FR

Français

EN

English

« * » indique les champs nécessaires

Question 1 : What are your blood pressure numbers ?*
Ce champ est masqué lorsque l‘on voit le formulaire.
Question 2 : What is your LDL (bad) cholesterol number ?*
Ce champ est masqué lorsque l‘on voit le formulaire.
Question 3 : Are you diabetic ?*
Ce champ est masqué lorsque l‘on voit le formulaire.
Question 4 : Do you smoke cigarettes ?*
Ce champ est masqué lorsque l‘on voit le formulaire.
Ce champ est masqué lorsque l‘on voit le formulaire.
Question 5 : Do you have cardiac arrhythmia (or atrial fibrillation) ?*
Ce champ est masqué lorsque l‘on voit le formulaire.
Question 6 : How is your weight ?*
Ce champ est masqué lorsque l‘on voit le formulaire.
Question 7 : Physical exercise*
Ce champ est masqué lorsque l‘on voit le formulaire.
Question 8 : Healthy diet*

1. eat at least 5 fruits and vegetables per day
2. eat fish at least twice a week
3. eat less than 1500 mg of salt per day (one pich and a half of salt or equivalent to one level teaspoon)
4. drink less than 36 oz or 1 liter of sugar-sweetened beverage (including fruit juice, sodas, beer, wine, etc…)
.5 eat at least 1 oz per day of fiber rich food (dried fruits, soybean, lens, chickpeas, green beans, haricot beans, leek, spinach, flageolet beans, artichokes, fennel, celery, broccolis, potatoes, olives) or whole grains (rice, bread, pasta, plain flour, oats, bulgur,…)

Ce champ est masqué lorsque l‘on voit le formulaire.
Question 9 : Psychosocial stress*

(stress is defined by feeling irritable, filled with anxiety, having sleeping difficulties)
Are you under one of the 5 following factors?


1. permanent and intense stress at work
2. important stress at home
3. severe financial stress
4. stress secondary to a major life event in the preceding year (e.g., marital separation or divorce, loss of job or retirement, loss of crop or business failure, violence, major intrafamily conflict, major personal injury or illness, death or major illness of a close family member, death of a spouse)
5. treated for depression in the year before

Ce champ est masqué lorsque l‘on voit le formulaire.
Question 10 : Health Sleep*

. Never or rare insomnia . No sleep apnea
. 7 to 8 hours of sleep per night
. No excessive daytime sleepiness
. Early chronotype (being a “morning person”)

Ce champ est masqué lorsque l‘on voit le formulaire.
Question 11 : Did one of your parents had a myocardial infarction or a stroke before the age of 50?*
Ce champ est masqué lorsque l‘on voit le formulaire.
Ce champ est masqué lorsque l‘on voit le formulaire.

Your stroke risk is high.

See your GP for preventive treatment as soon as possible.

rouge

Even if adjustments are to be made, your stroke risk is moderate, do adjustments and keep up your efforts.

rouge

Bravo !

your stroke risk is low.

rouge


Get a report of your answers by e-mail by giving your details below, it will include personalized and detailed advices to reduce your stroke risk;

If you did not know your numbers when you answered the questionnaire, redo it after having checked them.

Personal data protection
The French Stroke Foundation will neither use your personal data for commercial purposes nor share them with others. There will be no processing of your data. You will ONLY receive the report and no other emails afterward.

Name*
Ce champ n’est utilisé qu’à des fins de validation et devrait rester inchangé.