Chapter 4 Health Symptoms
4.1 Background
The Health Symptoms Form asked the following 39 questions for symptoms assessment.
- Headache
- Feeling your heart pound or race
- Back pain
- Pain in arms, legs, or joints
- Fainting spells
- Stomach or abdominal pains
- Dizzy spells
- Tiredness or fatigue
- Chest pain
- Menstrual or menopausal problems
- Nausea, gas or indigestion
- Constipation, loose bowels or diarrhea
- Sexual problems
- Trouble sleeping
- Trouble falling asleep
- Awakening during sleep
- Shortness of breath
- Skin problems
- Trouble urinating
- Numbness in hands or feet
- Problems swallowing
- Sinus problems
- In the past 1-2 year have you had your blood pressure taken?
- In the past 1-2 years have you had your blood cholesterol (fat) checked?
- In the past 1-2 years have you had your blood glucose (sugar) checked?
- In the past year have you had an examination for blood in your stool performed?
- If you are over 50 years old, have you had a colonoscopy performed (bowel scope exam)?
- If you are a male, do you perform monthly testicular self-exams?
- If you are a male over the age of 50 years old, have you had a blood test performed to check your prostate?
- If you are a sexually active female and have a cervix, have you had a pelvic/PAP Smear examination every 3 years?
- If you are a female, do you perform monthly breast self-exams?
- If you are a female over 40 years old, have you had a breast x-ray (mammogram) performed every 2 years?
- Have you had a Rubella vaccine?
- Have you had a Hepatitis B vaccine?
- Have you had a Tetanus and Diphtheria vaccine (every 10 years)?
- If you never had chickenpox, have you had a Varicella vaccine?
- If you are over 50 years old, have you had a flu vaccine?
- If you are over 65 years old, have you had a pneumonia vaccine?
- From the following statements, please choose the most appropriate statement relating to your level of physical activity.