Female Questionnaire
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SYMPTOMS: GASTRO-INTESTINAL

Q157

Approximately how often do you suffer from unexplained nausea? Do not include nausea that has an obvious cause, for example pregnancy, hunger or motion sickness.
  • Don't know
  • Never / very rarely
  • Occasionally - a few times per year
  • Regularly - a few times per month
  • Often - several times per week

Q158

If you suffer significantly from unexplained nausea (at least once per week), for how long has this been a problem?
  • It is not a problem / don't know
  • It started within the last week
  • It started within the last month
  • I've had it for 1 to 3 months
  • I've had it for over 3 months

Q159

Approximately how often do you suffer from unexplained vomiting? Do not include vomiting that has an obvious cause, for example overeating or drinking too much alcohol.
  • Don't know
  • Never / very rarely
  • Occasionally - a few times per year
  • Regularly - a few times per month
  • Often - several times per week

Q160

If you suffer significantly from unexplained vomiting (at least once per week), for how long has this been a problem?
  • It is not a problem / don't know
  • It started within the last week
  • It started within the last month
  • I've had it for 1 to 3 months
  • I've had it for over 3 months

Q161

Do you suffer from excess lower bowel gas (flatulence)? The average adult passes gas ("farts") 8 to 20 times a day, but this depends on various factors. Try to compare yourself to others with similar diet and eating habits.
  • No / average / only after overeating / don't know
  • Yes, but it is probably due to my diet
  • Somewhat more than most people
  • Very much more than most people

Q162

When you pass gas ("fart"), how does it usually smell?
  • Don't know / it varies a lot / don't want to know!
  • Usually odorless
  • Usually about 'normal' / 'noticeable'
  • It varies between 'normal' and terrible
  • Usually terrible / people run away screaming

Q163

Do you have other stomach/digestive problems? For example, burping, bloating, upset stomach, heartburn, food remaining in stomach, rapid gastric emptying, problems digesting specific foods, ulcers, Gastritis, Helicobacter Pylori infection, Hiatal Hernia.
  • No / don't know
  • Only if I eat too much
  • Yes*
* more questions will be asked later

Q164

Abdominal symptoms. Are you experiencing any form of abdominal pain, discomfort, fullness, or bloating? (Your abdomen is the area between your chest and hips.)
  • Don't know
  • No
  • Yes*
* more questions will be asked later

Q165

Have you had any problems specifically affecting the bowels (intestines) or anus? For example, Ulcerative Colitis, Crohn's Disease, Diverticular Disease, Dysentery, Irritable Bowel Syndrome (IBS), Colon Polyps, Hemorrhoids, anal itching.
  • Don't know
  • No
  • Yes*
* more questions will be asked later

Q166

Within the past 3 years, have you become sick from consuming food or water in a country where it is known to be unsafe?
  • No / don't know
  • Yes, but symptoms resolved completely
  • Yes, long-term symptoms finally resolved
  • Yes, symptoms still present, partially resolved
  • Yes, symptoms still present with no resolution

Q167

Have you been infected with any form of parasite within the last 2 years? This includes worms, protozoa (such as Giardia), and amoeba, but not yeast, bacteria, or viruses.
  • Don't know
  • No
  • Yes*
* more questions will be asked later

SYMPTOMS: MOUTH/ORAL

Q168

Do you have bad breath?
  • No / don't know
  • Occasionally, minor
  • Often minor or occasionally moderate
  • Often moderate or occasionally very bad
  • Often very bad

Q169

Do you suffer from chapped lips?
  • No / don't know
  • Occasionally / moderately
  • Often / severely

Q170

In general, how plentiful is the saliva in your mouth?
  • My mouth is often very dry
  • My mouth is sometimes a bit dry
  • Normal / don't know
  • I always have plenty of saliva
  • Excess saliva, with a tendency to drool

Q171

Are your teeth sensitive or tender?
  • No / don't know
  • One or two teeth, occasionally
  • One or two teeth often / several occasionally
  • One or two teeth most of the time / several often
  • Several teeth, most or all of the time

