Data Dictionary for cedhaint
Number of Blaise fields: 968
| Seq # | Var | Question | Data Type/Coding |
|---|---|---|---|
| 1 | versiondate | Version Date | |
| 2 | formdescr | Form Description | |
| 3 | formno | Form Number | String[8] |
| 4 | version | Version Number | String[4] |
| 5 | gaitremind | For each exercise: Say, 'Remember to look straight ahead and stay as still as possible until I say, Begin. Ready? Begin.' Say, 'Begin' and press the forward button on the remote to start the measurement (time will start on the program) Count Steps (when applicable) Say, 'Stop' and press the Forward button a second time to end the measurement. Stop Stopwatch (when applicable) If the measurement was accurately performed, press the Slideshow button on the remote to move onto the next measurement (once Slideshow button is pressed, you CANNOT repeat the measurement) If the measurement needs to be repeated, press the Back button on the remote or select 'cancel current trial' on the computer screen. Check device to ensure green light is still flashing. [Press enter to continue] | |
| 6 | dynaintro | Say I'm going to place this belt around your waist. The belt contains a recording device that will track your movements. I'm going to press a button on a remote before and after each task. It is important that you don't begin the task until I say 'Begin' and don't stop until I say 'stop'. Before starting each task I want you to look straight ahead and stay as still as possibel until I say 'Begin' [Press enter to continue] | |
| 7 | walkint1 | 8 foot walk (trial 1) Place the DynaPort device around the waist of the participant, like a belt. DynaPort device should be located on the waistline, in center of the participant's back. Insert the scan disk with the participant's ID number labeled on it into the DynaPort device. Check that the green light on the DynaPort is on and then slide the device into the belt. Open the Dyrector MT program on your computer. Select the Perform tab. Make sure the COM port is selected and you have selected 'gait' under protocol. When you are ready to begin the gait test, select 'Start Measurement'. Check that the green light on the DynaPort is blinking. [Press enter to continue] | |
| 8 | walkint2 | 8 foot walk (trial 1) Now I am going to observe how you walk at your normal pace. This is our walking course. I want you to walk to the other end of the course at your usual speed, just as if you were walking to the store. I want you to walk all the way past this line until I say 'Stop.' Let me show you what my normal pace would be if I were to walk the course. [Demonstrate and then ask the participant:] Do you feel it would be safe for you to walk this course with me? [Have the participant stand with both feet together on top of the line.] Remember to look straight ahead and stay as still as possible until I say 'Begin'. Ready? Begin. [Press enter to continue] | |
| 9 | sidebysintro | POSTURAL STANDS: SIDE BY SIDE STAND-EYES OPEN For the next exercise, I would like you to place one foot beside the other in a comfortable position in front of this line. [Demonstrate the position.] [Optional prompt if needed:] You may use your arms, bend your knees, or move your body to maintain your balance, but try not to move your feet. Now you try it. [Extend hands palm side up for the participant to use for balance.] I'm going to support your arms while you get into the position. Try to hold this position until I say 'Stop'. [Once the position is attained, the examiner's place is to the side and slightly behind the participant.] [Press enter to continue] | |
