SECTION A: HISTORY
8. Does exposure to perfumes, insecticides,fabric shop odors and other chemicals provoke.
For each "yes" answer in Section A, circle Optimum Function: the point score for that question. Total Dysbiosis Questionnaire
your score and record it in the box at theend of the section. Then move to sections
9. Are your symptoms worse on damp, muggy
This questionnaire is designed for adults
and the scoring system is not asappropriate for children. It lists factors in
1. Have you taken tetracyclines (Sumycin,
10. Have you had athlete's foot, ring worm,
Panmycin, Vibramycin, etc.) or other antibiotics
"jock itch" or other chronic fungous infections
for skin acne or anything else for at least one
healthy gastrointestinal bacteria, directly
Have such infections been………………………
or indirectly promoting the overgrowth of
2. Have you at any time in your life, taken
other antibiotics for respiratory, urinary or other
found in individuals with dysbiosis related
infections in shorter courses four or more times
Filling out and scoring this questionnaire
3. Have you taken an antibiotic drug - even a
evaluate the possible role of dysbiosis incontributing to your health problems. Yet
4.Have you, at any time in your life, been
will not provide and automatic "Yes" or
14. Does tobacco smoke really bother you?.10
bothered by recurrent or persistent prostatitis,
vaginitis or other problems affecting your
15. Have you ever had a parasitic infection,
Note: Dysbiosis refers to the condition
dysentery, or unexplained episode of prolonged
where the normal healthy population of
5. Have you taken birth control pills……………
beneficial bacteria in the intestines has been
16. Have you ever consumed chlorinated (tap)
disrupted, leaving it open to the overgrowth
drinking water for more than 3 months?.15
of yeast, fungi, parasites and potentially harmful strains of bacteria. This intestinal imbalance in turn adversely affects other
6. Have you been pregnant…………………. important systems via toxic stress and interfering with nutrient absorption and utilization.
7. Have you taken prednisone, Decadron orother cortisone type drugs………………….
19. Do you drink alcohol or coffee daily?.20
For more than 6 months?.25For more than 2 weeks?.15
20. Do you have or have you ever had an ulcer,
colitis, crohn's disease or diverticulitis?……….35
Total Score, Section A: SECTION B: MAJOR SYMPTOMS SECTION C: OTHER SYMPTOMS
appropriate figure on the line following the
appropriate figure on the line following that
Total Score Section C:
If the symptom is occasional or mild = 1pt
Total Score Section A:
If the symptom is frequent &/or moderately
If a symptom is frequent &/or moderate =
Total Score Section B:
If the symptom is sever &/or disabling =
Grand Total Score
Add total score and record it in the box at
over 120 and in men with scores over 80.
15. Persistent vaginal burning or itching ______
and 40 in men, dysbiosis is unlikely to be
contributing to your health challenges.
20. Cramps and /or other menstrual irregularities
26. Wheezing or shortness of breath _____
Dr. Tim Irving DC, LMT, Nutritionist, CKTP
Total Score, Section B
Section1 Student Forenames: Last Name: Date of Birth: Place of Birth: Parental Address: Fathers Address if Different: Phone Number: Phone Number: Email Address: Email Address: Name and Address of Current GP: Does your child take any regular medication, Does your child have any known allergies? Is your child on the BUPA School Medical Insurance
Katrin Auer (Wien) „Political Correctness“ – Ideologischer Code, Feindbild und Stigmawort der Rechten Seit Mitte der 90er Jahre wurden der Begriff „political correctness“ und ein Metadiskurs über „political correctness“ in österreichischen und deutschen Medien- und Politikdiskursen etabliert. Vor allem der Metadiskurs, der sich mit den ideologischen Inhalten und realpoliti
SECTION A: HISTORY
SECTION B: MAJOR SYMPTOMS