Q172

Do you suffer from clenching or grinding of teeth while you sleep (Bruxism)? If you sleep with a partner, it may be worth asking them.
  • No / don't know
  • Mildly - it was mentioned but I feel/see no signs
  • Moderately - I grind my teeth but no damage yet
  • Seriously - some damage to teeth
  • Severely - extensive damage to teeth

Q173

Are any of your teeth noticeably loose? A very small amount of tooth movement is normal. Only mention movement that seems to be more than it used to be or which is accompanied by pain. Do not include teeth that are loose due to past trauma/injury.
  • Don't know
  • No
  • Yes, one
  • 2-4
  • More than 4 teeth

Q174

How often do you get dental cavities?
  • Not applicable / don't know
  • I have none at all - perfect teeth
  • None in the past 5 years
  • 1 or 2 in the past 5 years
  • 3 or more in the past 5 years

Q175

Tooth loss. Have you lost any of your adult teeth for any reason?
  • I am a child without all adult teeth / don't know
  • I still have all of my adult teeth
  • I have only lost wisdom teeth
  • Yes, I have lost one or more adult teeth*
* more questions will be asked later

Q176

Other than dental cavities, are there any white chalky spots, brown stains, or areas of pitting on your teeth?
  • Don't know
  • No, definitely not
  • Yes, on some teeth
  • Yes, on most teeth

Q177

How many mercury amalgam ("silver") fillings do you currently have in your teeth?
  • Don't know
  • None
  • 1 to 3, all in good condition
  • 4 to 7 in good condition, or 1 to 3 in poor
  • 8 or more in good condition, or several in poor

Q178

Have you had any mercury amalgam fillings removed?
  • No / don't know
  • 1 to 3
  • 4 to 6
  • 7 to 10
  • More than 10

Q179

If you have had mercury amalgam fillings removed, were they removed using special procedures to protect you from additional mercury exposure?
  • Not applicable / don't know
  • All amalgams still present
  • Yes, all removals used protective measures
  • Some of the removals were done with precautions
  • No special precautions were taken

Q180

How often do your gums bleed when you brush your teeth?
  • Never / don't know
  • Rarely, and only with hard brushing
  • At least once a month
  • At least once a week
  • Always or most of the time

Q181

Do your gums have dark spots or areas?
  • No / normal pink color / don't know
  • Yes, at least one
  • Yes, more than one, or a larger area

Q182

Has your sense of taste declined within the past few years, for reasons other than nasal congestion?
  • Don't know
  • No, my sense of taste has remained about the same
  • Yes, but it is due to ongoing nasal congestion
  • Yes, it is somewhat worse now
  • Yes, it is a lot worse now

Q183

Looking in the mirror, is your tongue covered by a white coating? A healthy tongue is smooth, moist, pink or pale red in color.
  • No / the coating is another color / don't know
  • Yes, there is a slight white coating
  • Yes, there is a heavy white coating

Q184

Do you ever cough up small, soft lumps of material ("curds")? The material is usually whitish in color and may have an unmistakable foul odor, especially when the lumps are crushed.
  • Don't know
  • No
  • Yes, whitish or yellowish but no foul odor
  • Yes, whitish or yellowish and they smell bad
  • Yes, but another color (please add a note)

Q185

Speech. Which word / phrase best describes the way you speak?
  • Slowly
  • Incoherently - people often don't understand me
  • Averagely - accurately / don't know
  • Rapidly

Q186

Within the past few years, months or weeks, has your voice changed in any way, for no apparent reason?
  • No / don't know
  • A little, I think
  • Moderately - I have had a few comments about it
  • Significantly - Many have noticed it
  • Yes, it has changed almost beyond recognition

Q187

Has your ability to speak declined for no obvious reason? A minor decline means people can still understand you, but you have trouble saying some words or speaking clearly. A severe decline means people often can not understand you any more.
  • No / there is an obvious reason / don't know
  • Minor decline occurring over more than 1 year
  • Severe decline occurring over more than 1 year
  • Minor decline within the past year
  • Severe decline within the past year

Q188

Has your voice become hoarse (rough or grating in sound)?
  • No / don't know
  • Yes, for less than one week
  • Yes, for less than one month
  • Yes, for less than one year
  • Yes, for more than one year

Q189

How often do you get Mouth Ulcers, also known as Canker Sores'? These are small, painful ulcers (not blisters) inside the cheeks, lips or under the tongue, usually lasting from 3 to 10 days.
  • Don't know
  • I have never had one
  • Less than once a year
  • I usually get one or more each year
  • I keep getting them!

