Sub-health life questionnaire 1
Experts pointed out that "sub-health state" is a state between sick and disease-free, which is manifested as: often feeling uncomfortable, easily tired, not sleeping well, losing appetite, or often feeling headache. The acceleration of work rhythm, the reduction of physical exercise times and unhealthy living habits are the main reasons for falling into the "sub-health" state. Through the questionnaire, we can know your basic physical condition, and we will provide you with fitness, nutrition and lifestyle suggestions to improve your health. For your health, please fill in the questionnaire truthfully and answer it quickly. The survey does not involve personal privacy and is only used for scientific research. Your personal data and health records will be kept safe for you, please rest assured.
First, personal basic information
Name: Gender: Age:
Education A Graduate B Undergraduate C Junior College D Other
Is there anything unusual in the recent physical examination results? The answer is b no.
You have the following disease history (1 above), so it is recommended not to take the physical fitness test.
□ Coronary heart disease □ Hypertension □ Arthritis □ Other diseases aggravated by exercise.
Second, the questionnaire part
I. Sports Survey (You can skip this survey if you answer no to the question/kloc-0).
1. Do you take part in physical exercise?
A is B, isn't it?
2. How many times do you take part in physical exercise every week?
A 1-2 times B 3-4 times C 5 times or more
3. What is the average time for each physical exercise?
A 30 minutes or less, B 30-60 minutes, C 60 minutes or more.
4. What is your main purpose of taking part in physical exercise?
A prevent diseases, b lose weight, keep fit, and c improve sports ability.
D Relieve stress, adjust mood, e socialize, f others.
5. What sports do you often take part in?
A running b swimming c race walking d mountain climbing e bike f aerobics (dance) g ball games h martial arts I other j bodybuilding and strength exercises.
6. What is the main form of your physical exercise?
A working time organization B spare time organization C spare time spontaneous.
7. Where do you take part in physical exercise?
A free stadium b paid stadium c road or street d room
E office f park g open space h other
8. What is the main reason that affects your participation in physical exercise?
A has no interest, B has no time, C has no funds, D has no venue, E has no technical guidance, and F has others.
B, sub-health scale
(A) the body senses
1. Self-rated health status: A is very good, B is very good, C is generally poor in D and E is poor.
2. Physical examination: A is very good, B is very good, C is generally poor, D is poor, and E is poor.
3. self-examination of appetite: a is good, b is good, c is generally poor, and d is poor.
4. Sleep self-examination: A is good, B is good, C is poor, D is poor, and E is poor.
5. The situation of defecation: A is very good, B is very good, C is generally poor, and D is poor.
6. Conscious fatigue: A without B occasionally C sometimes D often E always.
7. I feel very tired in the morning: A without B occasionally C sometimes D often E always.
8. Headache and backache: A without B occasionally C sometimes D often E always.
9. Sore throat and joint pain: A without B occasionally C sometimes D often E always.
10, easy to catch a cold and have a fever: A without B occasionally C sometimes D often E always.
(2) Mental state
1. Adaptive ability: A is very good, B is very good, C is generally poor in D and E is poor.
2. Conscious memory: A is good, B is good, C is generally poor, D is poor, and E is poor.
3. Conscious concentration: A is good, B is good, C is poor, D is poor, and E is poor.
4. Conscious reaction ability: A is good, B is good, C is average, D is poor, and E is poor.
5. Self-conscious irritability and melancholy: A without B occasionally C sometimes D often E always.
(3) Social adaptation
1. Self-conscious working ability: A is good, B is good, C is average, D is poor, and E is poor.
2. Conscious workload: A is easy, B is easy, C is generally heavier, and E is heavier.
3. interpersonal relationship: a is good, b is good, c is generally poor, d is poor, and e is poor.
4. Family relationship: A is good, B is good, C is generally poor, D is poor, and E is poor.
5. Enrich your life consciously. No: A is good, B is good, C is poor, D is poor, and E is poor.
C, self-test questionnaire
(A) Sub-health self-inspection
Your sub-health, your eating habits, your psychological changes in the face of various pressures, nervousness and fatigue, and your personal health care awareness can all be reflected through this assessment. Referring to our suggestions can help you recover and maintain a good health and better resist the invasion of diseases.
