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----- Original Message ----- From: Bonnie Rowley <[log in to unmask]> To: <[log in to unmask]> Sent: Thursday, February 24, 2000 9:20 PM Subject: (fwd) Parkinson's Disease Survey for Science Fair project. > Hi all, > Jeans Bartlett <[log in to unmask]>, pwp who is not currently on PIE, > has asked me to fwd the below survey. > Bonnie > daughter of Jim 77/72 > [log in to unmask] > > > > Subject: Parkinson's Disease Survey for Science Fair project. > > > > > Hello - > > > My name is Kristin and I am a 9th grader at Winfield High School in West > Virginia. My science fair topic is the influence of simple genetic factors > and environmental conditions on Parkinson's Disease. Through the help of > Hazel Brendlin (a Parkinson's patient who's a friend of my mother's), I have > prepared the enclosed survey. It is a Microsoft Word document. > > > To be considered a valid study, my teacher said that more than 50 > responses are needed. Please take a few minutes to complete the survey and > return it to me via e-mail. If there are chatrooms or other Parkinson's > groups that could participate, could you forward this message to them. > > > The responses are needed before 6 March 2000 so that I can prepare the > poster and report. Thanks to Hazel and all of you for your help. > > > > > > Kristin ([log in to unmask]) > > > Parkinson’s Disease Survey > > Are you male _______ or female _______? > What state or country do you live in? _____________________________________ > What is your ethnic background (race)? Caucasian___; Hispanic_____; African > American_____; Asian_____; American Indian ________; Other ___________ > > How old are you? Under 20 ___; 20 - 30 ____; 30-40 ____; 40 - 50 ____; 50 - > 60 ____; 60 - 70 ____; 70 - 80 _____; over 80 _____ > > What color is your hair (original color)? Brown ____; black _____; blonde > _____; red _____ > What color are your eyes? Black ___; brown _____; blue _____; green ____; > other ______ > Do you or did you play any sports? No ____; Yes _____ If yes, > please answer these questions: > What sport or sports? _______________________________________________ > What age did you play? Teens ______; young adult (20-35) _______; Middle > age (35-50) ________; senior ________ > > What level of education do you have? High school ____; college ____; > graduate school ____; vocational school ____; Professional degree _____ > > At the time you were diagnosed. > What was your age? _________________ > What was your height? _______________ > What was your weight? _______________ > Does anyone else in your family have PD? __________________ > Who? ______________________________________________________________ > What were your early symptoms? _________________________________________ > Did you have depression? Yes ______ No _____ > In your early years, did you live near: > Pesticide plant Yes _____ No ______ > Chemical Plant Yes _____ No _______ > Or on a Farm Yes _____ No ______ > In New Jersey Yes _____ No ______ > Do you, or did you prior to PD, smoke? Yes _____ No ______ > Do you, or did you prior to PD, drink (more than 2 drinks/week)? Yes ______ > No______ > How has PD changed your life? > ____________________________________________________________________________ __ > ____________________________________________________________________________ __ > Do you think Parkinson’s is or can be genetically transferred? Yes _____ > No ______ > Why or why not? > ____________________________________________________________________________ __ > ____________________________________________________________________________ __ > If there is anything else you think I should know about Parkinson’s disease, > please feel free to state it after this question. > > Thank you for your time and help. I would especially like to thank Hazel > Brendlin for her help in reviewing the questions and contacting the Columbus > Research Group for Parkinson’s Disease. > > PLEASE E-MAIL TO KRISTIN ([log in to unmask]) BEFORE 6 MARCH 2000. >