| << contents | Appendix 1 | Appendix 3 |
| 1a. IN THE LAST YEAR, Have you had an ITCHY skin condition - by itchy we mean scratching or rubbing the skin? YES [ ] NO [ ] |
IF YOU HAVE ANSWERED "NO" PLEASE SKIP TO QUESTION 4a
IF YOU HAVE ANSWERED "YES" PLEASE ANSWER THE QUESTIONS IN THE SHADED BOX BELOW
| 1b. Have you had this itchy skin condition in the LAST WEEK? YES [ ] NO [ ] 2. How old were you when this skin condition began? Under 2 [ ] 2 to 5 [ ] 5 to 10 [ ] Over 10 [ ] 3. Has this skin condition ever affected the skin creases in the past - by skin creases we mean fronts of elbows, behind the knees, fronts of ankles, around the neck, or around the eyes? YES [ ] NO [ ] |
| 4a. Have you ever suffered from asthma - by asthma we mean bouts of wheezing with coughing? YES [ ] NO [ ] 4b. Have you ever suffered from hay fever - by hay fever we mean bouts of sneezing with a runny nose or itchy eyes in the summer? YES [ ] NO [ ] 5. In the last year, have you suffered from a dry skin in general? YES [ ] NO [ ] 6. In the last year, have you suffered from any of the following skin complaints: (PLEASE CIRCLE ONE OR MORE). a) eczema b) warts c) psoriasis d) facial spots e) none of these |