Table 1 Questionnaire Summary
From: The Canadian celiac health survey – the Ottawa chapter pilot
Demographics |
|---|
Age, sex, age of diagnosis |
Level of education, family income |
Diagnosis |
Pre-diagnosis symptoms and duration |
Status of recovery from symptoms |
Other diagnoses |
Possible triggers |
Number and types of doctors consulted |
Diet |
Adherence to gluten-free diet |
Difficulty in following diet |
Rating of information sources |
Difficulty with labelling of foods |
Quality of Life |
SF12 Health Survey © |
Celiac-specific quality of life questions for adults/children |
Bone disease |
History of fractures |
Bone density status |
Osteoporosis treatment |
Reproduction |
Specific questions for women and men |
Celiac disease in family members |
Testing of first-degree relatives for CD |
Suspected CD in family |
Other diseases of members/ first-degree relatives |
Gastrointestinal, cancer, autoimmune, blood, endocrine, neurological, musculoskeletal, other |