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STUDY OF THE HEALTH PROFILE OF DRDO EMPLOYEES WITH SPECIAL EMPHASIS ON CORONARY RISK FACTORS DIVISION OF HEALTH INSTITUTE

OF NUCLEAR MEDICINE AND ALLIED SCIENCES, DELHI

PROJECT PROFORMA (INM-310)


PERSONAL DATA ID Lab: Location.. Age:years Date:.. SexM/F

Name:..

Dob:

Designation Dept. No of years . Address: E mail:Telephone No....

INFORMED CONSENT

1. 2.

The study objective is to evaluate the health profile of employees in DRDO Procedure o You will be asked to answer an information sheet to collect data relevant to the study. This will be followed by physical examination and sampling of blood, ECG and X-ray of chest (if indicated). Blood collected will be used only for estimating various hematological, biochemical and metabolic parameters. o If all the parameters are within normal limits, no further evaluation is needed o If further evaluation is indicated, you will be informed.

3.

Possible benefits/risks This is a cross-sectional study of DRDO employees to screen for cardiac and metabolic disorders like diabetes. Since some illnesses may be silent, early detection will help tackling the disease effectively. In others, normal health profile will be reassuring. There is no risk involved from the study.

4.

Extent of confidentially of records Your identity in this study will be treated as confidential. Data will be coded and will be accessed by the investigators in the presence of PI. The results of the study, including laboratory or any other data, may be published for scientific purposes but will not give your name or include any identifiable references to you.

5.

Authorization I have read and understood this consent form, and I volunteer to participate in this research study.

Participants Signature: Date: Signature and name of witness: Signature of Person Obtaining Consent:

PERSONAL INFORMATION

1. 2.

Marital status Diet

: Single : Veg

Married Non Vegetarian

Divorced Mixed

Widow/widower

If Non vegetarian Mean calories consumed per day 3. Smoking : Yes No

/ Unknown

If yes, cigarettes/bidis/cigars/pipes No: per day ---up to 5/6-10 /11-20 4. Passive smoking : Yes No

If yes, spouse/friends/relatives, daily/occasional 5. Physical activity : How do you rate your level of physical activity? (i) Sedentary Light Moderate Heavy

(ii)Flights of stairs (10 steps) you climb each day ____ /unknown (iii) Morning walk: (iv) Evening walk: yes yes no no specify _____ km specify _____ km

(v) Total walking distance per day (include everything) 6. Beverages consumption: (i) Do you consume: coffee (ii) Cups/day: (iii) Alcohol consumption: yes If yes, 7. daily weekly twice no weekly thrice ___/day tea soft drinks all of above

Hand preferred for: (i) Eating: (ii) Writing:

(1=right, 2=left 9=unknown) (1=right, 2=left 9=unknown)

8.

Menstrual history:

(a) Menstrual periods: normal/abnormal (elaborate) .. (b) Obstetric history: live births /abortions h/o surgery (elaborate) 3

9.

Dental History (i) How many times do you brush your teeth? (a) Once daily (b) Twice daily (c) Thrice daily (d) Twice regularly (ii) How much time do you spend for brushing your teeth? (a) Three minutes & above (d) Less than a minute (iii) How often do you notice bleeding from your gums? (a) Daily during brushing (c) Spontaneously during chewing (a) Never (b) Twice (b) 8- 16 no (c) Once (b) Sometimes during brushing (d) never noticed (d) Every quarter (d) 24- 32 (b) Two minutes & above (c) One minute & above

(iv) How often have you undergone professional scaling during the last one year? (v) How many decayed, restored, missing & replaced teeth do you have? (a) Less than 8 10 Medications used : (i) (ii) yes (c) 16- 24 Duration of use: _____________ ( ______________ ______________ )

Specify name (no. of years used

11. 12. 13.

Occupational exposure to chemicals/toxins Past illnesses: yes no yes

.. If yes, ______________ (duration -- years) no .. .. .. .. .. .. ..

