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Table 1 The detailed content of the questionnaire used in the current study

From: Analysis of medical expenditure and socio-economic status in patients with ocular chemical burns in East China: a retrospective study

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