| 10 | turn1intro | 360° TURN Now I would like you to make a complete turn at your normal walking pace and turn until you reach your starting point. [Demonstrate] Now you try it. Line your feet on top of the tape and begin turning when I say 'Begin' and turn until you reach your starting point. Remember to look straight ahead and stay as still as possible until I say 'Begin'. Ready? Begin. [Press enter to continue] | |
| 11 | poststndintro | POSTURAL STANDS: SIDE BY SIDE STAND-EYES CLOSED Now I want you to do this again, but this time I want you to do it with your eyes closed. I'm going to support your arms while you get into the position. Try to hold the position until I say 'Stop.' [Press enter to continue] | |
| 12 | getup1intro | GET UP AND GO (trial 1) Place a chair behind the start line for the eight foot walk. Now I'm going to have you walk this course again but this time you're going to be seated in this chair with your back rested agains the back of the chair. Then, you're going to stand up from this chair, walk to the other end of the course at your normal pace past the line, turn around, walk back to the chair and sit down. [Demonstrate exercise] [Press enter to continue] | |
| 13 | tandemintro | TANDEM WALK (HEEL-TOE WALK) Now I want you to walk this course again but this time I want you to place one foot in front of the other with the heel touching the toe of the other foot like this, alternating feet. [Demonstrate exercise.] If you feel you are losing your balance, step out like this and then resume walking again. I want you to continue this walk all the way past this line before you stop. Participant should start with both feet on top of the line of tape. Remind participant to stay as still as possible until you say 'begin'. Ready? Begin [Press enter to continue] | |
| 14 | walk8intro | BACK AND FORTH 8 FOOT WALK TWICE I would like you to walk this course again. I want you to walk to the other end of the course at your usual speed, just as if you were walking to the store. This time, however, I want you to walk all the way past this line, turn around and walk back to the starting line. When you pass the starting line I want you to turn around and walk to the other end of the course, turn around and walk back. [Demonstrate] Do you feel it would be safe for you to walk this course with me? Participant should start with both feet on top of the line of tape. Remeber to look straight ahead and stay as still as possible until I say 'Begin'. Ready? Begin. [Press enter to continue] | |
| 15 | gaitquip | Is the Gait Test Equipment Available? | 1= Yes 2= No |
| 16 | domove2 | [Interviewer, Is the Gait Test Equipment being worn by the participant during these exercises?] | 1= Yes 2= No |
| 17 | dynaid | DynaPort Device id | String[10] |
| 18 | diskid | Disk ID | String[10] |
| 19 | walk1 | 8 foot Walk (trial 1) Press M on the DynaPort device to start recording Say, 'Ready? Begin.' Start Stopwatch Count Steps Say, 'Stop'. Press M to stop recording Check device to ensure green light is still flashing. Is test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 20 | move7b | Time (seconds): | 1.0 .. 60.0 |
| 21 | move7c | Number of steps taken: | 1 .. 60 |
| 22 | walk2 | 8 foot Walk (trial 2) Is test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 23 | move7d | Time (seconds): | 1.0 .. 60.0 |
| 24 | move7e | Number of steps taken: | 1 .. 60 |
| 25 | move7a | Record Aid used for 8 foot walk: | 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair as walking aid 6= Other |
| 26 | move7a1 | [SPECIFY] | String[20] |
