腸道微生物篩查申請表 Stool Donor Application Form

<現正積極招募中!!!>腸道微生物篩查申請表 Stool Donor Application Form

請填寫下列表格，如您合適我們篩選的條件，我們的研究團隊會根據你留下的資料與你聯絡。

您所提供的資料會用作有關硏究日後聯絡之用，只有專責研究人員方可查閱。
Please fill in the following form, and if appropriate, we will contact you according to the information.
Your information will be used for the purpose of this research only, and will be only accessible by the designated research staff.
Q1. 你是否同意填寫這份篩選問卷?
Do you agree to complete the screening questionnaire?

Q1. 你是否同意填寫這份篩選問卷?
Do you agree to complete the screening questionnaire? 同意 Agree 不同意 Disagree
初步篩選 Initial screening
Q2. 今天日期 Date of today Q2. 今天日期 Date of today / DD / MM YYYY
Q3. 性別 Sex

Q3. 性別 Sex 男 Male 女 Female
Q4a. 出生日期 Date of Birth Q4a. 出生日期 Date of Birth / DD / MM YYYY
Q5. 體重(公斤) Body Weight (kg)
Q4b. 年齡 Age
Q6. 身高 (米) Body height (m)
請注意單位為'米". The unit is "meter"
Q7. 身體質量指數 Body Mass Index (BMI)
計算方法=體重（公斤）÷身高（米）÷身高（米）
Calculation = Body weight (kg) ÷ Body height(m）÷ body height(m）

Q7. 身體質量指數 Body Mass Index (BMI)
計算方法=體重（公斤）÷身高（米）÷身高（米）
Calculation = Body weight (kg) ÷ Body height(m）÷ body height(m） <18 18-25 25-30 不清楚 Not sure
Q8. 如何得知這計劃?
Source of knowing this program?

Q8. 如何得知這計劃?
Source of knowing this program? 群發郵件 Mass mailings 海報 Poster 個人邀請 Personal invitation 其他 Other 其他 Other
Q9. 你是否未滿18歲或者超過50歲 (<18 或 >50)? (請注意：此問題為年齡是否『少過18歲』或『多過50歲』）
Are you less than 18, or greater than 50 years old?

Q9. 你是否未滿18歲或者超過50歲 (<18 或 >50)? (請注意：此問題為年齡是否『少過18歲』或『多過50歲』）
Are you less than 18, or greater than 50 years old? 是 Yes 否 No
Q10. 你是否定期服用藥物 (定義為需要服用三個月以上的藥物)?
Are you taking medication regularly (defined as a need to take drug more than three months)?

Q10. 你是否定期服用藥物 (定義為需要服用三個月以上的藥物)?
Are you taking medication regularly (defined as a need to take drug more than three months)? 是 Yes 否 No
Q11.如果你是男士, 是否腰圍大過90厘米（35.4寸）; 如果你是女士, 是否腰圍大過80厘米（31.5寸）?
Is your waist circumference ≥ 90 cm for men or ≥ 80 cm for women?

Q11.如果你是男士, 是否腰圍大過90厘米（35.4寸）; 如果你是女士, 是否腰圍大過80厘米（31.5寸）?
Is your waist circumference ≥ 90 cm for men or ≥ 80 cm for women? 是 Yes 否 No
Q12. 你是否曾吸煙 [定義為在六個月內每星期吸煙多於兩次 (包括香煙，雪茄和電子香煙)]?
Have you ever smoked (including cigarette, cigar, and electronic cigarette for ≥ 2 times a week for ≥ 6 months?)

Q12. 你是否曾吸煙 [定義為在六個月內每星期吸煙多於兩次 (包括香煙，雪茄和電子香煙)]?
Have you ever smoked (including cigarette, cigar, and electronic cigarette for ≥ 2 times a week for ≥ 6 months?) 是，在3個月內仍然有吸煙的習慣 Yes, still smoke within 3 months 從未吸煙 Never smoker 已經戒煙(已戒煙多少個月) Ex-smoker (Please specify, quitted for how many months)
Q13. 你是否經常飲酒?
How often do you drink alcohol on average?

