Category | Questions | Choice and appendix question |
---|---|---|
Data on demography and injury | Q1.name, gender,occupation, education | |
Q2.injury agent | ||
Q3.where injury occurred | ||
Q4.monocular or binocular injury | ||
Q5.hospitalization or not | If yes, the accumulative time of hospitalization | |
Q6.operation or not | If yes, monocular or binocular? Single or multiple operations? | |
Expense on treatment | Q7.Total expense on medical treatment | |
Q8.The proportions of the expense on drug, examination, operation and hospitalization, and the nutrition and transportation respectively | ||
Q9.The proportions of expense paid by the employer, insurance and patient himself respectively | ||
Loss of income | Q10.The personal income per year of the patient before and after the injury | If reduced, the main reason? |
Q11.The per capita income of the family per year before and after the injury | ||
Q12.the time required for care from family members (hours per day) | ||
The impact of the injury on the socio-economic status of the patients | Q13.Working or studying capacity | A:without difficulty, B:doing simple work or study, C: losing working or studying ability (being umployed or dropping out of school) |
Q14.The ability to perform daily activities | A: without difficulty, B: being able to do simple activity such as eating and clothing, C: entirely losing ability to perform daily acitvity and need care and help from others | |
Q15.Emotional anxiety or depression | A:without anxiety or depression, B: anxious or depressive somewhat, C: extremely anxious or depressive | |
Q16.The negative impact on the education of victims' children (if they had) | A: without negative impact, B: to some extent, C: very serious | |
Q17.The impact on the relationship between family members | A: no change,B: indifference, C: be discriminated, D: be discarded | |
Q18.The attitude of whole society towards them after injury | A: giving care and concern, B: indifferent, C: generally be discriminated, D: other |