| 27 | sidebys | POSTURAL STANDS: SIDE BY SIDE STAND-EYES OPEN Press M on the DynaPort device to start recording Say, 'Ready? Begin.' Start timing with the stopwatch Say, 'Stop'. Stop the stopwatch after 20 seconds or participant falls out of position. Press M on the DynaPort device when move has ended. Check device to ensure green light is still flashing. Is the test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 28 | turn1 | 360° TURN Press M on the DynaPort device to start recording Say, 'Ready? Begin.' Start timing with the stopwatch Say, 'Stop'. Press M on the DynaPort device when the turn is completed. Check device to ensure green light is still flashing. Is the test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 29 | move6f | Number of steps taken: | 1 .. 60 |
| 30 | move6e | Time (seconds): | 1.0 .. 60.0 |
| 31 | turn2 | 360° TURN Second trial Is test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 32 | move6h | Number of steps: | 1 .. 60 |
| 33 | move6g | Time (seconds): | 1.0 .. 60.0 |
| 34 | move6i | Record Aid used for 360 turn: | 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other |
| 35 | move6i1 | [SPECIFY] | String[20] |
| 36 | poststnd | POSTURAL STANDS: SIDE BY SIDE STAND-EYES CLOSED Press M on the DynaPort device to start recording Say, 'Ready? Begin.' Start timing with the stopwatch Say, 'Stop'. Stop the stopwatch after 20 seconds or participant falls out of position. Press M on the DynaPort device when move has ended. Check device to ensure green light is still flashing. Is the test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 37 | getup1 | GET UP AND GO (trial 1) Press M on the DynaPort device to begin recording Say, 'Ready? Begin.' Press M on the DynaPort device when the participant has returned and sat back down in the chair. Check device to ensure green light is still flashing. Is the test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 38 | getup2 | GET UP AND GO (trial 2) Is the test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 39 | getaid | Record Aid used for GET UP AND GO: | 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other |
| 40 | getaid_specify | [SPECIFY] | String[20] |
| 41 | tandem | TANDEM WALK (HEEL-TOE WALK) Press M on the DynaPort device to begin recording Say, 'Ready? Begin.' Say, 'Stop' when participant has returned to starting point Press M on the DynaPort to stop recording Check device to ensure green light is still flashing. Is the test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 42 | move8 | Interviewer: Record number of errors, e.g. Sidesteps: | 0 .. 60 |
| 43 | tandaid | Record Aid used for Tandem Walk: | 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other |
| 44 | tandaid_specify | [SPECIFY] | String[20] |
| 45 | walk8 | BACK AND FORTH 8 FOOT WALK TWICE Press M on the DynaPort device to begin recording Say, 'Ready? Begin.' Say, 'Stop' when participant has returned to starting point Press M on the DynaPort to stop recording Check device to ensure green light is still flashing. Is the test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 46 | walk8aid | Record Aid used for BACK AND FORTH WALK: | 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other |
| 47 | walk8aid_specify | [SPECIFY] | String[20] |
| 48 | sttoeopen | Toe Stand (Eyes Open) Describe the position while demonstraiting. Once the participant is ready: Press M on the DynaPort device to begin recording Say, 'Ready? Begin.' Start timing with stopwatch Stop timing if the participant falls out of position or max time of 10 seconds is reached. Press M on the DynaPort device Maximum time is 10 seconds. Is the test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 49 | move6 | Time (seconds) : | 1.0 .. 10.0 |