Q13. 你是否經常飲酒?
How often do you drink alcohol on average? 是，經常性飲酒（每星期≥3次） Yes, regular drinker (≥3 times per week) 是，社交或應酬時才飲酒 (每星期<3次) Yes, social drinker (<3 times perweek) 否，從不飲酒 No, never
Q14.你是否每星期排便少過3次以上? (請注意：此問題為每星期是否『少過三次』排便）
Do you have bowel movements less than 3 times per week?

Q14.你是否每星期排便少過3次以上? (請注意：此問題為每星期是否『少過三次』排便）
Do you have bowel movements less than 3 times per week? 是 Yes 否 No
病歷 Medical History
Q15. 你是否曾被建議不要捐血或捐糞便?
Have you ever been advised NOT to donate blood or stool?

Q15. 你是否曾被建議不要捐血或捐糞便?
Have you ever been advised NOT to donate blood or stool? 是 Yes 否 No
Q16. 你是否曾被診斷感染人類免疫力缺乏病毒或患有愛滋病?
Have you ever been diagnosed with HIV or AIDS？

Q16. 你是否曾被診斷感染人類免疫力缺乏病毒或患有愛滋病?
Have you ever been diagnosed with HIV or AIDS？是 Yes 否 No
Q17. 你是否曾被診斷有乙型肝炎?
Have you ever been diagnosed with hepatitis B?

Q17. 你是否曾被診斷有乙型肝炎?
Have you ever been diagnosed with hepatitis B? 是 Yes 否 No
Q18. 你是否曾被診斷有丙型肝炎?
Have you ever been diagnosed with hepatitis C?

Q18. 你是否曾被診斷有丙型肝炎?
Have you ever been diagnosed with hepatitis C? 是 Yes 否 No
Q19. 你是否曾被診斷有肺結核病(肺癆)?
Have you ever been diagnosed with tuberculosis?

Q19. 你是否曾被診斷有肺結核病(肺癆)?
Have you ever been diagnosed with tuberculosis? 是 Yes 否 No
Q20. 你是否曾被診斷感染人類T-淋巴細胞病毒?
Have you ever been diagnosed with Human T-cell Lymphotropic Virus (HTLV)?

Q20. 你是否曾被診斷感染人類T-淋巴細胞病毒?
Have you ever been diagnosed with Human T-cell Lymphotropic Virus (HTLV)? 是 Yes 否 No
Q21. 你是否曾使用過非法藥物（例如，未經醫生批准的靜脈注射藥物或娛樂性藥物)？
Have you ever used illicit drugs? (e.g. drugs intravenously not prescribed by a clinician, recreational drugs)?

Q21. 你是否曾使用過非法藥物（例如，未經醫生批准的靜脈注射藥物或娛樂性藥物)？
Have you ever used illicit drugs? (e.g. drugs intravenously not prescribed by a clinician, recreational drugs)? 是 Yes 否 No
Q22. 你是否曾進行任何“風險較高”的性行為（例如，肛交，同性戀，多個性伴侶，不固定的性伴侶，與性工作者的性行為，匿名性接觸，與使用靜脈藥物的人的性接觸等)？
Have you ever engaged in any “at risk” sexual behavior (e.g. anal sex, homosexual, multiple sexual partners, unfixed sexual partner, sexual activity with a sex worker, anonymous sexual contacts, sexual contacts with someone who uses intravenous drugs etc.)?

Q22. 你是否曾進行任何“風險較高”的性行為（例如，肛交，同性戀，多個性伴侶，不固定的性伴侶，與性工作者的性行為，匿名性接觸，與使用靜脈藥物的人的性接觸等)？
Have you ever engaged in any “at risk” sexual behavior (e.g. anal sex, homosexual, multiple sexual partners, unfixed sexual partner, sexual activity with a sex worker, anonymous sexual contacts, sexual contacts with someone who uses intravenous drugs etc.)? 是 Yes 否 No
病歷 Medical History
Q23. 你是否曾被診斷有乳糜瀉（主要會影響到小腸的長期自體免疫性疾病)?
Have you ever been diagnosed with celiac disease (an autoimmune disease affecting small intestine)?