Q190

Have you had any symptoms in or around your mouth not mentioned above? For example, cold sores, red or white patches, blisters, pain, abnormal tastes, soreness, tongue problems.
  • Don't know
  • No
  • Yes*
* more questions will be asked later

SYMPTOMS: EYES/VISION

Q191

Approximately how often do your eyes itch?
  • Never / rarely / don't know
  • A few times a month
  • A few times a week
  • At least once a day

Q192

Are your eyelids sometimes red?
  • Don't know
  • No
  • Mildly / occasionally
  • Moderately / often
  • Severely / most or all of the time

Q193

How moist do your eyes tend to be?
  • Usually very dry, I need eye drops
  • Sometimes slightly dry
  • About average / don't know
  • Sometimes slightly too moist / watery
  • Usually watery / too moist, causing teariness

Q194

Are you nearsighted or farsighted? For additional information see optical prescription.
  • No, my vision is fine / don't know
  • I'm very nearsighted / -7.0 diopters or over
  • I'm somewhat nearsighted / up to -7.0 diopters
  • I'm somewhat farsighted / up to +7.0 diopters
  • I'm very farsighted / +7.0 diopters or over

Q195

How well can your eyes focus on close objects? Slowly bring a newspaper or book closer to your eyes. Without wearing glasses or contact lenses, approximately how far from your eyes is the page when the regular-size letters start to blur?
  • I can't do this test / don't know
  • Less than 4 inches (10cm)
  • 4-11 inches (10-28cm)
  • 12-36 inches (30-90cm or 1-3 feet)
  • Over 36 inches (90cm or 3 feet)

Q196

With the help of a friend or a mirror, gently pull down your lower eyelids and look at the inside surface. What color is it? Only answer if your eyes feel 'normal', without problems such as dryness, itchiness, pain, swelling, or infection.
  • I can't do this test / don't know
  • I have current eye problems
  • Very pale/white, (almost) no trace of pink or red
  • Light pink
  • Rich pink or red

Q197

How light or dark is the color of your eyes?
  • Very light (e.g. very light blue or gray)
  • Lighter than average
  • About average / don't know
  • Darker than average
  • Very dark (e.g. very dark brown)

Q198

Do you have dark areas/circles under your eyes?
  • No / don't know
  • Yes, slightly
  • Yes, definitely

Q199

Do you have bags under your eyes?
  • No / don't know
  • Yes, somewhat
  • Yes, pronounced

Q200

Does the outside 1/3 of your eyebrow area have little or no hair growth? In other words, do your eyebrows fail to extend out to edge of your eyes?
  • No / don't know
  • Yes

Q201

Have you had any eye problems? For example, vision changes/loss, pain, irritation, redness, yellow color, bulging, eyeball jerking, poor night vision, high sensitivity, infection, discharge, injury, surgery, Cataracts, Glaucoma, Macular Degeneration.
  • No / don't know
  • Yes*
* more questions will be asked later

SYMPTOMS: EARS/HEARING

Q202

How much wax accumulates in your ears?
  • Don't know
  • Very little / none as far as I can tell
  • Some, needs very occasional cleaning
  • Quite a lot, requires regular cleaning
  • A lot - blocks ears and requires frequent cleaning

Q203

Do you have a diagonal crease (wrinkle) on one or both of your earlobes? A crease may be partial (only partway across the earlobe) or full (completely across the earlobe).
  • No / don't know
  • Partial crease on one ear
  • Partial crease on both ears
  • Full crease on one ear, possibly partial on other
  • Full crease on both ears

Q204

Have you had any ear/hearing problems? For example, poor hearing, recent hearing loss, unusual sounds, Tinnitus, infections, earache.
  • No / don't know
  • Yes*
* more questions will be asked later