| 50 | strlopen | Standing on Right Leg (Eyes Open) Describe the position and demonstrate. Once the participant is ready: Press M on the DynaPort device to begin recording Say, 'Ready? Begin.' Start timing with stopwatch Stop timing if the participant falls out of position or max time of 10 seconds is reached. Press M on the DynaPort device Maximum time is 10 seconds. Is the test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 51 | move6a | Time (seconds) : | 1.0 .. 10.0 |
| 52 | stllopen | Standing on Left Leg (Eyes Open) Describe the position and demonstrate. Once the participant is ready: Press M on the DynaPort device to begin recording Say, 'Ready? Begin.' Start timing with stopwatch Stop timing if the participant falls out of position or max time of 10 seconds is reached. Press M on the DynaPort device Maximum time is 10 seconds. Is the test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 53 | move6c | Time (seconds) : | 1.0 .. 10.0 |
| 54 | pegboardrt | PURDUE PEGBOARD Is the test performed with right hand? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 55 | pegboardlt | PURDUE PEGBOARD Is the test performed with left hand? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 56 | admin1 | PURDUE PEGBOARD -- ADMINISTRATION: [PLACE PEGBOARD IN FRONT OF R, WITH WELLS AT TOP AND PEGS IN FIRST AND LAST WELLS. SAY:] `I want to see how quickly you can place these pegs [POINT] into these holes [POINT] - like this without skipping any holes. [EXAMINER PLACES 4 PEGS WITH RIGHT HAND IN RIGHT-HAND COLUMN.] Now for practice you try it with your right hand.' [ALLOW SUBJECT TO PLACE 4 PEGS IN RIGHT COLUMN; ENCOURAGE WITH `good;' REPEAT PROCESS IF SUBJECT DOES NOT COMPLETE PRACTICE ITEMS SATISFACTORILY. THEN REPLACE PEGS.] >>>>> PRESS ENTER TO CONTINUE <<<<< | String[1] |
| 57 | admin2 | [SAY: ]`Good. You have the idea. Now, when I tell you to begin, pick up the pegs one at a time and place them in this column [POINT TO RIGHT-HAND COLUMN] with your RIGHT HAND as quickly as you can. Again, please do not skip any holes. Ready? Begin. '[START TIMER AS YOU SAY `BEGIN;' EACH TRIAL IS *30 SECONDS*. WATCH R; PROMPT TO PICK UP ONLY ONE PEG AT A TIME, TO USE ONLY ONE HAND AT A TIME, AND NOT TO SKIPHOLES, AS NECESSARY; IF R MAKES SIGNIFICANT ERRORS DURING TRIAL (E.G., USING BOTH HANDS, PLACING PEGS IN WRONG COLUMN, SKIPPING HOLES, ETC.) **IT IS PERMISSIBLE TO REPEAT 1 TRIAL**. IF NECESSARY, COVER ONE COLUMN OF HOLES WITH THE PANEL THAT SLIDES OVER THE WELLS. ONLY VERBALLY REMIND BEYOND THIS, HOWEVER. AT 30 SECONDS SAY:] `stop'. >>>>> PRESS ENTER FOR FIRST TRIAL <<<<< | String[1] |
| 58 | admin3 | PURDUE PEGBOARD -- ADMINISTRATION: [PLACE PEGBOARD IN FRONT OF R, WITH WELLS AT TOP AND PEGS IN FIRST AND LAST WELLS. SAY:] `I want to see how quickly you can place these pegs [POINT] into these holes [POINT] - like this without skipping any holes. [EXAMINER PLACES 4 PEGS WITH LEFT HAND IN LEFT-HAND COLUMN.] Now for practice you try it with your left hand.' [ALLOW SUBJECT TO PLACE 4 PEGS IN RIGHT COLUMN; ENCOURAGE WITH `good;' REPEAT PROCESS IF SUBJECT DOES NOT COMPLETE PRACTICE ITEMS SATISFACTORILY. THEN REPLACE PEGS.] >>>>> PRESS ENTER TO CONTINUE <<<<< | String[1] |