Q23. 你是否曾被診斷有乳糜瀉（主要會影響到小腸的長期自體免疫性疾病)?
Have you ever been diagnosed with celiac disease (an autoimmune disease affecting small intestine)? 是 Yes 否 No
Q24. 你是否曾被診斷有炎症性腸炎，包括：克隆氏症和潰瘍性結腸炎?
Have you ever been diagnosed with inflammatory bowel disease, including Crohn's Disease and ulcerative colitis?

Q24. 你是否曾被診斷有炎症性腸炎，包括：克隆氏症和潰瘍性結腸炎?
Have you ever been diagnosed with inflammatory bowel disease, including Crohn's Disease and ulcerative colitis? 是 Yes 否 No
Q25. 你是否曾被診斷有腸易激綜合症?
Have you ever been diagnosed with irritable bowel syndrome?

Q25. 你是否曾被診斷有腸易激綜合症?
Have you ever been diagnosed with irritable bowel syndrome? 是 Yes 否 No
Q26. 你是否曾被診斷有原因不明的長期便秘或長期腹瀉?
Have you ever been diagnosed with idiopathic chronic constipation or chronic diarrhea?

Q26. 你是否曾被診斷有原因不明的長期便秘或長期腹瀉?
Have you ever been diagnosed with idiopathic chronic constipation or chronic diarrhea? 是 Yes 否 No
Q27. 你是否曾被診斷有瘧疾?
Have you ever been diagnosed with malaria?

Q27. 你是否曾被診斷有瘧疾?
Have you ever been diagnosed with malaria? 是 Yes 否 No
Q28. 你是否曾被診斷有錐蟲病?
Have you ever been diagnosed with trypanosomiasis?

Q28. 你是否曾被診斷有錐蟲病?
Have you ever been diagnosed with trypanosomiasis? 是 Yes 否 No
Q29. 你是否曾被診斷有自體免疫性疾病, 包括：結締組織病，甲狀腺疾病，炎性關節炎（例如，全身性紅斑狼瘡，類風濕性關節炎，銀屑病關節炎), 銀屑病或脫髮症?
Have you ever been diagnosed with systemic autoimmunity, including connective tissue disease, thyroid disease, inflammatory arthritis (e.g. SLE, rheumatoid arthritis, psoriatic arthritis), psoriasis or alopecia?

Q29. 你是否曾被診斷有自體免疫性疾病, 包括：結締組織病，甲狀腺疾病，炎性關節炎（例如，全身性紅斑狼瘡，類風濕性關節炎，銀屑病關節炎), 銀屑病或脫髮症?
Have you ever been diagnosed with systemic autoimmunity, including connective tissue disease, thyroid disease, inflammatory arthritis (e.g. SLE, rheumatoid arthritis, psoriatic arthritis), psoriasis or alopecia? 是 Yes 否 No
Q30. 你是否曾被診斷有心血管疾病或代謝綜合徵, 包括: 中風、糖尿病（1型或2型)、高血壓、高膽固醇（總膽固醇或低密度脂蛋白）、空腹血糖高、心臟病(例如，動脈粥樣硬化，心肌梗塞或充血性心力衰竭)?
Have you ever been diagnosed with cardiovascular or metabolic syndrome, e.g. stroke, diabetes (Type 1 or Type 2), high blood pressure, high cholesterol (total or LDL), high fasting glucose, heart disease (e.g. atherosclerosis, myocardial infarction, congestive heart failure)?

Q30. 你是否曾被診斷有心血管疾病或代謝綜合徵, 包括: 中風、糖尿病（1型或2型)、高血壓、高膽固醇（總膽固醇或低密度脂蛋白）、空腹血糖高、心臟病(例如，動脈粥樣硬化，心肌梗塞或充血性心力衰竭)?
Have you ever been diagnosed with cardiovascular or metabolic syndrome, e.g. stroke, diabetes (Type 1 or Type 2), high blood pressure, high cholesterol (total or LDL), high fasting glucose, heart disease (e.g. atherosclerosis, myocardial infarction, congestive heart failure)? 是 Yes 否 No
Q31. 你是否曾被診斷有神經系統疾病, 包括: 多發性硬化症, 帕金森氏病, 阿爾海默氏病, 癡呆或癲癇?
Have you ever been diagnosed with neurological conditions, including multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, dementia or epilepsy?

