Etcha Sketch Toy Story Cake

Questionnaire

Dear friends, colleagues and listeners .....

in addition to the previous post now enclose the questionnaire for the assessment of the quantity \\ quality 'of the rest taken directly from the site of Aims that I would use to search for in the previous post about zero ........

DISORDERS OF SLEEP AND SLEEP
QUESTIONNAIRE SCREENING FOR MEDICAL WORK

Surname ... ... ... ... ... ... ... ... .... Name ... ... ... ... ... ... ... ... .... Date of Birth ... ... ... ... ... ..
Sesso 􀀀 F 􀀀 M Età …….. Peso kg……… Altezza m ……… BMIA .................
Azienda …………………………………………………………………………………………..
Settore lavorativo……………...................………. Mansione ……………………….................
Orario di lavoroB 􀀀 giornaliero 􀀀 turnista
1) How many hours must sleep at night to stay healthy during the day? 􀀀> 8
􀀀 6-8
􀀀 <6
2) Given the choice, would prefer: 􀀀 sleep early at night and get up early in the morning
􀀀 bed late at night and sleep till late in the morning hours to sleep
􀀀 conventional
3) In Overall are you satisfied with the quality of your sleep? 􀀀 very
􀀀 enough
􀀀
􀀀 little to nothing
4) In the past, sleep better? 􀀀
􀀀 is not until (in years) .............................
because: 􀀀 life events
􀀀 orari di lavoro
􀀀 altro…………………………………
5) Riesce abitualmente a dormire il numero di ore di cui ha bisogno?
􀀀 si
􀀀 no perché ? ...............................................................
quante ore dorme ? ...............................................
6) Al risveglio del mattino si sente generalmente fresco e riposato? 􀀀 si
􀀀 no
7) Fa abitualmente pisolini? 􀀀 si perché: 􀀀 recupero sonno
􀀀 altro ………………………….....
􀀀 no because: I can not 􀀀
􀀀 I do not need
8) habitual snoring at night? 􀀀 no
􀀀
􀀀 you do not know
9) It has usually respiratory pauses in sleep (or perceived as reported by the partner
awakening with choking?) 􀀀 no
􀀀
􀀀 you do not know
Ver 06/11/2007
10 ) Usually during the day you feel tired and sleepy? 􀀀
􀀀 is no
11) During the day, often falling asleep? 􀀀
􀀀 is no
12) has had in past traffic accidents and injury probably due to sleepiness?
􀀀 no
􀀀 you
13) notes disorders (specify if previous or current)
􀀀 sleep disorders are no
􀀀 􀀀
􀀀 insomnia sleep apnea syndrome (OSAS), excessive daytime sleepiness
􀀀
􀀀 nocturnal myoclonus, periodic (PLM) and / or
legs syndrome (RLS)
􀀀 more ... ... ... ... ... ... ... ... ... ... ... ... ... ... ....
􀀀 neuropsychiatric disorders is not
􀀀 􀀀 anxious-depressive syndrome, epilepsy
􀀀
􀀀 major head trauma
􀀀
􀀀 another headache ... ... ... ... ... ... ... ... ... ... ... ... ... ..
internal pathologies (in effect) no 􀀀
􀀀 􀀀 COPD is
􀀀
􀀀 diabetes mellitus, hypertension heart disease
􀀀
􀀀 anemia
􀀀 musculoskeletal diseases
􀀀 more ... ... ... ... ... ... ... ... ... ... ... ... ... ..
14) taking medications which can interfere with the oversight (hypnotic or other purposes)?
􀀀
􀀀 is no 􀀀 antihistamines
􀀀
􀀀 cortisone
􀀀 antihypertensive drugs (use 􀀀 􀀀 abuse ex)
􀀀 antidepressants
􀀀 benzodiazepines
􀀀 neuroleptics
􀀀 non-benzodiazepine hypnotics
􀀀 melatonin
􀀀 more ... ... ... ... ... ... ... ... ... ... ... ... ... ...
15) How many coffee drinks in 24 hours? None 􀀀
􀀀 1-3
􀀀> 3
Ver 06/11/2007
16) As usually within 24 hours of drinking alcohol (wine, beer, spirits)?
(in units AlcolicheC)
􀀀 non drinker
􀀀 moderate drinker (1-2 AU / day)
􀀀 average drinker (3-5 AU / day)
􀀀 strong drinker (> 5 AU / day)
17) In his work there may be exposure to neurotoxic?:
􀀀
􀀀 is no 􀀀 solvents (trichlorethylene, toluene, styrene, acetone, etc.).
􀀀 anesthetic gas
􀀀 pesticide
􀀀 carbon monoxide
􀀀 mercury
􀀀 other ......................................... ............
SE SHIFT WORK ----------- ---------------------------------- --------------------------
18) How many years working in shifts? ... ... ... ... ... ... ... ... ...
19) Type of duty:
􀀀 loop
􀀀 cycle operation (interruption nel fine settimana)
􀀀 turni a rotazione con notte
􀀀 turni a rotazione senza notte
􀀀 turno fisso 􀀀 notturno
􀀀 diurno
􀀀 altro ………………………………………………………………
􀀀 a rotazione rapida (cambio del turno ogni 1 o 2 o 3 gg)
􀀀 a rotazione lenta (cambio del turno ogni 4 o più gg)
senso di rotazione 􀀀 mattino, pomeriggio, notte
􀀀 pomeriggio, mattino, notte
20) Quanti turni notturniD effettua nell’arco a year (on average)? ... ... ... ... ... ... ... ... ... ... ..
21) hours beginning and end of shifts: morning ... ... ... ... ... ... ... ... ... ... ....
afternoon ... ... ... ... ... ... ... ... ... ..
night. ... ... ... ... ... ... ... ... ... ... ... ...
22) During the shifts, the captain falling asleep? 􀀀
􀀀 is not in as: 􀀀
􀀀 morning afternoon night
􀀀
23) After the night shift, how many hours you can sleep an average day followingseven? ... ... ....
Ver 06/11/2007
Appendix
If the patient responds positively to at least two of the questions No 8 - 9 - 10 to 11, state:
- neck circumference (cm) F ........................
- micro-retrognaziaG 􀀀 is no 􀀀
If the patient responds positively to at least one of the questions No 10 - 11 - 22,
administered the Epworth Sleepiness Scale .
Notes ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ...
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
CONCLUSIONI 􀀀 non disturbi della vigilanza
􀀀 da inviare a Specialista
􀀀 da controllare nel tempo
Data ……………… Firma del Medico ……………………………………………..
I declare that as reported in this questionnaire is true and
undertakes to inform the competent physician whenever any change is persistent
state of health in some way involving the sleep-wake cycle.
Signature of employee ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ..

