Foot health and quality of life among university students: cross-sectional study

Sao Paulo Med J. 2018;136(2):123-8 123 ORIGINAL ARTICLE DOI: 10.1590/1516-3180.2017.0264230917 Foo heal h and quali y o li e among uni e si y s uden s: c oss-sec ional s udy Da id Rod íguez-SanzI, Daniel Ba bei o-Fe nándezII, Ma a Elena Losa-IglesiasIII, Jesús Luis Sale a-CanosaIV, Daniel López-LópezV, Na alia To a uela-Ca iónVI, Rica do Bece o-de-Bengoa-VallejoVII Podia ic Medicine and Su ge y Clinic, Uni e si y o Co uña, Fe ol Spain INTRODUCTION One o he mos c i ical pe iods in human de elopmen is be ween he ages o 18 and 33 yea s, which is he b idge be ween childhood and adul hood.1 Du ing his pe iod o physical, psycho- logical, social and sexual de elopmen , young people g adually assume esponsibili y o hei own heal h.2 In addi ion, his age g oup has speci ic oo heal h issues ha di e om hose o o he age g oups, such as ankle sp ains, inea pedis, onychomycosis, plan a wa s and ing own oenails.3-6 They a e also subjec ed o di e en kinds o gene al changes, such as g ea e au on- omy, con ol o e hei li es yle, con ol o e physical ac i i y and de elopmen o a i udes and belie s abou heal h and inancial p oblems.7,8 E en a his age, un ea ed oo p oblems can lead o scoliosis, pos u al p oblems, slowe walking speeds, une en plan a p essu e dis ibu ion, di icul y in ca ying ou daily ac i i ies, inc eased isk o alling and appea ance o neu ological diseases,9,10 all o which can a ec hese indi iduals’ academic achie emen , quali y o li e, pe sonal au onomy and wellbeing.11 Poo oo heal h is now ecognized by he go e nmen s in gene al as an impo an public heal h issue because o i s nega i e impac on indi iduals and on socie y. This includes di icul y in pu ing on shoes, pain, gai diso de s, educed walking speed, a ia ion in plan a p essu es and isk o alling.12-14 Despi e he ex en o his p oblem, he ela ionship be ween oo heal h and quali y o li e du ing his de elopmen al pe iod has no been s udied. In he gene al popula ion, he p e a- lence o oo heal h p oblems is be ween 71% and 87%. The p oblems ela e o claw oes, hal- lux algus, hamme oes, o e lapping oes, hallux ex ensus, pes planus, Mo on’s neu oma, ai- lo ’s bunions, plan a ascii is and pes ca us.15,16 Al hough hese p oblems a e mul i ac o ial, hey may p edic loss o independence, ulne abili y,17 de enselessness18 and educed quali y o li e and wellbeing. IBSc, PT, MSc, PhD. Assis an P o esso , Resea ch G oup, School o Heal h, Exe cise and Spo , Eu opean Uni e si y o Mad id, Villa iciosa de Odón, Mad id, Spain. o cid.o g/0000-0002-3629-6590 IIBSc. Ex e nal Collabo a o and Resea ch, Heal h and Podia y Uni , Depa men o Heal h Sciences, School o Nu sing and Podia y, Uni e si y o Co uña, Fe ol, Spain. o cid.o g/0000-0003-4810-1903 IIIBSc, RN, BSc, MSc, PhD. Full P o esso , Facul y o Heal h Sciences, King Juan Ca los Uni e si y, Alco cón, Spain. o cid.o g/0000-0001-7588-2069 IVMD, PhD. Associa e P o esso , Clinical Epidemiology Resea ch G oup, Depa men o Heal h Sciences, School o Nu sing and Podia y, Uni e si y o Co uña, Fe ol, Spain. o cid.o g/0000-0002-4330-0850 VBSc, BSc, MSc, PhD. Assis an P o esso and Resea ch, Heal h and Podia y Uni , Depa men o Heal h Sciences, School o Nu sing and Podia y, Uni e si y o Co uña, Fe ol, Spain. o cid.o g/0000-0002-9818-6290 VIDP, MSc, PhD. Assis an P o esso , Depa men o Podia y, Uni e si y o Se ille, Se ille, Spain. o cid.o g/0000-0002-4316-5492 VIIRN, BSc, MLIS, DPM, PhD, DHL. Full P o esso , Depa men o Physio he apy and Podia y, School o Nu sing, Physio he apy and Podia y, Complu ense Uni e si y o Mad id, Mad id, Spain. o cid.o g/0000-0003-1568-7602 KEYWORDS: Foo . P ima y heal h ca e. Quali y o li e. ABSTRACT BACKGROUND: Foo p oblems a e belie