The Derivative
4.2 Mean value theorem
Hospital No... Date: ...
Name: ... Score:...
Address: ... Diagnosis ...
The aim of this questionnaire is to measure how much your skin problem has affected your life OVER THE LAST WEEK. Please tick ( ) one box for each question.
1 Over the last week, how itchy, sore, painful or stinging has your skin been?
Very Much A Lot A Little Not At All
2 Over the last week, how embarrassed or self conscious have you been because of your skin?
Very Much A Lot
A Little Not At All
3 Over the last week, how much does your skin interfered with you going shopping or
looking after your home or garden?
Very Much A Lot A Little Not At All
Not relevant
4 Over the last week, how much has your skin influenced the clothes you wear?
Very Much A Lot A Little Not At All
Not relevant
5 Over the last week, how much has your skin affected any social or leisure activities?
Very Much A Lot A Little Not At All
Not relevant
6 Over the last week, how much has your skin made it difficult for you to do any sport?
Very Much A Lot A Little Not At All
Not relevant
lxxxix
7 Over the last week, has your skin prevented you from working or studying?
Yes
No Not relevant
if ‘No’ over the last week how much has your skin been a problem at work or studying?
Alot A little Not At All
8 Over the last week, how much as your skin created problems with your partner or any of your close friends or relatives?
Very Much A Lot A Little Not At All
Not relevant
9 Over the last week, how much as your skin caused any sexual difficulties?
Very Much A Lot A Little Not At All
Not relevant
10 Over the last week, how much of a problem has the treatment for your skin been, for example by making your home messy, or by taking up time?
Very Much A Lot A Little Not At All
Not relevant
Please check you have answered EVERY question. Thank you.
©AY Finlay, GK Khan, April 1992
DERMATOLOGY LIFE QUALITY INDEX
xc
[EVERY DAY SPOKEN NIGERIAN ENGLISH]
Hospital No... Date: ...
Name: ... Score:...
Address: ... Diagnosis ...
The purpose of this questionnaire is to know how much your skin problem has affected your life OVER THE LAST ONE WEEK. Please tick one box for each question.
1 Over the last week, how much has your skin been itching you, paining you, stinging or biting you?
Very much A lot A little Not at all
2. Over the last week, how self conscious or ashamed have you been because of the way your skin is?
Very much A lot A little Not at all
3. Over the last week, how much has your skin problem affected your going to the market or taking care of your house or compound?
Very much A lot A little Not at all
Does not apply
4. Over the last week, how much has your skin problem determined the type of clothes you wear?
Very much A lot A little Not at all
Does not apply
xci 5
.
Over the last week, how much has your skin problem affected your social outings and activities?
Very much
A lot A little Not at all
Does not apply
6. Over the last week, how much has your skin problem made it difficult for you to play any sport?
Very much A lot A little Not at all
Does not apply
7 Over the last week, has your skin problem prevented you from doing your job or school work?
Yes No
If your answer is “No”, over the last week how much has your skin problem hindered your job or school work?
A lot A little Not at all
8. Over the last week, how much has your skin caused problems between you and your spouse or boyfriend/girlfriend, or any of your relations or close friends?
Very much A lot A little Not at all
Does not apply
xcii
9. Over the last week, how much has your skin problem affected your `having fun’/`sleeping with’
your spouse/boyfriend/girlfriend?
Very much A lot A little Not at all
Does not apply
10. Over the last week, how much has the treatment for your skin inconvenienced you, for example by making your house messy, or by taking your time?
Very much A lot A little Not at all
Does not apply
Please check you have answered EVERY question. Thank you.
©AY Finlay, GK Khan, April 1992.
xciii
YORUBA TRANSLATION
OSUWON BI AILERA AWO ARA SE FA IDIWO SI IGBE AYE ALAFIA.
Nomba ile iwosan ... Deeti...
Oruko ... Oruko aru awo ara...
Adiresi...
Idi ti a fig be iwe ibeere yi jade ni lati mo bi kokoro ti o yo si ara re ti se idiwo fun o lati bi ose kan sehin.
Jowo ko ami maaki yi sinu apoti ti o wa niwaju ibeere kookan.
1 Lati bi ose kan seyin, bawo ni awo ara re se yun o, da egbo, dun o tabi ta o si?
O yun mi gidigan Pupo
Die Ko yun mi rara
2. Lati bi ose kan seyin, nje o se akiyesi ara re nigba gbogbo tabi oju nti o nitori bi ara re se ri?
Gidigan Pupo
Die Rara
3. Lati bi ose kan seyin, nje bi ara re ti n se idiwo fun o lati lo si oja, se itoju ile tabi ogba re?
Gidigan Pupo
Die
Rara Ko ni nkankan se
pelu re.
xciv 4. Lati bi ose kan seyin, nje bi ara re tin je ki o kiyesi
iru aso ti iwo yi o wo?
Gidigan Pupo
Die Rara
Ko ni nkankan se
pelu re.