Q31. 你是否曾被診斷有神經系統疾病, 包括: 多發性硬化症, 帕金森氏病, 阿爾海默氏病, 癡呆或癲癇?
Have you ever been diagnosed with neurological conditions, including multiple sclerosis, Parkinson’s disease, Alzheimer’s disease, dementia or epilepsy? 是 Yes 否 No
Q32. 你是否曾被診斷有先天性或慢性肝病?
Have you ever been diagnosed with congenital or chronic liver disease?

Q32. 你是否曾被診斷有先天性或慢性肝病?
Have you ever been diagnosed with congenital or chronic liver disease? 是 Yes 否 No
Q33. 你是否曾被診斷有惡性腫瘤/癌症?
Have you ever been diagnosed with malignancy?

Q33. 你是否曾被診斷有惡性腫瘤/癌症?
Have you ever been diagnosed with malignancy? 是 Yes 否 No
Q34. 你是否曾被診斷患有情緒/精神疾病（例如抑鬱症，躁鬱症，精神分裂症或妄想症，飲食失調)？
Have you ever been diagnosed with emotional / psychiatric illnesses (e.g. Depression, Bipolar disorder, Schizophrenia or delusional disorder, Eating disorder)?

Q34. 你是否曾被診斷患有情緒/精神疾病（例如抑鬱症，躁鬱症，精神分裂症或妄想症，飲食失調)？
Have you ever been diagnosed with emotional / psychiatric illnesses (e.g. Depression, Bipolar disorder, Schizophrenia or delusional disorder, Eating disorder)? 是 Yes 否 No
Q35. 你是否曾被診斷有嗜伊紅性食道炎（經由過敏原引發的免疫相關、慢性及發炎性的疾病)?
Have you ever been diagnosed with eosinophilic disorders of the gastrointestinal tract (an immunology-related, chronic, inflammatory diseases through allergen) ?

Q35. 你是否曾被診斷有嗜伊紅性食道炎（經由過敏原引發的免疫相關、慢性及發炎性的疾病)?
Have you ever been diagnosed with eosinophilic disorders of the gastrointestinal tract (an immunology-related, chronic, inflammatory diseases through allergen) ? 是 Yes 否 No
血液傳播疾病的風險 Risk of Blood Transmittable Disease
Q36. 你或你的家人是否曾被診斷有克雅二氏症（一種發生在人類身上的傳染性海綿狀腦病)?
Have diagnosed Creutzfeldt-Jakob’s disease (CJD) ever occurred in your family (An transmissible spongiform encephalopathy that occurs in humans)?

Q36. 你或你的家人是否曾被診斷有克雅二氏症（一種發生在人類身上的傳染性海綿狀腦病)?
Have diagnosed Creutzfeldt-Jakob’s disease (CJD) ever occurred in your family (An transmissible spongiform encephalopathy that occurs in humans)? 是 Yes 否 No
Q37. 自1980年1月1日起你是否曾注射牛製的胰島素?
Have you received bovine insulin injection since 1 January 1980?

Q37. 自1980年1月1日起你是否曾注射牛製的胰島素?
Have you received bovine insulin injection since 1 January 1980? 是 Yes 否 No
外遊歷史 Travel history
Q38. 從1980年1月1日至1996年12月31日期間，你是否曾於英國總共逗留了三個月或更長時間?
Have you spent a total of three or more months in the UK between 1 January 1980 and 31 December 1996?

Q38. 從1980年1月1日至1996年12月31日期間，你是否曾於英國總共逗留了三個月或更長時間?
Have you spent a total of three or more months in the UK between 1 January 1980 and 31 December 1996? 是 Yes 否 No
Q39. 從1980年1月1日到現在，你是否曾在法國總共逗留了五年或更長時間?
Have you spent a total of five or more years in France between 1 January 1980 and the present?

Q39. 從1980年1月1日到現在，你是否曾在法國總共逗留了五年或更長時間?
Have you spent a total of five or more years in France between 1 January 1980 and the present? 是 Yes 否 No
Q40. 從1980年1月1日到現在，你是否曾在歐洲其他地方總共逗留了五年或更長時間？
Have you spent a total of five or more years in other areas in Europe between 1 January 1980 and the present?