ed o educe quali y o li e and a e inc easingly p esen . E enamong young adul s o uni e si y age, un ea ed oo p oblems can lead o pos u al and mobili y p oblems. Acco dingly, ou aim he e was o de e mine he ela ionship be ween oo heal h and quali y o li e and gene al heal h among male and emale uni e si y s uden s. DESIGN AND SETTING: Obse a ional c oss-sec ional quan i a i e s udy conduc ed a he Podia ic Med- icine and Su ge y Clinic o he Uni e si y o Co uña, Fe ol, Spain. METHODS: A sample o 112 pa icipan s o median age 22 yea s came o a heal h cen e , whe e sel - e- po ed da a we e egis e ed, including p o essional ac i i y, and sco es ob ained h ough he Foo Heal h S a us Ques ionnai e (FHSQ) we e compa ed. RESULTS: In Sec ion One o he FHSQ, he uni e si y s uden s eco ded lowe sco es o 66.66 in he oo - wea domain and 60 in he gene al oo heal h domain and highe sco es o 84.37 in he oo pain domain and 93.75 in he oo unc ion domain. In Sec ion Two, hey ob ained lowe sco es o 60 in he o e all heal h domain and 62.50 in he igo domain and highe sco es o 100 in he physical ac i i y and 87.50 in he social capaci y domain. Di e ences be ween males and emales we e e alua ed using he Wilcoxon ank-sum es , which showing s a is ical signi icance (P < 0.05) ega ding he dimensions o oo wea and gene al oo heal h. CONCLUSIONS: These uni e si y s uden s’ quali y o li e ela ing o oo heal h was poo . This appea s o be associa ed wi h he uni e si y pe iod, ega dless o gende . ORIGINAL ARTICLE | Rod íguez-Sanz D, Ba bei o-Fe nández D, Losa-Iglesias ME, Sale a -Canosa JL, López-López D, To a uela-Ca ión N, Bece o-de-Bengoa-Vallejo R 124 Sao Paulo Med J. 2018;136(2):123-8 Based on hese issues, i is impo an o conside illnesses and de o mi ies o he oo , pos u al al e a ions and o he unde lying diseases as ac o s o be aken in o accoun when planning ea - men and p e en i e ca e ac i i ies. Mo eo e , he e is a need o ca e and ollow-up ega ding oo heal h o uni e si y s uden s ha so a emains una ended. Such issues need o be add essed in seeking o ensu e be e quali y o li e and wellbeing o uni- e si y s uden s. Thus, we sough o de e mine he s a e o oo heal h among male and emale uni e si y s uden s and i s ela ionship o hei o e all quali y o li e and gene al heal h. A p esen li le is known abou he ac o s ha a ec he de elopmen o oo heal h. Foo p oblems a e p edisposing ac o s o he appea - ance o inju ies in la e li e ha could be p e en ed h ough implemen ing p og ams o imp o e he gene al condi ion o uni e si y s uden s’ ee . METHODS This s udy was app o ed by he Resea ch E hics Commi ee o he Uni e si y o Co uña, in Co uña, Spain. All pa icipan s ga e w i en in o med consen . E hical s anda ds o esea ch on human beings based on he Decla a ion o Helsinki (Wo ld Medical Associa ion) and he Con en ion o he Council o Eu ope on human igh s and biomedicine, as well as hose based on UNESCO’s Uni e sal Decla a ion on he Human Genome and Human Righ s and hose o o he app op ia e na ional o ins i u- ional o ganiza ions we e adhe ed o. Responden s S uden s be ween he ages o 18 and 33 yea s o simila socioeconomic le el pa icipa ed in his c oss-sec ional s udy be ween Sep embe 2014 and May 2015. Pa icipan s we e ec ui ed om he Clinic o Podia ic Medicine and Su ge y (CPMS), which p o ides ea men o oo diseases and diso de s a heUni e si y o Co uña, in Fe ol, Spain. Ad e isemen s we e placed on he CPMS websi e and in Uni e si y newsle e s. In o ma ion lea le s we e p o ided o s uden s clinicians, s uden s om ano he heal h science college o he Uni e si y like nu sing, medicine o physio- he apy. Addi ionally, no ices we e placed on local bulle in boa ds. These s uden s came o he Podia ic Medicine and Su ge y Clinic. They we e eligible o inclusion