My hair often falls out when I get up in the morning. (5 points)
B feels depressed and often in a daze. (3 points)
C often forgets what he has considered. (10)
D is afraid to walk into the office, feeling that the work is boring. (5 points)
E doesn't want to face colleagues and bosses, and has the desire to be autistic. (5 points)
F the work efficiency is declining, and the boss has expressed his dissatisfaction with you. (5 points)
G after working 1 hour, I feel tired, chest tightness and shortness of breath. (10)
H work mood can never be high, nameless anger is great, but there is no energy attack. (5 points) I often look forward to escaping from the office so that I can go home early and lie in bed for a while. (5 points)
J is very sensitive to the surrounding pollution and noise, and is more eager to have a quiet landscape and rest than others. (5 points) K is no longer keen on gathering friends, and has a feeling of being energetic and barely entertaining. (2 points)
I often can't sleep at night. Even if I did, I was always dreaming, and my sleep quality was poor. (10) m feels immune decline, often feels whole body pain and often catches a cold. (5 points)
N sexual ability declines, often feel exhausted and have no desire for sex. (10)
O Your total score is:
Compare the above symptoms and test whether you have sub-health, or to what extent? If your cumulative total score exceeds 30 points, it means that health has sounded the alarm; If the total score exceeds 50 points, you need to sit down, reflect on your life and strengthen exercise and nutrition. If the total score exceeds 80 points, go to the hospital to find a doctor, adjust your psychology, or apply for a vacation and have a good rest for a while!
(2) Health self-test
A Have a good appetite and eat well.
B. sleep quickly and soundly
No habit of smoking or drinking.
D defecate regularly every day and defecate smoothly.
E life is regular and not easy to break.
F the weight is relatively stable, with no ups and downs.
G is not easy to catch a cold.
Not afraid of cold, heat, diarrhea, palpitation, chest tightness, etc. After getting up, I feel comfortable, clear-headed and not tired. J always feels relaxed and comfortable at the end of the day.
After working all day, I still have the energy to do something. I have my own interests and hobbies.
M has leisure time in a day.
Be good at forgetting troubles and trifles.
O happy most of the time, not easy to get angry.
P is interested in the exercise plan and can stick to it.
When I get up in the morning, I always feel how wonderful a new day is.
1. Do you think you are healthy?
A healthy b unhealthy c subhealth
2. How do you want to improve your health?
A see a doctor, B eat nutrition, C diet.
3. Do you want to have your own nutritionist?
A hopes that b doesn't want c to have it in the future.
Do you want a dietitian to tailor your diet?
A hopes that b doesn't want c to have it in the future.
Sub-health life status questionnaire II
How many of the following options are appropriate for your situation? The more options you encounter, the more serious your sub-health. Please fill in according to your own real situation. Thank you.
1. Gender ○ Male ○ Female
Before that, did you know about sub-health?
Know, know, occasionally hear, for the first time.
3. Do you feel healthy?
○ Very unhealthy, not sick ○ Not sure about your situation ○ Sick.
Sleep is a good guarantee for our work efficiency and good mood. Are you satisfied with your sleep?
Satisfied, I always feel energetic when I wake up. Not satisfied, often insomnia. I don't think I have enough sleep. I feel very tired after a lot of sleep.
5. Do you feel that you have the following symptoms?
I often feel dizzy, headache, dryness, lethargy, head and neck pain, sometimes stiffness, eye pain, poor immunity, excessive sweating, frequent colds, frequent spontaneous sweating, night sweats, excessive sweating and colds.
6. Do you have the following symptoms?
○ Obesity ○ Excessive stress ○ Dyslipidemia, hyperglycemia, hypertension, etc.
7. Do you often feel that you often have the following symptoms?
○ irritability ○ headache ○ dizziness ○ dizziness ○ anxiety ○ forgetfulness ○ inattention.
8. Do you often have the following symptoms ○ Feeling mental fatigue, thinking disorder ○ Frequent panic, anxiety and inferiority ○ Physical fatigue, weakness and physical discomfort with unknown reasons or excluding the causes?
