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.