in he s udy h ough a non-p obabili y consecu i e sampling echnique. The inclusion c i e ia we e ha hey needed o be heal hy olun ee s wi h - ou any ele an medical eco ds o amily his o y and ha hey ga e consen o en ollmen in o he s udy. The exclusion c i e ia included immunodep ession, his o ies o auma and oo su ge y, neu ological al e a ions and lack o o only pa - ial au onomy in pe o ming daily ac i i ies.19 Da a collec ion All measu emen s we e made by a single esea che . Heigh ,weigh and body mass index (BMI) we e de e mined du ing he isi o he clinic. The s uden s hen comple ed he Foo Heal h S a us Ques ionnai e (FHSQ). This sel -adminis e ed ques ionnai e on heal h- ela ed quali y o li e is in ended speci ically o he oo and has been ecognized as a alida ed es .20,21 Foo -speci ic and gene al heal h- ela ed quali y o li e was assessed using e sion 1.03 o he FHSQ,22 which con ains h ee sec ions. The i s sec- ion consis s o 13 ques ions e lec ing ou domains ela ing o oo heal h (Appendix 1): oo pain, oo unc ion, oo wea and gene al oo heal h. The i s sec ion has demons a ed high deg ees o con en , c i e ion and cons uc alidi y (C onbach α = 0.89-0.95) and high e es eliabili y (in aclass co ela ion coe icien = 0.74-0.92).23 I has been shown o be he mos app o- p ia e measu emen o oo heal h- ela ed quali y o li e o pa h- ological skin and nail condi ions and o neu ological, o hopedic and musculoskele al diso de s, among o he s.24,25 Each domain has a speci ic numbe o ques ions (Appendix2): ou on pain, ou on unc ion, h ee on oo wea and wo on gene al oo heal h. The assessmen o pain and unc ion is based on phys- ical phenomena; he e alua ion o oo wea uses p ac ical aspec s o a ailabili y and shoe com o ; and he pe cep ion o gene al oo heal h is based on he pa ien s’ sel -assessmen o he s a e o hei ee . Each ques ion allows se e al answe s, and hese a e placed on a Like - ype o dinal scale (wo ds o ph ases co esponding o a nume ical scale). The desc ip o s o hese scales a y o each domain, and he pe son comple ing he ques ionnai e should choose only one esponse, i.e. whiche e esponse is hough o be he mos app op ia e. The ques ionnai e does no p o ide an o e all sco e bu , a he , i gene a es an index o each domain. To ob ain hese indi- ces, he esponses a e analyzed h ough compu e so wa e (FHSQ, e sion 1.03). A e p ocessing he da a, he so wa e p oduces a sco e anging om 0 o 100. A sco e o ze o ep esen s he wo s s a e o heal h o he oo , while 100 is he bes possible condi ion. The second sec ion o he FHSQ includes ques ions ha e lec ou gene al heal h- ela ed domains (Appendix 2): gene al heal h, physical ac i i y, social capaci y and igo . The domains and ques- ions in his sec ion a e la gely adap ed om he Medical Ou comes S udy 36-I em Sho -Fo m Heal h Su ey,24 which has been ali- da ed o use in he Aus alian popula ion.25 Speci ic ques ions o he FHSQ ha assess sec ion 2 domains a e shown in Appendix 2. Las ly, he hi d sec ion con ains ques ions asking o socio- demog aphic da a such as he pa icipan s’ age and sex and abou hei medical eco ds. Sample size The smalles clinically impo an di e ence in FHSQ sco es is 21 poin s.21,22 Assuming a s anda d de ia ion o a ound 29 o a bila - e al hypo hesis and an alpha o 5%, a leas 94 s uden s would be Foo heal h and quali y o li e among uni e si y s uden s: c oss-sec ional s udy | ORIGINAL ARTICLE Sao Paulo Med J. 2018;136(2):123-8 125 needed o de ec a 21-poin di e ence wi h 80% powe . S uden s we e en olled consecu i ely un il he sample size was achie ed. S a is ical me hods Con inuous a iables we e exp essed as he median and in e qua - ile ange. Di e ences be ween men and women we e compa ed using independen es s i he da a we e no mally dis ibu ed o he Wilcoxon