5? Need to pay attention to 10. We must improve our living habits from now on.
1 1 or above need regular inspection, and there is no disease precursor.
Name and telephone number
XXX health center
Sub-health life status questionnaire 3
1. 1 Are you satisfied with your current health? (single choice)
A. Very satisfied
C. Satisfaction D. General
E. dissatisfied
1.2 have you had the following questions in the last two years? (multiple choice)
A. Motor system problems such as lumbar vertebrae, spinal column and hyperosteogeny
B. prostatic hyperplasia, urinary tract infection and other urinary system problems
C. Digestive system problems such as stomach and liver D. Nervous system problems such as insomnia
E. Endocrine system problems such as hormone disorder F. Reproductive system problems
G. Lung and respiratory problems H. Cardiovascular problems
I. Others (please specify) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
1.3 If you feel unwell, but don't know the reason, what do you usually do? (single choice)
A. After symptoms appear, inquire about possible diseases yourself before making a decision.
B. Unless it is an emergency, major trauma and other situations that you can't handle yourself, you will solve it yourself.
C. Go to the hospital for a thorough examination and seek expert opinions and suggestions.
D. Ask your family or friends around you
E. make judgments based on your common sense and buy your own medicine for treatment.
F. Go home and have a rest. G. Go to the physical examination center for health screening.
H. hold it for a while
I. Others (please specify) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
1.4 Have you ever heard of sub-health? (single choice)
A. I have heard of it, and I basically know it. B: I've heard of it, but I don't know much about it.
C. Never heard of it
1.5 About the following? What explanation would you choose for sub-health? (single choice)
A. a state between health and disease, so there is? Second health? Equal appellation
B.it's a minor illness, which is lighter than the general illness.
C. Sick state
D. Others (please specify) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
1.6 What is the following? What sub-health have you had in the past two years? (multiple choice)
A. Often tired and weak, slow to respond B. Insomnia and dreaminess
C. headache, dizziness, dizziness, tinnitus D. backache and leg pain
E. Chest tightness, shortness of breath, sweating and loss of appetite.
G. irritability, anxiety, forgetfulness and inattention
H. indifference, despair, loneliness, emptiness and recklessness
I. Others (please specify) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
1.7 Have you ever encountered the following situations in your life? Sub-health problems? (multiple choice)
A. More sensitive to urban pollution and noise, and more eager for quiet and peaceful landscapes to cultivate body and mind than ordinary people.
B. I'm not as keen on gathering friends as I used to be, and I feel reluctant to socialize.
C. I look forward to leaving the office early so that I can go home and lie in bed for a while.
D. I am angry because I can't improve my work mood, but I don't have the energy to attack.
E. often depressed, staring blankly out of the window.
F. I often can't sleep at night. Even if I did, my sleep quality was poor. I often dream and wake up easily.
G. decreased immunity, easy to catch a cold.
H. I can't remember what happened yesterday today, which often happens recently.
First, I woke up in the morning and found falling hair on the pillow.
J. is afraid to walk into the office and feels bored at work
K. I don't want to face people I know around me, and I have an autistic tendency.
After working for an hour, I feel tired, chest tightness and shortness of breath.
Mi (short for meter) is inefficient, and the boss has begun to be dissatisfied with you.
L: The amount of food per meal is very small. Excluding the weather and taste factors, it still tastes like chewing wax.
O. there is an obvious downward trend in weight. When I get up in the morning, I will find my eyes deep and my chin protruding.
Page (abbreviation of page) has decreased sexual ability
Q. Others (please specify) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
1.8 If you find yourself there? Sub-health, what's your attitude? (single choice)
A. actively seek measures to restore health.
B.anyway, it will get better naturally. C. I feel more anxious and overwhelmed.
D. Others (please specify) _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
1.9 Have you received any attention and help from others for your sub-health status? (single choice)
A. My family cares about me. They will let me take part in exercise or take me to see a doctor and urge me to treat.
B. The unit or leader doesn't know everyone's situation.
C. The unit or leader knew about everyone's situation, but did not give any care and help.
D. The unit or leader has noticed everyone's physical condition and will arrange rest and workload adjustment to help everyone.