Q40. 從1980年1月1日到現在，你是否曾在歐洲其他地方總共逗留了五年或更長時間？
Have you spent a total of five or more years in other areas in Europe between 1 January 1980 and the present? 是 Yes 否 No
Q41. 從1980年1月1日到現在，你是否曾於英國或法國接受過輸血?
Have you received blood transfusion in the UK or France between 1 January 1980 and the present?

Q41. 從1980年1月1日到現在，你是否曾於英國或法國接受過輸血?
Have you received blood transfusion in the UK or France between 1 January 1980 and the present? 是 Yes 否 No
Q42. 從1980年1月1日和1996年12月31日期間，你是否曾於歐洲的美軍基地工作或生活了六個月或更長時間?
Have you worked or lived for a total of six or more months at US Military bases in Europe between 1 January 1980 and 31 December 1996?

Q42. 從1980年1月1日和1996年12月31日期間，你是否曾於歐洲的美軍基地工作或生活了六個月或更長時間?
Have you worked or lived for a total of six or more months at US Military bases in Europe between 1 January 1980 and 31 December 1996? 是 Yes 否 No
方便時間 Availability
Q43. 你是否能夠在每星期至少3個工作日，於排便後的2小時內攜帶糞便樣本到威爾斯親王醫院?
Can you come or bring back the stool within 2 hours after defecation to Prince of Wales Hospital at least 3 weekdays per week?

Q43. 你是否能夠在每星期至少3個工作日，於排便後的2小時內攜帶糞便樣本到威爾斯親王醫院?
Can you come or bring back the stool within 2 hours after defecation to Prince of Wales Hospital at least 3 weekdays per week? 是 Yes 否 No 不清楚 Not sure
Q44. 如果你已經通過了所有篩查測試, 你是否能定期回來捐贈糞便?
Can you come back for regular stool donation if you have passed all screening tests?

Q44. 如果你已經通過了所有篩查測試, 你是否能定期回來捐贈糞便?
Can you come back for regular stool donation if you have passed all screening tests? 是 Yes 否 No 不清楚 Not sure
Q45. 你是否同意我們將來與你聯絡（包括: 致電或WhatsApp）再作進一步篩查或研究跟進？
Do you agree to be contacted (including phone calls or WhatsApp) for further screening or research in future?

Q45. 你是否同意我們將來與你聯絡（包括: 致電或WhatsApp）再作進一步篩查或研究跟進？
Do you agree to be contacted (including phone calls or WhatsApp) for further screening or research in future? 同意 Agree 不同意 Disagree
2019 冠狀病毒疫苗 / Covid-19 Vaccination
Q46. 你是否已接種兩劑2019冠狀病毒疫苗 (科興或復必泰)?
Did you have 2 doses of Covid-19 vaccinations (Sinovac or BioNTech)?

Q46. 你是否已接種兩劑2019冠狀病毒疫苗 (科興或復必泰)?
Did you have 2 doses of Covid-19 vaccinations (Sinovac or BioNTech)? 是, 我已接種兩次疫苗 Yes, I have had 2 doses of vaccination 否, 我暫時未有計劃接種疫苗 No, I do NOT have the plan for vaccination yet 否, 但我將安排在以下日子接種疫苗 No, but I plan to have vaccination at the following date (MM/YYYY)
Q46a. 請寫明最後一劑疫苗接種的日期
Please specify the date of your LAST dose of vaccine Q46a. 請寫明最後一劑疫苗接種的日期
Please specify the date of your LAST dose of vaccine / DD / MM YYYY
個人資料 Personal information

我們將會在閣下提交申請後的四星期內聯絡合資格的申請者｡假如在申請四星期後我們未有聯絡閣下﹐代表閣下暫時未能通過現有的初步篩選｡
We will contact eligible individuals within four weeks of your application. Applicants not contacted by our staff can be considered NOT passing the initial screening.
*公告
請填寫正確的email, 儲存我們的WhatsApp號碼作為聯絡人之一，以便接收日後重啟計劃的訊息。（中文大學腸胃科WhatsApp號碼：5463 6839）

也請簡單在下面留下個人資料，方便日後我們主動聯絡你（敬請留意E-mail和WhatsApp訊息），所有資料只供香港中文大學研究之用。中文大學對申請者的篩選有最終決定權。謝謝你們的支持！