| 59 | admin4 | [SAY: ]`Good. You have the idea. Now, when I tell you to begin, pick up the pegs one at a time and place them in this column [POINT TO LEFT-HAND COLUMN] with your LEFT HAND as quickly as you can. Again, please do not skip any holes. Ready? Begin. '[START TIMER AS YOU SAY `BEGIN;' EACH TRIAL IS *30 SECONDS*. WATCH R; PROMPT TO PICK UP ONLY ONE PEG AT A TIME, TO USE ONLY ONE HAND AT A TIME, AND NOT TO SKIPHOLES, AS NECESSARY; IF R MAKES SIGNIFICANT ERRORS DURING TRIAL (E.G., USING BOTH HANDS, PLACING PEGS IN WRONG COLUMN, SKIPPING HOLES, ETC.) **IT IS PERMISSIBLE TO REPEAT 1 TRIAL**. IF NECESSARY, COVER ONE COLUMN OF HOLES WITH THE PANEL THAT SLIDES OVER THE WELLS. ONLY VERBALLY REMIND BEYOND THIS, HOWEVER. AT 30 SECONDS SAY:] `stop'. >>>>> PRESS ENTER FOR FIRST TRIAL <<<<< | String[1] |
| 60 | trial11 | 1. Trial 1, Right Hand [ENTER NUMBER OF PEGS CORRECTLY PLACED] | 0 .. 25 |
| 61 | trial21 | [AT COMPLETION OF TRIAL 1, REPLACE PEGS AND SAY:] `Now I want you to do the same thing with your LEFT HAND. Pick up the pegs one at a time and place them in this column [POINT TO LEFT-HAND COLUMN] with your left hand. Work as quickly as you can and do not skip any holes. Ready? Begin.' [TRIAL IS 30 SECONDS WITH SAME PROCEDURES AS TRIAL 1.] 2. Trial 2, Left Hand [ENTER NUMBER OF PEGS CORRECTLY PLACED] | 0 .. 25 |
| 62 | trial301 | [AT COMPLETION OF TRIAL 2, REPLACE PEGS AND SAY:] `Now I want you to do this again with your RIGHT HAND. Place the pegs one at a time in this column [POINT TO RIGHT-HAND COLUMN COLUMN] with your right hand. Work as quickly as you can and do not skip any holes. Ready? Begin.' [TRIAL IS 30 SECONDS WITH SAME PROCEDURES AS TRIAL 1.] 3. Trial 3, Right Hand [ENTER NUMBER OF PEGS CORRECTLY PLACED] | 0 .. 25 |
| 63 | trial4 | [AT COMPLETION OF TRIAL 3, REPLACE PEGS AND SAY:] `Now I want you to do this again with your LEFT HAND. Place the pegs one at a time in this column [POINT TO LEFT-HAND COLUMN] with your left hand. Work as quickly as you can and do not skip any holes. Ready? Begin.' [TRIAL IS 30 SECONDS WITH SAME PROCEDURES AS TRIAL 1.] 4. Trial 4, Left Hand [ENTER NUMBER OF PEGS CORRECTLY PLACED] | 0 .. 25 |
| 64 | projid | ^formdescr Form: ^formno Version: ^version (^versiondate) Enter project ID number. | String[8] |
| 65 | visit | Enter curent visit code from face sheet: CODE F/U Year CODE F/U Year CODE F/U Year CODE F/U Year 00 = Baseline 08 = 8th F/U 16 = 16th F/U 24 = 24th F/U 01 = 1st F/U 09 = 9th F/U 17 = 17th F/U 25 = 25th F/U 02 = 2nd F/U 10 = 10th F/U 18 = 18th F/U 26 = 26th F/U 03 = 3rd F/U 11 = 11th F/U 19 = 19th F/U 27 = 27th F/U 04 = 4th F/U 12 = 12th F/U 20 = 20th F/U 28 = 28th F/U 05 = 5th F/U 13 = 13th F/U 21 = 21th F/U 29 = 29th F/U 06 = 6th F/U 14 = 14th F/U 22 = 22th F/U 30 = 30th F/U 07 = 7th F/U 15 = 15th F/U 23 = 23th F/U | String[2] |
| 66 | baseyear | Enter year of baseline from face sheet: | 1993 .. 2025 |
| 67 | autodate | Automatic Date. | Date type |
| 68 | autotime | Automatic Time. | TimeType |
| 69 | autolog | Automatic Logged Date. | Date type |
| 70 | intid | INTERVIEWER ID | 100 .. 997 |
| 71 | compid | Laptop id | String[7] |
| 72 | dateint | Date of interview | Date type |
| 73 | gender | Enter participant's gender. | 1= Male 2= Female 3= Transgender |
| 74 | igender | Which gender do you identify with? | 1= Male 2= Female |
| 75 | hivpos | HIV [[INTERVIEWER: Is the study participant HIV+?]] Are you HIV+? | 1= Yes 2= No |
| 76 | hivhow | HOW DO YOU THINK YOU GOT INFECTED WITH HIV? | 1= IDU 2= SEX WITH MEN 3= SEX WITH WOMEN 4= BLOOD TRANSFUSION/NEEDLESTICK 5= UNKNOWN |
| 77 | hivdiag | What year were you diagnosed? | 1970 .. 2025 |
| 78 | hivtrea | What year did you start therapy? [Enter 8888 if never started therapy] | 1970 .. 8888 |
| 79 | hivhist | Were you on a different antiretroviral therapy BEFORE your current therapy? If yes, please describe. | String[200] |
| 80 | vlnotdetect | VIRAL LOAD [[INTERVIEWER: Was the participant's most recent viral load undetectable?]] | 1= Yes 2= No |
