Male and female adults were recruited from diverse sociocultural, educational and economic backgrounds in 9 countries (total n = 2657). 22. Methods. Answer all questions that apply. The Health Questionnaire Forms are used by different health organisations to check out the problems faced by the patients. PHQ-9 is an instrument, validated for Portuguese, which is widely used to identify individuals at risk of depression [32, 33]. This study was designed to culturally adapt and validate the Physical Activity Questionnaires for Adolescents (PAQ-A) in the Polish language. I have had problems with my lungs/breathing, heart, blood, or have been diagnosed with COVID-19. with a health professional) any physical health needs they might have. The 7-item versions are best used when assessment time is limited and a single measure of global health is desired. (2009). Physical health is a key part of that vision. This is not intended to provide a diagnosis – only trained health professionals should do this. The International Physical Activity Questionnaire - Short Form (IPAQ-SF) has been recommended as a cost-effective method to assess physical activity. Patient Health Questionnaire-9 (PHQ-9) [edit | edit source] The PHQ-9 can be used in conjunction with the PHQ-2. the questionnaire, as well as other relevant information from the patient. The PHQ-9 in this context performs, to some extent, the same kind of function that an examination performs in a physical health context, fitting the patient’s subjective descriptions to a set of symptom categories that can, in turn, be cited as the basis for a diagnosis (see also Dowrick et al., 2009). FORM E -- NIAA HEALTH QUESTIONNAIRE / INTERIM FORM . (Use “ ” to indicate your answer) Not at all Several During the past 4 weeks how much of the time has your condition interfered with your social activities? Based on the answers provided by the patients, the physician or the doctor would get a clear idea of the medical condition. afrotc physical health screening questionnaire to the cadet: it mandatory you complete this questionnaire prior to and during your participation in the air force reserve officer training corps cadet training (pt) program instructions if you are starting the pt program, print date under the column marked "first if you are taking a physical Patient Name . The Physical Safeguards standards in the Security Rule were developed to accomplish this purpose. The Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) questionnaire were applied. This Sports Health Questionnaire may only be used for students who received a valid sports physical during the 201920 school year- (one completed on or after April 15, 2019.A school may require a student to have a valid physical exam. (like visiting with friends, relatives, etc) SQUASH is a fairly reliable (r = 0.58) and reasonably valid (r = 0.45) questionnaire to measure physical activity. A lack of physical activity is common in older adults. General: ! Question #9: Who pays for the cost of the examination? This evaluation is only to determine readiness for sports participation. Adolescent depression is associated with adverse emotional and functional outcomes and suboptimal physical health. 7.2.3 Child physical activity questionnaire. The PHQ-9 may be a part of a complete psychiatric screening process that evaluates all areas of mental health. The purpose of the PAQ manual is to ensure that you can easily administer the PAQ Scoring for the PHQ-9 range from 0-27, with increasing scores indicating increased severity of depression. The PHQ contains modules on 12 different mental health disorders including mood, anxiety, and some of the sleep disorder modules. Patient Health Questionnaire (PHQ-9) The outcome measures used was the Pediatric functional health questionnaire. PURPOSE Instruments to assess physical activity are needed for (inter)national surveillance systems and comparison. The PHQ-2 includes the first two items of the PHQ-9. Krause, J. S., Saunders, L. L., et al. When screening for depression the Patient Health Questionnaire (PHQ-2) can be used first (it has a 97% sensitivity and a 67% specificity). (NOTE: All personal health and medical information provided in Part B is confidential and will be disclosed by UHS ONLY with the individual’s written consent.) Physical Activity for Health Questionnaire This short survey is investigating Scottish medical students’ knowledge of the physical activity guidelines for different age groups and their confidence in applying these to their clinical practice. Stress & Recovery Questionnaire (cont’d) 2019 Precision Nutrition precisionnutrition.com What, if anything, do you do right now to cope and / or recover from stressors? To use the PHQ-9 to screen for all types of depression or other mental illness: • All positive answers (positive is defined by a “2” or “3” in questions 1-8 and by a “1”, “2”, or “3” in question 9) should be followed up by interview. The PACE-UP trial offered the opportunity to assess this, using the self-administered International Physical Activity Questionnaire (IPAQ) and waist-worn accelerometry. Physical