ank-sum es i no . The da a we e analyzed using he SPSS s a is ics package. Alpha was se a 0.05, and all es s we e wo- ailed. The Foo Heal h S a us Ques ionnai e e sion 1.03 was used o ob ain quali y-o -li e sco es ela ing o oo heal h. RESULTS A o al o 112 uni e si y s uden s o less han 33 yea s o age we e en olled. The sample analyzed included 85 women (75.9%) and 27men (24.1%) be ween 18 and 33 yea s o age. Mos s u- den s we e no mal weigh (BMI o 22.27 kg/m2). These esul s a e shown in Table 1. Table 1 also shows he clinical domains o he FHSQ ques- ionnai e and he sociodemog aphic cha ac e is ics o he in o - man s. Ascan be seen, mos o he in o man s we e no mal weigh (BMI = 22.27kg/m2). All a iables showed non-no mal dis ibu ion (P < 0.05), and he e o e he Wilcoxon ank-sum es was used. Table 2 shows a compa ison o he sco es ob ained h ough he FHSQ. Sec ion One o he FHSQ e alua ed ou speci ic oo domains, namely pain, unc ion, heal h and oo wea . The median sco es we e highe in ela ion o assessmen o pain and unc ion, and lowe in ela ion o oo heal h and oo wea . Sec ion Two ga e an assessmen o ou domains o gene al wellbeing: o e all heal h, physical unc ion, social capaci y and igo . In his sec ion, he median oo pain sco es o men and women we e 87.50 and 81.25 espec i ely and he unc ion sco es o men and women we e bo h 93.75, The oo heal h sco es we e 85 and 60 o men and women espec i ely, and he oo wea sco es we e 75 and 58.33 o menand women espec i ely (Table 2). The median sco es o physical unc ion and social capaci y we e signi ican ly lowe han hose o o e all heal h and igo , o bo h men and women. The di e ences be ween males and emales we e s a is i- cally signi ican (P<0.05) o he dimensions o he FHSQ ques- ionnai e ha assessed oo wea and gene al oo heal h. These esul s appea in Table 2. DISCUSSION The pu pose o his s udy was o de e mine he ela ionship be ween quali y o li e and oo heal h among male and emale uni e si y s uden s, gi en ha he high p e alence o oo p ob- lems has been ecognized by he go e nmen s as a h ea o pub- lic heal h. Foo heal h is essen ial o uni e si y s uden s, in ha i enables hem o ha e g ea e au onomy, ha e con ol o e hei li es yles and do physical ac i i y.26 In a s udy on he popula ion in Spain aged 40 yea s o olde , he ollowing p e alences o podia ic medical abno mali ies we e ound: claw oe (69.7%), hallux algus (38.0%) and hallux ex ensus (15.8%).15 The p e alences inc eased wi h age and we e highe among emales.27 The esul s om he ew s udies on his opic indica e ha he impac o oo heal h on quali y o li e is no as ob ious as i appea s Table 1. Sociodemog aphic and clinical cha ac e is ics o he sample popula ion To al g oup Median (IQ ange) n = 112 Male Median (IQ ange) n = 27 Female Median (IQ ange) n = 85 P- alue Male e sus emale Age, yea s 22 (3) 23 (5) 22 (3) 0.562 Weigh (kg) 63 (19.5) 80 (18) 58 (11) 0.000 Heigh (cm) 168 (12.5) 180 (7) 165 (10) 0.000 Body mass index (kg/m2) 22.27 (4.25) 24.03 (4.79) 21.80 (4.07) 0.009 IQ = in e qua ile. Table 2. Compa isons o Foo Heal h S a us Ques ionnai e su ey sco es o o al g oup and gende g oups To al g oup Median (IQ ange) n = 112 Male Median (IQ ange) n = 27 Female Median (IQ ange) n = 85 P- alue Male e sus emale Foo pain 84.37 (18.12) 87.50 (15) 81.25 (24.37) 0.122 Foo unc ion 93.75 (18.75) 93.75 (12.50) 93.75 (18.75) 0.127 Foo wea 66.66 (41.66) 75 (18.333) 58.33 (41.66) 0.005 Gene al oo heal h 60 (27.5) 85 (25) 60 (30) 0.037 O e all heal h 60 (20) 60 (20) 60 (20) 0.730 Physical ac i i y 100 (5.56) 100 (5.56) 100 (5.56) 0.170 Social capaci y 87.50 (25) 87.50 (25) 87.50 (25) 0.176 Vigo 62.50 (25) 68.75 (25) 62.50 (25) 0.103 IQ = in e qua ile. ORIGINAL ARTICLE | Rod íguez-Sanz D, Ba bei o-Fe nández D, Losa-Iglesias ME, Sale a -Canosa JL, López-López D, To a uela-Ca ión N, Bece o-de-Bengoa-Vallejo R 126 Sao Paulo Med J. 2018;136(2):123-8 o be.15,28 On he o he hand, ou esul s con i m ha emale uni- e si y s uden s ha e lowe median oo wea and gene al heal h sco es han hose o men, hus indica ing ha hey ha e poo e quali y o li e in ela ion o hese wo domains. We did no ind any di e ences in any o he domain. This inding is consis en wi h s udies om o he au ho s.29-32 Fu he mo e, ou s uden s had lowe median sco es o gen- e al heal h and igo . This si ua ion is associa ed wi h g ea e lim- i a ions in ca ying ou a wide ange o physical ac i i ies, a lack o ene gy o pa icipa ing in ac i i ies and an inc eased isk o becoming socially isola ed.8,22 Gi en hese esul s, i seems necessa y o poin ou he impo - ance o medical and podia ic ca e and ollow-up, wi h he aim o p e en ing he appea ance o illnesses and de o mi ies o he oo . This is undamen al o enabling imp o emen o uni e si y s uden s’ heal h, quali y o li e and au onomy. We we e unable o compa e ou esul s wi h hose o o he s udies, gi en he di e ences in c i e ia and me hodological a i- a ions, because we did no ind any simila s udies on quali y o li e ela ing o oo heal h. This shows ha he e is a need o u he esea ch on his opic, in o de o ind ou abou he di e en he apeu ic in e en ions used by p o essionals wi hin podia y and medicine ha migh imp o e oo heal h and quali y o li e, no only among uni e si y s uden s bu also in he gene al popula ion. Ou s udy includes se e al impo an limi a ions ha need o be acknowledged. Fi s ly, his s udy was pe o med in a clinic o podia ic medicine and su ge y wi h a small numbe o pa - icipan s. Secondly, expanding da a collec ion o o he coun ies may help o iden i y whe he he e is any cul u e in which his associa ion does no exis and iden i y he mechanisms in ol ed in oo heal h and heal h in gene al. Las ly, he ec ui men me h- odology showed se e al d awbacks ela ing o he ela i ely small sample size. A mo e di e se sample, including indi iduals om se e al coun ies, would be bene icial o imp o ing he s eng h o such s udies. This highligh s he need o u he esea ch on he impo ance o medical and podia ic ca e and ollow-up o he ee and o heal h in gene al, in o de o p e en he appea ance o illnesses and de o mi ies o he ee and main ain he o e all heal h o he body. This is undamen al o enabling imp o emen o uni e si y s uden s’ heal h, quali y o li e, wellbeing and au onomy. CONCLUSIONS O e his s udy pe iod, hese uni e si y s uden s had poo qual- i y o li e ela ing o oo heal h. This appea s o be associa ed wi h he uni e si y pe iod, ega dless o gende . The e o e, he e is a need o de elop oo heal h beha io ha enables p ope ca e and ollow-up o he ee . 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Acknowledgemen s: We would like o hank he s a and pa ien s o he Podia ic Heal h Resea ch Uni , Uni e si y o Co uña, Spain Sou ces o unding: None Con lic o in e es : None Da e o i s submission: Augus 21, 2017 Las ecei ed: Sep embe 11, 2017 Accep ed: Sep embe 23, 2017 Add ess o co espondence: Daniel López López Uni e sidade da Co uña, Unidade de In es igación Saúde e Podoloxía Depa amen o de Ciencias da Saúde Campus Uni e si a io de Es ei o s/no 15403 Fe ol - Spain E-mail: [email p o ec ed] ORIGINAL ARTICLE | Rod íguez-Sanz D, Ba bei o-Fe nández D, Losa-Iglesias ME, Sale a -Canosa JL, López-López D, To a uela-Ca ión N, Bece o-de-Bengoa-Vallejo R 128 Sao Paulo Med J. 2018;136(2):123-8 Appendix 1. Basic domains o oo and o e all heal h, assessed using he Foo Heal h S a us Ques ionnai e Domain Theo e ical cons uc Meaning o lowes sco e (0) Meaning o highes sco e (100) Foo pain Type, se e i y and du a ion. E alua ion o oo pain in e ms o ype o pain, se e i y and du a