| 81 | viralload | What was the viral load? | 41 .. 500000 |
| 82 | vldate | What was the date of the most recent viral load? | Date type |
| 83 | cd4count | What was the participant's most recent CD4 count? | 1 .. 2000 |
| 84 | cd4date | What is the date of the most recent CD4 count test? | Date type |
| 85 | heart | MEDICAL HISTORY Now, I have some questions about a number of specific medical conditions. 1. Have you ever been told by a doctor, nurse or therapist that you had a heart attack or coronary, or coronary thrombosis, or coronary occlusion, or myocardial infarction? | 1= Yes 2= Suspect or possible 3= No |
| 86 | chf | CONGESTIVE HEART FAILURE Have you ever been told by a doctor, nurse or therapist that you had congestive heart failure? | 1= Yes 2= Suspect or possible 3= No |
| 87 | cancer | CANCER OR MALIGNANCY 1. Have you ever been told by a doctor, nurse or therapist that you had ... Cancer, malignancy or tumor of any type? | 1= Yes 2= Suspect or possible 3= No |
| 88 | ca1a | 1a. Where was it? [OR: Where was the most recent cancer that you had?] [SPECIFY] | String[20] |
| 89 | diabetes | DIABETES Have you ever been told by a doctor, nurse or therapist that you had ... 1. Diabetes, or sugar in the urine, or high blood sugar? | 1= Yes 2= Suspect or possible 3= No |
| 90 | db1 | 2. Has a doctor, nurse or therapist, ever told you to take insulin or injections for your high blood sugar? | 1= Yes 2= No |
| 91 | highbp | HIGH BLOOD PRESSURE Have you ever been told by a doctor, nurse or therapist that you had ... 1. High blood pressure? | 1= Yes 2= Suspect or possible 3= No |
| 92 | bp3 | 2 Has a doctor, nurse, or therapist ever told you to take medicine by mouth for your high blood pressure? | 1= Yes 2= No |
| 93 | thyroid | THYROID DISEASE Have you ever been told by a doctor, nurse or therapist that you had ... 1. Thyroid disease? | 1= Yes 2= Suspect or possible 3= No |
| 94 | th3 | 2. Has a doctor, nurse, or therapist ever told you to take medicine by mouth for your thyroid condition? | 1= Yes 2= No |
| 95 | highchol | HIGH CHOLESTEROL Have you ever been told by a doctor, nurse or therapist that you had ... 1. High cholesterol? | 1= Yes 2= Suspect or possible 3= No |
| 96 | ch3 | 2. Has a doctor, nurse, or therapist ever told you to take medicine by mouth for your cholesterol condition? | 1= Yes 2= No |
| 97 | anemia | ANEMIA Have you ever been told by a doctor, nurse or therapist that you had ... anemia? | 1= Yes 2= Suspect or possible 3= No |
| 98 | liverdis | LIVER DISEASE Have you ever been told by a doctor, nurse or therapist that you had ... liver disease? | 1= Yes 2= Suspect or possible 3= No |
| 99 | hepc | HEPATITIS C Have you ever been told by a doctor, nurse or therapist that you had ... hepatitis C? | 1= Yes 2= Suspect or possible 3= No |
| 100 | hepb | Chronic HEPATITIS B Have you ever been told by a doctor, nurse or therapist that you had ... Chronic hepatitis B? | 1= Yes 2= Suspect or possible 3= No |
| 101 | pancrea | Pancreatitis Have you ever been told by a doctor, nurse or therapist that you had ... Pancreatitis? | 1= Yes 2= Suspect or possible 3= No |
| 102 | neurpath | Neuropathy Have you ever been told by a doctor, nurse or therapist that you had ... Neuropathy? | 1= Yes 2= Suspect or possible 3= No |
| 103 | legsfeet | BAD CIRCULATION IN YOUR LEGS OR FEET Have you ever been told by a doctor, nurse or therapist that you had ... Bad circulation in your legs or feet? | 1= Yes 2= Suspect or possible 3= No |
| 104 | lungdis | CHRONIC LUNG DISEASE Have you ever been told by a doctor, nurse or therapist that you had ... Emyphysema, asthma, chronic bronchitis, or chronic obstructive lung disease? | 1= Yes 2= Suspect or possible 3= No |
