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A MACROSCOPIC VIEW OF A DISEASE ©

(A disease - factor connection at a glance)

Purpose

The objective of this project is to identify the probable connection between a disease and the factors (i.e. life styles, working and living environments, heredity, and many others) that may affect the disease.

Significance

It is hoped that this effort, will help to identify the cause(s) of a disease, and subsequently accelerate its cure.

Please read
Nick's, CEO of FKW, message.

View background information 

Questionnaire

We value your privacy

This is an Anonymous Questionnaire

Your IP is not tracked or stored. Cookies, are also NOT stored during this procedure.

 Estimated time to complete the questionnaire: 10-12 minutes.

Brief Instructions:
Answering all questions is mandatory.
The answers that have a checkbox checkbox icon on their left, should be checked only if they apply to you. These are related to questions concerning the diseases you are currently suffering, your father's and mother's diseases, the medications, drugs, vitamins and supplements you may take. Be aware that you may check more than one answers or none if not applicable.
Which is the country of your origin?
What Ethnicity are you?
What is your gender?
How old are you?
Alternatively, you may type in the year of your birth.
years old
In which country did you spend most of your life?
This is asked because living in a country other than the one of your origin may affect your diet and other parameters of your life significantly.
 How many  years
What is your current marital status?
What is your education level?
Your financial status:

Based on your family income, in which of the following categories you rank yourself.

From which disease(s) you are currently suffering?
You may select more than one disease or skip this question if you have nothing to select.
This list will be filled after you state your Gender (3rd question from top).
Did your father have (or had) any of the following diseases?
You may select more than one disease or skip this question if you have nothing to select.
Waiting to be filled...
Did your mother have (or had) any of the following diseases?
You may select more than one disease or skip this question if you have nothing to select.
Have you been exposed to X-rays for medical reasons?
How many?  (approximately)
Are you subjected to security scanning (X-rays) in buildings and airports?
How many in your lifetime?  (approximately)
Have you been exposed to CAT-scans?
Medical machines that visualize the human body interior, similarly the MRI scanners.
How many?  (approximately)
Have you been exposed to MRI-scans?
How many?  (approximately)
Have you been exposed to PET (Proton Emission Tomography) examination?
How many?  (approximately)
Have you been exposed to Cardiolite heart test?
Is a type of nuclear scanning test. Measures the heart's ability to respond to external stress in a controlled clinical environment.
How many?
Have you been exposed to Angiogram examination?
Technique used to visualize the inside of blood vessels and organs of the body by injecting a radio-opaque contrast agent into the blood vessel and imaging using X-ray based techniques.
How many?
Have you ever been anesthetized for several hours (i.e. 3 or more hrs) because of surgery?
Are you frequently or systematically exposed to the sun?
For how many hours per day?
Are you taking the proper precautions?
Did you ever had head injuries (from sports or otherwise)?
How many hours per day are you using your Mobile phone?
Do you use bluetooth devices such as ear phone, head phone or handsfree (earbud)?
How many hours per day?  (approximately)
Do you have a job?
Is the environment you live stressful?
Is the environment you live polluted?
Do you live or work or have you ever lived or worked close to electrical power facility?
Less than 5 miles / 8 Kms (in straight line distance)
For how many years?
Do you live or work or have you ever lived or worked close to a lab heavily involved in chemical, biological, or radiation related research?
Less than 20 miles / 32 Kms (in straight line distance)
For how many years?
Do you live or work or have you ever lived or worked close to a high traffic freeway?
Less than 2 miles / 3 Kms (in straight line distance)
For how many years?
In which distance (straight line)?
Do you live or work or have you ever lived or worked close to a major airport?
Less than 10 miles / 16 Kms (in straight line distance)
For how many years?
Do you live or have you ever lived close to agricultural fields that are frequently sprayed with pesticides?
Less than 5 miles / 8 Kms (in straight line distance)
For how many years?
Do you live or have you ever lived in a region that it is Radon gas designated?
For how many years?
Do you live or work or have you ever lived or worked close in a mosquito (Zika, West Nile, or Dengue) area?
Less than 0.5 miles / 1 Kms (in straight line distance)
Do you live or have you ever lived close to a war zone?
Less than 10 miles / 16 Kms (in straight line distance)
For how long?
 
Based on your diet, what are you?
Does your diet include vegetables?
Does your diet include fruits?
Does your diet include dried nuts?
Does your diet include carbohydrates?
Does your diet include junk and/or processed food?
Does your diet include sweets?
Does your diet include dark chocolate?
Do you add more salt in your everyday food besides the salt which exists natually in the foods you eat?
Do you add extra sugar, besides the one which you are naturally intake from fruits and other foods you eat everyday?
Does your diet include soft drinks on a daily basis?
Does your diet include artificial sweetener drinks on a daily basis?
Does your diet include coffee on a daily basis?
Does your diet include alcohol on a daily basis?
When cooking, do you use aluminum pans or foils?
For how many years?
When cooking, do you use teflon pans?
For how many years?
When cooking, do you use plastic containers in microwave ovens?
For how many years?
Do you use plastic containers for packaging?
For how many years?
Do you take any of the following medications?
Waiting to be filled...
Do you use illicit drugs?
Marijuana, and the likes.
Do you take vitamins?
Waiting to be filled...
Do you take supplements?
Waiting to be filled...
Hours of sleep

How many hours do you sleep daily (in average)?

Are you napping (sleeping) at noon or other time of the day? If yes, how long daily (in average)?

Do you have frequent nightmares?
Do you smoke?
Are you exposed (indirectly) to smoking environments?
Do you colour your hair?
For how many years?
Are you physically active?
See definition by the World Health Organization
Do you do aerobic exsercises or dance?
Do you exercise by jogging?
Do you exercise by swimming?
Do you practice violent sports?
Are you socially active?
Are you sexually active?
Are you mentally active?
Do you have family issues that frustrate you?
Are you a moody person?
Do you have a pet?
Do you listen to relaxing and soft music?
The completeness of the Questionnaire is checked upon submission since all questions must be answered. If such questions that are not answered at all or not answered completely, are found, then you will be prompted to answer them. After that, you are kindly asked to re-submit the Questionnaire.
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