History of illness in family:

If yes, (i) Heart disease (< 55years in males) (<65 years in females) (ii) Sudden Death from Heart Disease (iii) Diabetes mellitus (iv) Hypertension (v) Thyroid disorders (vi) Stroke (vii) Others Specify (ix) H/o any previous surgery

(viii) H/o hernia swelling/deformity or any observable abnormality _______________________________________________ _______________________________________________ (x) Interim diagnosis of a thyroid condition? (0=No,1=Yes,9=Unknown) If yes, write diagnosis 14. Occupational Data: -------------------------(a) Dept : ---------------------------------------

(b) Nature of work: --------------------------------------(c) Any Chemical: --------------------------------------(d) Duration : ---------------------------------------4

LIFESTYLE QUESTIONNAIRE
Section-I We want to know how your health has been in general over the past few weeks. Please read the questions below and each of the four possible answers. Tick the response that best applies to you. Thank you for answering all the questions. Have you recently: Been able to concentrate on what you are doing? Lost much sleep over worry? Felt that you are playing a useful part in things? Felt capable of making decisions about things? Felt constantly under strain? Felt you couldnt overcome your difficulties? Been able to enjoy your normal day-to-day activities? Been able to face up to your problem? Been feeling unhappy or depressed? Been losing confidence in yourself? Been thinking of yourself as a worthless person? Been feeling reasonably happy, all things considered? Better than usual Not at all More so than usual More so than usual Not at all Same as usual No more than usual Same as usual Same as usual No more than usual No more than usual Less than usual Rather more than usual Less so than usual Less so than usual Rather more than usual Rather more than usual Less so than usual Less so than usual Rather more than usual Rather more than usual Rather more than usual Less so than usual Much less than usual Much more than usual Much less than usual Much less than usual Much more than usual Much more than usual Much less than usual Much less than usual Much more than usual Much more than usual Much more than usual Much less than usual

Not at all

More so than usual More so than usual Not at all Not at all

Same as usual

Same as usual No more than usual No more than usual No more than usual

Not at all

More so than usual

Same as usual

Section-II Read each of the events listed below and check the box next to any event which has occurred in your life in the last two years. There is no right or wrong answer. The aim is just to identify which of these events you have experienced lately. Life events Death of a spouse Divorce Marital separation Death of close family member Personal injury/illness Marriage Fired at work Marital reconciliation Change in health of a family member Pregnancy Sex difficulties Gain of new family member Change in financial state Death of close friend Change to different line of work Change in number of arguments with spouse Loan over Rs. 8 lakhs Change in responsibilities at work Life events Son or daughter leaving home Trouble with in-laws Outstanding personal achievement Wife begins or stops work Natural calamity like earthquake, floods Change in living conditions Revision in personal habits Trouble with boss Change in work hrs or conditions Change in residence Change in place of office Change in recreation Change in social activities Loan less than Rs. 1 lakh Change in sleeping habits Change in no. of family get-togethers Change in eating habits Minor violations of the law

Section-III

Disagree very much

Disagree moderately

The following questions concern your beliefs about jobs in general. They do not refer only to your present job.

A job is what you make of it If you know what you want out of a job, you can find a job that gives it to you Making money is primarily a matter of good fortune Promotions are usually a matter of good fortune When it comes to landing a very good job, who you know is more important than what you know It takes a lot of luck to be an outstanding employee on most jobs Most employees have more influence on their supervisors than they think they do The main difference between people who make a lot of money and people who make a little money is luck

Section-IV Wellness is a process that involves more than just exercise. Please take the time to answer these questions so that we can tailor a fitness program to suit your needs. 1. What are your goals as they pertain to: (a) health (b) wellness (c) fitness 2. What is your current activity level? (a) How many times per week do you exercise? (b) For how long? (c) What is the intensity? (d) What activities do you do?

Agree moderately

Agree very much

Disagree slightly

Agree slightly

3. Do you have any special limitations (i.e. injuries, surgeries, disease etc.) that can be made worse by exercise? Please describe any such special condition in detail.

4. How much time per day and per week are you willing to devote to exercise?

5. What kinds of activities interest you most?

6. If you have attempted a regular exercise program before, what would you describe as your greatest roadblock to consistency? What do you find most frustrating about achieving wellness?