activity generally refers to a … Reference: Preparticipation Physical Evaluation (5th Edition): AAFP, AAP, ACSM, AMSSM, AOSSM, AOASM; 2019. This Sports Health Questionnaire may only be used for students who received a valid sports physical during the 201920 school year- (one completed on or after April 15, 2019.A school may require a student to have a valid physical exam. It is not intended to take the place of an evaluation by a trained medical professional. The questionnaire reflected the criteria of a survey developed by the American College of Sports Medicine (ACSM) to measure the physical activity of elders. ysical activity among older persons, reliable and valid measures of physical activity are required that can also detect the expected types of physical activity changes in this population. 10. Format questionnaires to be simple and easy for respondents to understand and achieve answers that are accurate as possible. J Phys Act Health. Items 4 and 11 are specific to adults and therefore blacked out … This study examined the usefulness of the Japan Nurses’ Health Study (JNHS) questionnaire for self-administered physical activity surveys. Bauman A, et al. The HADS is 1 of 3 instruments (Beck Depression Inventory-II [BDI-II], HADS, Patient Health Questionnaire-9 [PHQ-9]) endorsed by the National Institute for Health and Clinical Excellence for use in primary care in measuring baseline depression severity and responsiveness to treatment. File Type PDF Health History Questionnaire Physical Examination social workers all join with parents in safeguarding and promoting the health and well-being of school-aged children as a basic foundation for academic success. The Patient Health Questionnaire 9 symptom checklist (PHQ-9) questionnaire focuses on depression, the Physical Activity Readiness Questionnaire (PAR-Q) assesses an individual’s need to consult with a physician before beginning a physical activity program, and the Work Limitations Questionnaire (WLQ), addresses general work limitations. The Patient Health Questionnaire (PHQ-9) is a brief tool used to diagnose and measure severity of depression Illness involving the body, mood, and thoughts, that affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. You might want to share your results with your health care professional. Few trials have compared estimates of change in physical activity (PA) levels using self-reported and objective PA measures when evaluating trial outcomes. Several studies validating the IPAQ-SF have been conducted with differing results, but no systematic review of these studies has been reported. IN THE LAST YEAR, since your last complete Sports Qualifying Physical Exam with your physician or your Year 2 Annual Health Questionnaire, HAVE YOU HAD ANY CHANGES TO THE FOLLOWING QUESTIONS: Athlete Health Questionnaire Over the past 2 weeks, how often have you been bothered by any of the following problems? Patient Health Questionnaire-9 (PHQ-9) and EuroQol-5 Dimension (EQ-5D) were used to measure participants' mental health and … Adult Physical Activity Questions on the National Health Interview Survey: 1975-2012 i 1975 NHIS Physical Fitness Supplement (20 years and over) The U.S .Public Health Service would like to know how many adults participate in some form of exercise, or in one or more popular sports. (Circle response.) Patient Health Questionnaire - Patient Name page 2 None Height Date o Light Moderate Strenuo That type of regular exercise do you perform? Objective: Public health surveillance of physical activity in children in the UK depends on a parent-reported physical activity questionnaire which has not been validated. This form is valid for 3 calendar years from above date with a normal Annual Health Questionnaire. PATIENT HEALTH QUESTIONNAIRE PHQ-9 FOR DEPRESSION USING PHQ-9 DIAGNOSIS AND SCORE FOR INITIAL TREATMENT SELECTION A depression diagnosis that warrants treatment or treatment change, needs at least one of the first two questions endorsed as positive (little pleasure, feeling depressed) indicating the Note: The Paffenbarger Physical Activity Questionnaire was designed primarily to identify leisure-time physical activities associated with hypertensive cardiovascular disease in college alumni. A typical physical activity questionnaire includes questions about the different physical activities an individual does in a certain period of time, for example the different exercise routines he/she does everyday. The Physical Activity Questionnaire for Older Children (PAQ-C) and the Physical Activity Questionnaire for Adolescents (PAQ-A) provide a general measure of physical activity for youth from grades 4-12 (approximately ages 8-20). 