ion Ex eme pain in he ee and signi ican i acu e in na u e F ee om pain, no discom o Foo unc ion E alua ion o he ee in e ms o impac on physical unc ions Se e ely limi ed o he pe o mance o nume ous physical ac i i ies due o hei ee , such as walking, wo king and mo ing abou Pa ien s a e able o ca y ou all physical ac i i ies desi ed, such as walking, wo king and climbing s ai s Gene al oo heal h Sel -pe cep ion o he ee (assessmen o body image wi h espec o ee ) Pe cep ion o poo condi ion and s a us o he ee Pe cep ion o excellen condi ion and s a us o he ee Foo wea Li es yle ela ing o oo wea and ee G ea limi a ions o inding sui able oo wea No p oblem ob aining sui able oo wea . No limi a ions wi h espec o oo wea Gene al heal h E alua ion o subjec ´s sel - epo ed heal h s a us Poo pe cep ion o heal h s a us Ve y good gene al heal h s a us Physical ac i i y E alua ion o abili y in e ms o impac on physical unc ion Se e ely limi ed in pe o ming a b oad ange o physical ac i i ies Can pe o m all desi ed physical ac i i ies wi h no impai men o disabili y Social Capaci y Sel -pe cep ions o abili y o socially in e ac Limi ed abili y o in e ac wi hou p oblems, socially isola ed Good abili y o in e ac socially and expe iences no isola ion Vigo Li es yle issues ela ed o pe cei ed ene gy and ac i i y pa icipa ion Lacks ene gy o do hings No p oblems wi h ene gy le els Sec ion 1: oo heal h 1. Wha le el o oo pain ha e you had du ing he pas week? 2. How o en ha e you had oo pain? 3. How o en ha e you had oo pain? 4. How o en did you ge sha p pains in you ee ? 5. Ha e you ee caused you o ha e di icul ies in you wo k o ac i i ies? 6. We e you limi ed in he kind o wo k you could do because o you ee ? 7. How much does you oo heal h limi you walking? 8. How much does you oo heal h limi you climbing s ai s? 9. How would you a e you o e all oo heal h? 10. I is ha d o ind shoes ha do no hu my ee . 11. I ha e di icul y in inding shoes ha i my ee . 12. I am limi ed in he numbe o shoes I can wea . 13. In gene al, wha condi ion would you say you ee a e in? Sec ion 2 domains: o e all heal h 14. In gene al, how would you a e you heal h: 15. The ollowing ques ions ask abou ac i i ies you migh do du ing a ypical day. Does you heal h now limi you in hese ac i i ies? a. Vigo ous ac i i ies, such as unning, li ing hea y objec s, o (i you wan ed o) you abili y o pa icipa e in s enuous spo s. b. Mode a e ac i i ies, such as cleaning he house, li ing a chai , playing gol o swimming. c. Li ing o ca ying bags o shopping. d. Climbing a s eep hill. e. Climbing one ligh o s ai s. . Ge ing up om a si ing posi ion. g. Walking mo e han a kilome e . h. Walking one hund ed me e s. i. Showe ing o d essing you sel . 16. This ques ion asks o wha ex en you physical heal h o emo ional p oblems ha e in e e ed wi h you no mal social ac i i ies wi h amily, iends, neighbo s o social g oups. 17. These ques ions a e abou how you eel and how hings ha e been wi h you du ing he pas mon h. Fo each ques ion, please gi e he one answe ha comes closes . How much o he ime du ing he pas 4 weeks: a. Did you eel i ed? b. Did you ha e a lo o ene gy? c. Did you eel wo n ou ? d. Did you eel ull o li e? 18. Du ing he pas 4 weeks, how much o he ime ha e you emo ional p oblems o physical heal h in e e ed wi h you social ac i i ies (like isi ing wi h iends, ela i es, e c.)? 19. How ue o alse is each o he ollowing s a emen s o you? a. I seem o ge sick a li le easie han o he people. b. I am as heal hy as anybody I know. c. I expec my heal h o ge wo se. d. My heal h is excellen Appendix 2. Ques ions o he Foo Heal h S a us Ques ionnai e in sec ions 1 and 2 © 2018 by Associação Paulis a de Medicina This is an open access a icle dis ibu ed unde he e ms o he C ea i e Commons license.