*Notice
Please provide us your email and save our WhatsApp number in your contact list for our future notification regarding the reopening of the application. (CUHK GI team WhatsApp number: 5463 6839)

Kindly leave your personal contact information below for us to contact you in the future (Email OR WhatsApp messages). All data collected will be solely used by CUHK for research purpose. Should you have any enquiries, feel free to contact us via WhatsApp. CUHK has the sole discretion to determine applicants' eligibility for stool donation. Thank you for your support!
*公告
請填寫正確的email, 儲存我們的WhatsApp號碼作為聯絡人之一，以便接收日後重啟計劃的訊息。（中文大學腸胃科WhatsApp號碼：6315 6634）

也請簡單在下面留下個人資料，方便日後我們主動聯絡你（敬請留意E-mail和WhatsApp訊息），所有資料只供香港中文大學研究之用。中文大學對申請者的篩選有最終決定權。謝謝你們的支持！

*Notice
Kindly provide us your email and save our WhatsApp number in your contact list for our future notification regarding the reopening of the application. (CUHK GI team WhatsApp number: 6315 6634)

Kindly leave your personal contact information below for us to contact you in the future (Email OR WhatsApp messages). All data collected will be solely used by CUHK for research purpose. Should you have any enquiries, feel free to contact us via WhatsApp. CUHK has the sole discretion to determine applicants' eligibility for stool donation. Thank you for your support!
簡單篩查 Screener

請簡單填寫以下篩查問卷。謝謝。
Kindly fill in the screening questionnaire below. Thank you.
3. 身體質量指數 Body Mass Index (BMI)
計算方法=體重（公斤）÷身高（米）÷身高（米）
Calculation = Body weight (kg) ÷ Body height(m）÷ body height(m）

3. 身體質量指數 Body Mass Index (BMI)
計算方法=體重（公斤）÷身高（米）÷身高（米）
Calculation = Body weight (kg) ÷ Body height(m）÷ body height(m） <18 18-25 25-30 不清楚 Not sure
4. 你是否定期服用藥物 (定義為需要服用三個月以上的藥物)?
Are you taking medication regularly (defined as a need to take drug more than three months)?

4. 你是否定期服用藥物 (定義為需要服用三個月以上的藥物)?
Are you taking medication regularly (defined as a need to take drug more than three months)? 是 Yes 否 No
個人資料 Personal Information
1.中文姓名 Name in Chinese (例: 陳大文) *
英文姓名 Name in English (eg: Chan Tai Man) 如適用, if applicable *
2.性別 Gender *

2.性別 Gender 男 Male 女 Female
3. 年齡 Age *
4.體重 Weight ( 公斤/kg) (例: 58 "kg") *
5. 身高 Height (米/m) (例: 178 cm為1.78 "m") *
6. 您是否患有慢性病? Do you have a chronic disease? *

6. 您是否患有慢性病? Do you have a chronic disease? 是 Yes 否 No
7.您是否正在服用長期性藥物? Are you taking chronic medication? *

7.您是否正在服用長期性藥物? Are you taking chronic medication? 是 Yes 否 No
8.您是否曾經確診新冠肺炎? Have you ever been diagnosed with COVID-19? *

8.您是否曾經確診新冠肺炎? Have you ever been diagnosed with COVID-19? 是 Yes 否 No
9. 你是否能夠在每星期至少3個工作日，於排便後的2小時內攜帶糞便樣本到威爾斯親王醫院?
Can you come or bring back the stool within 2 hours after defecation to Prince of Wales Hospital at least 3 weekdays per week? *

9. 你是否能夠在每星期至少3個工作日，於排便後的2小時內攜帶糞便樣本到威爾斯親王醫院?
Can you come or bring back the stool within 2 hours after defecation to Prince of Wales Hospital at least 3 weekdays per week? 是 Yes 否 No 不確定 Not sure
聯絡電話 Contact number （日後用於致電和WhatsApp訊息) (For calling AND Whatsapp messages) *
電郵 Email (敬請正確填寫 Type correctly please) *
電郵 Email (再次核實)(re-enter) *
3. 出生日期 Date of Birth 3. 出生日期 Date of Birth / DD / MM YYYY
狀態 Status
你現在是國際生或交換生嗎？
Are you currently an international/ exchange student?

