Questionnaire

[Fabio Mariani <]

Dear colleague,

we  are  epidemiologists   of  the  Italian  National  Research  Council
interested in exploring the potentiality of INTERNET for performing some
epidemiological investigations at international level. As far as we know
it is the first attemp of this type in epidemiological research.
If you are interested in joining,  you are kindly requested  to fill  in
the following questionnaire for one day  (at your choice) in the week 27
March - 1 April 1995 and send it back to (EPID@localhost).
We  will pleased to answer any  questions  concerning the results of the
investigation (a gopher named  "EPID.CNUCE.CNR.IT"  will be available at
the IP port =7000).

Thank you very much for your co-operation

Yours sincerely

Fabio Mariani
Fabrizio Bianchi
Departement of Epidemiology
Institute of Clinical Physiology
National Research Council - ITALY
e-mail: marifa@localhost

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QUESTIONNAIRE


What country do you work in? !______________________________!

How many people live in the town where you work?
       !__! Up to 100,000
       !__! From 100,000 to 500,000
       !__! From 500,000 to 1,000,000
       !__! Greater than 1,000,000

Sex?       Male !__!           Female !__!

When were you born?     Year: !__!__!__!__!

What is the highest level of schooling that you have completed?
       !__! Completed primary school or less
       !__! Secondary school
       !__! Completed secondary school
       !__! College or university
       !__! completed college or university
       !__! Don't know, or does not apply

How long have you been working with a video terminal (VDT) or
a personal computer (PC)? (if less than 1 year code 1)
        (Years) !__!__!

The next three questions require information abaut your habits
during the last 30 days.
         How many hours have you worked weekly with a VDT or PC?
         (number of hours) !__!__!

         How many times (if any) have you staed up until the small
         hours working with a VDT or PC?
         (number of occasion) !__!__!

         Which of the following best describes your average distance
         from the screen?

                 !__! Up to 15 inches
                 !__! 15-30 inches
                 !__! greater tan 30 inches

On how many occasions (if any) have you ever had any of the following
problems for which you have taken medicine or consulted a physician?

                        Number of occasions in your lifetime
                        Never     1-2      3-5      6-9    10 or more
pain in the lower back  !__!      !__!     !__!     !__!      !__!
pain in the neck        !__!      !__!     !__!     !__!      !__!
pain in the shoulder    !__!      !__!     !__!     !__!      !__!
puffy eyes              !__!      !__!     !__!     !__!      !__!
weak eyesight           !__!      !__!     !__!     !__!      !__!
a severe headache       !__!      !__!     !__!     !__!      !__!
                        Number of occasions during the last 12 months
                        Never     1-2      3-5      6-9    10 or more
pain in the lower back  !__!      !__!     !__!     !__!      !__!
pain in the neck        !__!      !__!     !__!     !__!      !__!
pain in the shoulder    !__!      !__!     !__!     !__!      !__!
puffy eyes              !__!      !__!     !__!     !__!      !__!
weak eyesight           !__!      !__!     !__!     !__!      !__!
a severe headache       !__!      !__!     !__!     !__!      !__!
                        Number of accasions during the last 30 days
                        Never     1-2      3-5      6-9    10 or more
pain in the lower back  !__!      !__!     !__!     !__!      !__!
pain in the neck        !__!      !__!     !__!     !__!      !__!
pain in the shoulder    !__!      !__!     !__!     !__!      !__!
puffy eyes              !__!      !__!     !__!     !__!      !__!
weak eyesight           !__!      !__!     !__!     !__!      !__!
a severe headache       !__!      !__!     !__!     !__!      !__!
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