7. How do you feel about your body weight/ image?

8. Do you keep a regular sleep schedule? Time you awaken: Time you go to sleep:

9. Do you feel rested in the morning, or do you constantly feel sleep

deprived?

10. Do you rely on caffeine, etc., to give you energy throughout the day?

11. Have you had any significant life changes within the past two years (i.e. relocation, marriage, divorce, death in family)?

Section-V Listed below are people that may provide you help and assistance either face-to-face, in a group, or by telephone. Please check the response that best describes how helpful the sources have been to you during the past three to six months. If a source of help has not been available to you during this period of time, check the NA (Not Available) response. Sometimes helpful Generally helpful Not at all helpful Very helpful How helpful has each of the following been to you? Extremely helpful Not Available

Parents Relatives Partner/spouse Friends Neighbours Superiors Co-workers Subordinates

PRESENT SYMPTOMS

(i)

Chest pain of effort Have you had any pain or discomfort in your chest? Yes No. Do you get it when you walk uphill or hurry? Yes No Never hurries or walks uphill Do you get it when you walk at an ordinary pace on the level? Yes No What do you do if you get it while you are walking? Stop or slow down. Carry on. Record stop or slow down if subject carries on after taking nitroglycerine. If you stand still, what happens to it Relieved. Not relieved How soon? 10 minutes or less.. More than 10 minutes

(ii)

(iii)

(iv)

(v)

(vi)

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EXAMINATION

1.

Gen: Examination: Pulse __________

Rate

____________ Rhythm ___________

Pulses: Radial (Rt)________ Radial (Lt)_____ Post tibial(Rt)_____Post Post Tibial(Lt)____ Carotid(Rt)_______Carotid(Lt)_________ 2. Blood pressure: (to nearest 2 mm Hg)

Systolic 1st Reading

Diastolic

2nd Reading

3.

Anthropometry : Height (M) _______ weight (kg) ________ BMI (kg/m2) _________ Waist girth _______ Hip Girth _________ W/ H ratio _________

4.

Skin Fold:

(a) Biceps (b) Triceps (c) Subscapular (d) Suprailiac

____________ ____________ ____________ ____________

_______________ ______________ _______________ ______________ _______________ _______________ ______________ ______________

5.

System examination:

(a) Respiratory System

___________________________________________ ___________________________________________

(b) Cardiovascular system ___________________________________________ ___________________________________________ (c) Per abdomen ____________________________________________ ____________________________________________ (d) CNS ____________________________________________ ____________________________________________

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INVESTIGATIONS
6. Blood investigations o o o o o o o o o o o o o o o o o o o o o o o o o o o Hb .......................................................................................................................

TLC ......................................................................................................................... DLC neutrophils----, lympho----, mono-----, eosino-----, baso---ESR ........................................................................................................................ Blood sugar Fasting ....................................................................................................... Blood sugar 2 hrs after 75 g glucose ........................................................................... Serum total cholesterol ................................................................................................... Serum low density lipoprotein ........................................................................................ Serum very low density lipoprotein ................................................................................ Serum high density lipoprotein ....................................................................................... Serum triglycerides ....................................................................................................... Blood urea ................................................................................................................... Serum creatinine .......................................................................................................... Serum electrolytes .......................................................................................................... Serum uric acid .............................................................................................................. Serum bilirubin total .................................................................................................... Serum bilirubin - direct ............................................................................................................. Serum bilirubin - indirect ................................................................................................... SGOT ................................................................................................................................ SGPT ........................................................................................................................... Serum alkaline phosphatase ....................................................................................... Serum TSH ................................................................................................................... Urine (routine)- albumin-----, glucose----microscopy-------ECG .............................................................................................................................. Chest Xray PA view ...................................................................................................... 12

7.

Clinical Impression: Normal Abnormal * CAD * Non CAD with risk factors * Any other illness Coronary risk factors: Known Newly detected

Number Specify

On final result of the screening, the DRDO employee is 1. Ineligible 2. Eligible but refused 3. Eligible & participating If eligible and participating ie, code- 3; then Assign Base ID No- _________________________

M.Os Name & Signature ___________________ Date Checked by R.O. ________________________ Date

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