你現在是國際生或交換生嗎？
Are you currently an international/ exchange student? 是 Yes 否 No
你現在是本地生嗎？
Are you currently a local student?

你現在是本地生嗎？
Are you currently a local student? 是 Yes 否 No
請寫明過去一年曾居住過的國家（至少居住過6個月）
Please state the country of residence for the past year (residence for at least 6 months)
FAQs 常見問題:
Q1. 大便捐贈的重要性為何？
What is the importance of stool donation?
很多疾病都和腸道微生物失調有關。一些俗稱好菌的活性微生物能於健康人士的大便中找到。這些好細菌在身體裏進行代謝，不但能保持大腸粘膜上皮完整，同時也提高宿主的免疫系統。透過腸道微生物移植，有需要的病人可以從中獲得這些對健康有裨益的好細菌。 Many diseases are associated with an imbalanced profile of gut microbiota. There are a lot of live microorganisms, as known as good bacteria, in stool samples from healthy people. Not only the integrity of the cell lining of the gut walls can be improved by these good bacteria, the immunity of the host can also be enhanced through the metabolism of these microbes. Through Intestinal microbiota transplant (IMT), patients in need could benefit from the transfer of these health-promoting bacteria.
Q2. 我對是次計劃有興趣，該如何申請大便捐贈計劃？計劃對申請者的篩查步驟為何？
I am interested in the program. How should I apply for the Stool Donation Program? What are the steps of the screening process?
簡單填寫以下初步篩查問卷和留下個人資料。合資格的申請者將進行更詳細的健康問卷，血液和大便樣本測試。 Simply complete the screener and leave your contact below. Eligible applicants will be screened through health screening questionnaire, blood test and stool test.
Q3. 若成為定期大便捐贈者，日後如何進行捐贈? 獎勵會如何計算？
How do I donate stool if I become a qualified regular donor? How will the reward be determined?
捐贈者除了可親臨威爾斯親王醫院指定的洗手間即場提供大便樣本，也可自行在舒適的環境中預備樣本並於2小時內回醫院提交樣本。獎勵的計算將視乎捐贈者的捐贈次數、大便樣本的質素和重量而定。 Donors can either leave their stool sample on the spot in an indicated toilet in Prince of Wale’s Hospital, OR prepare their stool samples in their comfortable setting and return the samples within 2 hours of defecation. The reward depends on the frequency, quality and the total weight of donor’s stool donation.
Q4. 捐贈大便期間有飲食上的建議或限制嗎？
Is there any dietary advice or restriction when donating stools?
能夠提供優良的內在環境予腸道細菌茁壯成長非常重要。雖然計劃本身並未有執行嚴謹的飲食限制，我們鼓勵大家日常多進食原型食物，而取代不必要的加工食物，原因在於我們知道好些食物添加劑能夠破壞腸道微生物平衡。此外，結構較複雜的碳水化合物亦能促進好菌成長。至於營養補充品方面，大便捐贈者將需暫停任何服用當中的益生菌。 It is most important to provide a suitable internal environment for the gut bacteria to thrive. While the program per se will not apply strict dietary restriction on applicants, we do encourage stool donors, on a regular basis, consume whole foods in replacement of processed food as certain food additives are proposed to distort the profile of gut microbiota. Intake of carbohydrate with complex structure also favours fermentation of good bacteria. In terms of supplements, however, commercial probiotics are not allowed after becoming stool donors.
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Disclaimer The personal data collected will be used by Division of Gastroenterology & Hepatology and authorised personnel for processing the captioned purposes in accordance with relevant provisions of the Personal Data (Privacy) Ordinance.

<現正積極招募中!!!>腸道微生物篩查申請表 Stool Donor Application Form

初步篩選 Initial screening

病歷 Medical History

病歷 Medical History

血液傳播疾病的風險 Risk of Blood Transmittable Disease

外遊歷史 Travel history

方便時間 Availability

2019 冠狀病毒疫苗 / Covid-19 Vaccination

個人資料 Personal information

簡單篩查 Screener

個人資料 Personal Information

狀態 Status

FAQs 常見問題: