APPENDICES
The appendix 1
The questionnaire
On studying of the mediko-social characteristic of the child and his family
At questionnaire filling it is necessary to familiarise attentively with the put question and variants of answers to it after that to lead round a circle number of the chosen variant of the answer.
In case of need (at absence in the questionnaire of answers to the brought attention to the question or it is not considered your variant of the answer) the necessary answer is required to enter in the column "another".
We thank you in advance for participation in questioning!
1. A surname, a name, a patronymic of the child
2. A sex of a child:
• the female
• the man's
3. A date of birth of the child:
4. Growth
5. Weight
6. The characteristic of a current of pregnancy:
• What pregnancy under the account:
• As pregnancy proceeded:
- Toxicosis
- Rising of arterial pressure
- Edemas - discontinuing threat - another:
7. Diseases during pregnancy:
8. What medicinal preparations accepted during pregnancy:
9. What labours under the account
10. Labours:
• the urgent
• the premature
11. The characteristic of a current of sorts:
With stimulation
• the fast
Operative (by cesarean sections)
With obstetric grants (an application of forceps, vacuum)
12. Weight of the child at a birth
13. Growth of the child at a birth
14. Feeding of the child:
Natural to
Months
Admixed to
Months
• artificial to _____ months
• what admixtures were used?
15. Terms of introduction of a feeding up:
16. What feeding up:
17. Weight of the child in 12 months:
18. Growth of the child in 12 months:
19. Whether your child visited (-et) a preschool institution?
• yes
• is not present
20. Whether willingly your child visited (-et) a preschool institution?
• yes
• is not present
• not always
21. What school is visited by your child?
• General educational
• the Special school (to specify specialisation)
• Lycйe
• College
• the Grammar school
• HIGH SCHOOL
22. As you estimate a food of your child in an educational institution:
• it is unsatisfactory (why?)
• it is satisfactory
23. How you estimate a way of life of your child?
• Active
• Passive
24. What additional employment are visited by the child?
• sports
• music
• drawing
• dances
• computer classes
• another to (specify)
• there are no additional employment
25. How many hours daily your child spends in front of the TV?
• 0,5 hours
• till 1 o'clock
• 1-2 hours
• more than 2 hours
26. How many hours daily your child spends in front of the computer?
• 0,5 hours
• till 1 o'clock
• 1-2 hours
• more than 2 hours
27. Whether the dream of your child is sufficient?
• yes
• is not present
• I do not know
28. Whether the motor performance of your child is sufficient?
• yes
• is not present
• I do not know
29. The hereditary anamnesis to (underline):
• on adiposity: yes, no, I do not know
• by illnesses of a gastroenteric tract: yes, no, I do not know
30.
Whether your child endocrine diseases (a hypothyrosis, a hyperparathyreosis) suffers?31. With what of the specified diseases the child was ill?
• a lambliasis
• a helminthic invasion
• an intestinal infection
32. What accompanying diseases of a gastroenteric tract
Are present at the child?
• a gastritis
• gastroduodenit
• a peptic ulcer
• a dyskinesia zhelchevyvodjashchih ways
• other diseases (what?)
33. The transferred infectious diseases (ORZ, a chicken pox, a measles, a rubella, a parotitis, a scarlatina, an intestinal infection, a flu, a whooping cough, others):
34. The transferred and existing somatic diseases/operations:
35. Your child accepts any medicinal preparations? If yes, what:
36. Whether there is at the child a food allergy?
• Yes
• Is not present
• I do not know
37. If there is a food allergy, on what products:
38. Allergic reactions (a household allergy, pollen, an asthma, atopichesky a dermatitis, a frequent obstructive bronchitis, a rhinitis, a laryngospasm) (necessary to underline).
39. Whether the child laktaznoj insufficiency suffers?
• Yes
• Is not present
• I do not know
40. What complaints gastroenterologicheskogo character are shown by you and your child at the moment of the present reference:
41. Whether there was your child apropos gastroenterologicheskoj pathologies on hospitalisation and where:
• Yes (how many time)
• Is not present
42. The child received treatment concerning constipations?
• Yes
• is not present
43. If received treatment, where?
• In a hospital
• It is out-patient
• In other medical institution
• it is independent
44. Efficiency of treatment. Estimate in points on a five-point scale (1 without effect, 5 it is effective)
45. Presence of a crack in the field of an anus:
• was
• was not
• is now
46. A prolapse of the rectum
• was
• was not
47. A debut of constipations:
Since a birth
• More than 1 year
• Complaints about 1 year
• Complaints of 6 months
• Complaints 3 months
• Complaints last month
48. The reasons of occurrence of constipations:
Visiting of school,
• a kindergarten
Residence change
Other reasons
It is not known
49. How many once a day eats your child?
50. How many time the child eats
• At home:
In educational institution:
In public catering points:
51. Alimentary behaviour of the child
The child eats irregularly (the big breaks between meal)
perekusy between food intakes
Great volume of bakery products
suhoedenie
Water regimen a day (including tea, soup, kefir etc.), volume:
Small quantity of fruit, vegetables
52. Features (the products daily used in I am peeped / preparing houses)
Loves:
Does not love:
53. Appetite:
It is lowered
It is raised
The normal
54. Whether it became perceptible at the child kalomazanie?
55. The feces characteristic:
Fragmentirovannyj (-bobovidnyj ”,-about-vechy”) or a firm feces
Feces of the big diameter
The chair is not changed
56. Impurity in a chair (blood, slime, Adeps drops), presence of undigested nutrition.
57. Quantity of a chair:
The plentiful
In small quantity
Normal quantity
I do not know
58. Whether become perceptible at the child of an abdominal pain?
59. When the child has complaints to an abdominal pain:
Before a defecation
• during a defecation
• after a defecation
Periodically, irrespective of the defecation certificate
60. Whether the child a meteorism suffers?
• Yes
• Is not present
• I do not know
61. Whether there is at the child a sensation of incomplete evacuation of intestinal contents?
• Yes
• Is not present
• I do not know
62. The characteristic of parents of the child:
Mother | The father | |
Age | ||
Formation | ||
Trade | ||
Employment on work: the full or incomplete working day |
63. A state of health of mother:
• It is healthy
• G an astropathology
• Predilection to constipations
• Another:
64. A state of health of the father:
• It is healthy
• G an astropathology
• Predilection to constipations
• Another:
65. The characteristic of living conditions:
• Apartment - separate or municipal (necessary to underline)
• Number of rooms
• Presence of a separate room at the child
66. Whether there are in a family still children?
• Yes
• Is not present
67. If yes, how many and their age:
• One
• Two
• Three and more
68. A state of health of other children:
• Are healthy
• G an astropathology
• Predilection to constipations
• Another
69. What relatives live on one living space (the grandmother, the grandfather, others)
What diseases suffer:
• Are healthy
• G an astropathology
• Predilection to constipations
• Another
70. Relations in a family:
• Equal
• Benevolent
• Strained
• Disputed
The appendix 2
Fig. 1 Korporalnoe acupuncture
Fig. 2 Auricular acupuncture
Fig. 3 Superficial acupuncture by means of the massage platen
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Other medical related information APPENDICES:
- THE TABLE OF CONTENTS
- Appendices
- the Maintenance
- APPENDICES
- THE TABLE OF CONTENTS
- INTRODUCTION
- APPENDICES
- the Table of contents
- Appendices
- INTRODUCTION
- THE MAINTENANCE
- INTRODUCTION