripheral artery diseases ・Malignancy ・Other diseases |
5. The questionnaires about the operation A. Did you receive the operation? Yes or no If you answered “yes” a) The disease treated by operation, and operative procedure b) The date of the operation |
6. The questionnaires about familial history of other diseases Hypertension, angina, myocardial infarction, malignancy, hyperlipidemia, hyperuricemia and/or gout, renal diseases, cerebral infarction and other diseases |
1. Diet A. Do you have the following eating habits? ・Cook by yourself ・Family cook for you ・Eating out is often ・Chew well when eating. ・Eating quickly ・Snack a lot ・Like sweets ・Prefer fish to meat ・Eating fried foods is often ・Midnight snack is often ・Irregular meal time ・Skipping breakfast is often ・A late dinner What time do you eat dinner? ・Have a habit of drinking green tea How many cups of green tea do you drink a day? ・Have a habit of drinking coffee How many cups of coffee do you drink a day? |
2. Smoking Do you smoke? A. non-smoker B. ex-smoker C. current smoker If you answered B or C How many cigarettes did you smoke a day? ___ cigarettes a day for ___ years |
3. Alcohol drink Do you drink alcohol? A. No B. used to drink C. Yes If you answered B or C a) What’s kind of alcohol did or do you drink? sake, wine, beer, distilled spirits, others b) How much did or do you drink a day? ___ mL, ___ grasses a day c) How often did or do you drink? ___ days a week, ___ days a month |
4. Exercise A. Do you take moderate exercise except for walking? No, Yes, everyday; ___ times a week; ___ times a month What kind of exercise? How long? ___ minutes B. Do you walk for 15 minutes or more? No, Yes, everyday; ___ times a week; ___ times a month How long? ___ minutes |
5. Work What is your work? ・Light work such as desk work, housewife, student, or un-employee ・Moderate work such as standing for a long time to do the job ・Heavy work such as heavy labor ・Shift work ・Taxi driver ・Sales job |
6. Sleep and mental health A. How long do you sleep Bedtime ___ : ___ Wake-up time ___ : ___ Sleeping hours: ___ hours and ___ minutes B. Feeling stressed is often Yes or no |
7. Body weight A. How much did you weigh when you were the heaviest in the past? If you are women, exclude those when you were pregnancy. ___ kg at the age of ___ years old B. How much did you weigh when you were 20 years old? ___ kg |