KEY: A-
BMI (to be calculated only in cases of suspected pathological value) is calculated by dividing weight (in kilograms) by the square
height (in meters)
-B is considered to work also fixed night work shifts and work at unusual times but stable (eg baker, who works
from 3 to 11 am)
C-A units of alcohol = 12 grams of pure alcohol = 1 glass of wine = 125 ml 1 330 ml can of beer = 1 shot
40 ml of spirits ( simplified by "Health Institute" and "Italian Society Alcohology).
D-night shift is defined as work performed in part at least in the interval between midnight and five in the morning

E-Enter the total hours of sleep during the day, although in different episodes
F-La circumference of the neck is considered pathological if more than 43 cm (males) and 41 cm (females).
G-Unit all craniofacial dysmorphism that may cause a reduction in the size of the upper air
.

Annex 1;

EPWORTH Sleepiness Scale

that probably has to doze off or fall asleep in the following situations, regardless of
feeling tired?
The question refers to the usual habits of life in the last period. If
not been found recently in some of the situations listed below, try to imagine how you would feel
.
Use the following scale to choose the most points for every situation:
O = I do not ever fall asleep
1 = I have some chance of falling asleep
I have a 2 = discreta probabilità di addormentarmi
3 = ho un'alta probabilità di addormentarmi
Situazioni
a. Seduto mentre leggo ____
b. Guardando la TV ____
c. Seduto, inattivo in un luogo pubblico (a teatro, ad una conferenza) ____
d. Passeggero in automobile, per un'ora senza sosta ____
e. Sdraiato per riposare nel pomeriggio, quando ne ho l'occasione ____
f. Seduto mentre parlo con qualcuno. ____
g. Seduto tranquillamente dopo pranzo, senza avere bevuto alcoolici ____
h. In automobile, fermo per pochi minuti nel traffico ____
SOMMA ____

RISULTATO

Se il punteggio totalizzato è superiore 10, which is an indication of excessive daytime sleepiness.