2016 SCHOOL HEALTH PROFILES SCHOOL PRINCIPAL QUESTIONNAIRE This questionnaire will be used to assess school health programs and policies across your state or school district. Patient Health Questionnaire - page 2 . Physical Therapist Scan date: @ Other Medical Doctor Other O Physical Therapist Laborer '9 Homemaker FT Student Self-employed @ Unemployed Date Ø Retired Other Off work Other . Screening for Depressive Disorder in Elderly Patients with Chronic Physical Diseases Using the Patient Health Questionnaire-9 Psychiatry Investig . To supplement the material included here, the reader should refer to a previous article by Paffenbarger and colleagues (9… ... (Bipolar Disorder), and a physical disorder, medication, or other drug as the biological cause of the depressive symptoms. As with all the standards in this rule, compliance with the Physica nd Methods: Baseline and postintervention data were collected from 72 Latinas (mean age = 43.01; SD = 9.05) who participated in Caminando con Fe/Walking with Faith, a multilevel intervention promoting PA among church-going Latinas. The International Physical Activity Questionnaire (IPAQ) was developed to measure health-related physical activity (PA) in populations. The International Physical Activity Questionnaire (IPAQ) was developed to measure health-related physical activity (PA) in populations. 2003;35. The PHQ is a component of a family of connected measures, as well as the PHQ-9, that is the depression scale from the PHQ, and also the PHQ-15, that is that the physical symptom scale from the PHQ. A lack of physical activity is common in older adults. 2.1) (9) or the AHA/ACSM Health/Fitness Facility Preparticipation Screening Questionnaire (Fig. the PRIME-MD called the Patient Health Questionnaire (PHQ) was developed and validated. Many languages. However, the MSK-HQ needs to be further evaluated across settings and different languages. Mental Health Questionnaire Dependent Variable – Depression Independent Variable - Physical health, emotional health, stress, anxiety, trust, isolation Name (Optional) _____ Age a) <15 b) 15 – 30 years c) 30 – 45 years d) 45 – 60 years e) 60+ years Gender a) Male b) Female c) Prefer not to say 1. This Sports Health Questionnaire may only be used for students who received a valid sports physical during the 201920 school year- (one completed on or after April 15, 2019.A school may require a student to have a valid physical exam. This tool assesses the 15 most common physical symptoms in primary care. "Validity of the brief patient health questionnaire mood scale (PHQ-9) in the general population." If there is a need to have more information about a child or adolescent’s physical health, the 7+2 versions produce METHODS Male and female adults were recruited from diverse sociocultural, educational and economic backgrounds in 9 countries (total n = 2657). Note to women: If you are pregnant, or attempting to become pregnant, do not dive. It should not be used as a substitute for regular health … How many servings of fruit/veg do you eat a day? Measures physical, mental, & social health [Northwestern U. via NIH grant] Strengths & Difficulties Questionnaire 25-item parent+teacher+self behavioral screening [emotion, conduct, hyperactivity, peer problems, prosocial behavior] 3-16 year olds. The Musculoskeletal Health Questionnaire (MSK-HQ) has been developed to measure musculoskeletal health status across musculoskeletal conditions and settings. The purpose of the PHQ-2 is to screen for depression in a “first-step” approach. Participants completed the GPAQ and were asked to wear the accelerometer for 7 consecutive days at baseline and again 6 months later. number of years. ... HEART HEALTH QUESTIONS ABOUT YOU Yes No 5. Physical Health Question Title * 1. The number of physical activity domains per questionnaire … please not. Please submit the completed questionnaire to University Health Service’s confidential fax (901) 448-7255 or email to Evelyn Lewis, Occupational Health Coordinator, elewis4@uthsc.edu. Describe your symptoms Patient Signature Date 5. instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9). Demographic information collected was sex, grade, sport(s) played, and zip code. Sports Questionnaire Sports Health Questionnaire ... (Bipolar Disorder), and a physical disorder, medication, or other drug as the biological cause of the depressive symptoms. Coronary heart disease (CHD) is the leading cause of death in the United States, accounting for >700 000 deaths in 1996. State of California —Health and Human Services Agency Department of Health Care Services Licensing and Certification Division MS 2600 PO Box 997413 Sacramento, CA 95899-7413 DHCS 5011 (06/13) ADP 100225 (Staff Only) (06/13) Certification Standards Staff Health Questionnaire EMPLOYEE HEALTH QUESTIONNAIRE Exercise and well-being: a review of mental and physical health benefits associated with physical activity. Cancer: (Liu, 2011) Poor correlations between the ActiGraph and the PASE (r = 0.16); Lung Cancer: (Granger, 2015; n=69; mean age = 68 years (age range= 61-74); time after diagnosis= 2, 4, and 6 months). Health checks include: checks of height and weight; blood tests for sugar and cholesterol; check smoking, physical activity and alcohol use; blood pressure check . The questions on child physical activity are slightly less detailed than those for adults [16]. 