5. Lati bi ose kan seyin, nje bi ara re ti n se idiwo fun o lati jade lo si ipejo po awon eniyan ati lati sin mi.
Gidigan Pupo Die
Rara Ko ni nkankan se
pelu re.
6. Lati bi ose kan seyin, nje bi ara re tin je ki o nira fun o lati se ere idaraya
Gidigan Pupo
Die
Rara Ko ni nkankan
se pelu re.
7. Lati bi ose kan seyin, nje bi ara re ti ri se idiwo fun o lati si se tabi keko?
Beni Beko
Ti idahun re ba je bee ko, bawo ni ara re se di ise tabi eko re lowo?
Pupo Die Rara
xcv 8. Lati bi ose kan seyin, bawo ni bi awo ara re se ri
se fa wahala laarin iwo ati oko tabi aya re, awon ebi re tabi awon ore timo timo re?
Gidigan Pupo
Die
Rara Ko ni nkankan se
pelu re.
9. Lati bi ose kan seyin, ye, bi awo re ti ri se idiwo fun o nipa ibalopo?
Gidigan Pupo Die
Rara Ko ni nkankan se
pelu re.
10. Lati bi ose kan seyin, nje awo ara yi fun o ni iyonu fun apeera gba asiko re, ooti ile re ati na o powo repete.
Gidigan Pupo
Die
Rara Ko ni nkankan se
pelu re.
Jowo ri daju pe o dahun gbogbo ibeere won yi. E se.
©AY Finlay, GK Khan, April 1992.
xcvi APPENDIX 3
PATIENT’S INFORMATION SHEET
TITLE OF STUDY: VITILIGO: CLINICAL SPECTRUM, ASSOCIATED OCULAR AND AUDITORY DISORDERS AND ITS EFFECT ON THE QUALITY OF LIFE OF PATIENTS AT THE OBAFEMI AWOLOWO UNIVERSITY TEACHING
HOSPITALS COMPLEX ILE-IFE
PRINCIPAL INVESTIGATOR: Dr Patrick Echekwube
Introduction: You have been selected to participate in a research study with the above title.
This
document will provide you with necessary information about the study.
Purpose of study: Vitiligo is a disorder which causes loss of skin colour due to destruction of the pigment cells which produce melanin in the skin. Pigment cells in the eyes and ears could also be affected and when severe could cause visual and hearing impairment. Vitiligo can also reduce the Quality of Life in affected patients.
Procedure: You would be interviewed in a comfortable room in the Dermatology clinic of the hospital by
the principal investigator. You would be asked questions pertaining to your personal demographic
characteristics as well as details of your medical history and you would fill a questionnaire designed to measure how much your skin problem affected your life over the past one week and your entire skin would be examined. In addition, you would also have eye and ear examination done at the Ophthalmology and ENT departments. All these would take less than one hour. You would thereafter be given two monthly clinic appointments and the outcome of the treatment offered would be documented.
Benefit: You will not derive any direct benefit from participating in this research. However you
would be informed of the results of the examination findings and advised regarding any health
implication of the findings.
Cost of participation: There are no financial costs to you from participating in this study.
xcvii
Risk: There are no physical risks from responding to the interview questions, and you would not be
required to answer questions that may be embarrassing. The physical examinations are not associated with any physical injury.
Compensation: Though your participation is valued, there will be no financial reward for your
participation in this study.
Confidentiality: All the information that you provide or that is derived from physical examination will be handled with strict confidentiality. Information will be stored securely on personal computers and paperwork will be kept away from unauthorized persons. The result of the study may be published in scientific journal or presented at scientific meeting but under no circumstances will you be identified, nor will your personal details be revealed.
Respondents’ right: Individuals selected to participate in the study have the right to withhold their consent. Subjects who are unwilling to participate or who withdraw from the study will not be disadvantaged in any way and the physician-patient relationship will in no way be compromised by such decisions. Respondents who have any further question pertaining to the study or their rights are free to contact:
Dr Patrick Echekwube Department of Dermatology OAUTHC, Ile-Ife
Phone: 08036791574
APPENDIX 4
xcviii
INFORMED CONSENT FORM
VITILIGO: CLINICAL SPECTRUM, ASSOCIATED OCULAR AND AUDITORY DISORDERS AND ITS EFFECT ON THE QUALITY OF LIFE OF PATIENTS AT THE OBAFEMI AWOLOWO UNIVERSITY TEACHING HOSPITALS’
COMPLEX, ILE-IFE
SERIAL NUMBER...
This is to certify that I have been fully informed about the study and have accepted to participate. My refusal to further participate in this study at any stage will not in any way affect my regular management.
I consent voluntarily to participate in this study and understand that I have the right to withdraw from the study at any time.
Yes No
Signature/thumb print of patient ……… Date………
Signature of person obtaining consent ………Date………
xcix APPENDIX 5
c APPENDIX 6
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