2. Fatigue ! If this is positive, the PHQ-9 can then be used, which has 61% sensitivity and 94% specificity in adults. Executive Health Questionnaire (Returning Patient) Page 1 Executive Health Questionnaire PLEASE FAX THIS COMPLETED REPORT MRN # ... Have you made any changes to your diet or eating habits since your last Executive Health Physical: Yes No If yes, please provide details: Have you made any changes to your supplementation routine since last year? INTERIM HEALTH QUESTIONNAIRE 88 Fort Couch Road, Suite 100 Pittsburgh, PA 15241 Phone: 412-831-1114 Fax: -831 6965 Waterdam Waterdam Commons Office Park Phone: 724-969-6970 Fax: 724-969-6975 Patient’s Name: _____ DOB: _____ Since your child’s last physical exam: 1. Med Sci Sports Exerc. Health-related quality of life (HRQOL) was assessed using the number of days of poor physical or mental health reported during the 30 days preceding Wave 4, and the number of days on which poor health limited a respondent’s usual activities … S1. Physical Health Check questionnaire Annual health checks are recommended for people experiencing mental illness. The health questionnaire looks at how your mental and physical illnesses affect your ability to work – this section only gives advice on mental illness. Though, once an individual is an employee, the employer must pay for the expense of any examinations. According to the study, published in the Journal of the American Osteopathic Association, Patient Health Questionnaire (PHQ-9) scores, a standard … The DSM-5 Level 2—Somatic Symptom—Child Age 11–17 is an adaptation of the 15-item Patient Health Questionnaire Physical Symptoms (PHQ-15) that assesses the domain of somatic symptoms in children and adolescents. ADOLESCENT PHYSICAL HEALTH QUESTIONNAIRE ADOLESCENT PHYSICAL HEALTH QUESTIONNAIRE TMPN Revised 10/08/2015 Page 3 of 4 Name: Today’s Date: Date of Birth: Please mark any of the following conditions that you may have on a recurrent basis. Both the Pediatric and Parent Proxy measures have a 7-item and 9-item version. It can be used to formulate a provisional diagnosis as well as to measure depressive symptoms dimensionally. questionnaire The coding column is used as a guide for analysis of the physical activity data. Preparticipation Physical Evaluation HISTORY FORM (Note: This form is to be filled out by the patient and parent prior to seeing the physician. 15, 2019), they may complete the Health Questionnaire for 2020-21 for all seasons. ew Patient Health Questionnaire Page 2 of 3 Family History (Use back of page if needed) Age Medical conditions Indicate Healthy -or- diabetes, high blood pressure, cholesterol, heart disease, stroke, cancer (type) Mother Living Deceased Father Living Deceased Sibling F M Living Deceased Sibling F M Living ... HEART HEALTH QUESTIONS ABOUT YOU Yes No 5. Patient Health Questionnaire 9 (PHQ-9) The PHQ-9 is a nine-item self-report instrument that was developed for use in medical settings (Kroenke et al., 2001). This examination addresses 12 different mental health disorders. The medical evaluation shall be performed by an authorized health care provider. Falls as a child? Purpose. Physical activity. Healthy Family Chiropractic, PC. INSTRUCTIONS 1. The Patient Health Questionnaire (PHQ) is a multiple-choice self-report inventory that is used as a screening and diagnostic tool for mental health disorders of depression, anxiety, alcohol, eating, and somatoform disorders.It is the self-report version of the Primary Care Evaluation of Mental Disorders (PRIME-MD), a diagnostic tool developed in the mid-1990s by Pfizer Inc. Patient Health Questionnaire (PHQ-9) It consists of 12 questions and should take no longer than 5 … The aim of developing the World Health Organization (WHO) Global Physical Activity Questionnaire (GPAQ) was to have a tool that would produce valid and reliable estimates of physical activity, especially relevant to developing countries where patterns of energy expenditure differ from developed countries because people experience diverse ways of life. Patient completes PHQ-9 Quick Depression Assessment. 1 Several studies have confirmed the overall benefit of physical activity in reducing the risk of CHD. Epub 2017 May 16. Chills or night sweats ! Background Depression, which is a serious medical illness, is prevalent worldwide and it negatively impacts the adolescent lifestyle. PHYSICAL ACTIVITY READINESS QUESTIONNAIRE Name Male/Female Date of Birth Address Tel no Email This PAR-Q is designed to help you help yourself. FORM E -- NIAA HEALTH QUESTIONNAIRE / INTERIM FORM . Executive Health Questionnaire (Returning Patient) Page 1 Executive Health Questionnaire PLEASE FAX THIS COMPLETED REPORT MRN # ... Have you made any changes to your diet or eating habits since your last Executive Health Physical: Yes No If yes, please provide details: Have you made any changes to your supplementation routine since last year? The UWHC's standard preoperative history and physical examination form, the Guide's documentation template for physical therapist patient/client management (outpatient form), 1 and the patient health history questionnaire utilized by the UWHC Spine Physical Therapy Clinic were used as guides for the initial questionnaire development.
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