| 105 | kidneyf | KIDNEY FAILURE Have you ever been told by a doctor, nurse or therapist that you had ... Kidney failure or bad kidneys? | 1= Yes 2= Suspect or possible 3= No |
| 106 | tia | TRANSIENT ISCHEMIC ATTACK Have you ever been told by a doctor, nurse or therapist that you had ... Stroke or mini stroke? | 1= Yes 2= Suspect or possible 3= No |
| 107 | pneumonia | PNEUMONIA Have you ever been told by a doctor, nurse or therapist that you had ... pneumonia? | 1= Yes 2= Suspect or possible 3= No |
| 108 | shingles | SHINGLES Have you ever been told by a doctor, nurse or therapist that you had ... Shingles? | 1= Yes 2= Suspect or possible 3= No |
| 109 | tb | TB Have you ever been told by a doctor, nurse or therapist that you had ... TB or Tuberculosis? | 1= Yes 2= Suspect or possible 3= No |
| 110 | natdis | LIFE EVENTS The next questions are about difficult or stressful things that sometimes happen to people. Please indicate whether it happened to you personally, you witnessed it happen to someone else, you learned about it happening to someone close to you, or it doesn't apply to you. Consider your entire life growing up. Natural disaster (e.g., flood, hurricane, tornado, earthquake) | 1= Doesn't apply to me 2= Learned about it happening to someone close to me 3= I witnessed it happening to someone else 4= It happened to me |
| 111 | fire | Fire or explosion | 1= Doesn't apply to me 2= Learned about it happening to someone close to me 3= I witnessed it happening to someone else 4= It happened to me |
| 112 | transport | Transportation accident (e.g., car accident, boat accident, train wreck, plane crash) | 1= Doesn't apply to me 2= Learned about it happening to someone close to me 3= I witnessed it happening to someone else 4= It happened to me |
| 113 | accident | Serious accident at work, home, or during recreational activity | 1= Doesn't apply to me 2= Learned about it happening to someone close to me 3= I witnessed it happening to someone else 4= It happened to me |
| 114 | toxic | Exposure to toxic substance (e.g., dangerous chemicals, radiation) | 1= Doesn't apply to me 2= Learned about it happening to someone close to me 3= I witnessed it happening to someone else 4= It happened to me |
| 115 | physical | Physical assault (e.g., being attacked, hit, slapped, kicked, beaten up) | 1= Doesn't apply to me 2= Learned about it happening to someone close to me 3= I witnessed it happening to someone else 4= It happened to me |
| 116 | weapon | Assault with a weapon (e.g., being shot, stabbed, threatened with a knife, gun, bomb) | 1= Doesn't apply to me 2= Learned about it happening to someone close to me 3= I witnessed it happening to someone else 4= It happened to me |
| 117 | sexual | Sexual assault (rape, attempted rape, made to perform any type of sexual act through force or threat of harm) | 1= Doesn't apply to me 2= Learned about it happening to someone close to me 3= I witnessed it happening to someone else 4= It happened to me |
| 118 | unwanted | Other unwanted or uncomfortable sexual experience | 1= Doesn't apply to me 2= Learned about it happening to someone close to me 3= I witnessed it happening to someone else 4= It happened to me |
| 119 | warzone | Combat or exposure to a war-zone (in the military or as a civilian) | 1= Doesn't apply to me 2= Learned about it happening to someone close to me 3= I witnessed it happening to someone else 4= It happened to me |
| 120 | captivity | Captivity (e.g., being kidnapped, abducted, held hostage) | 1= Doesn't apply to me 2= Learned about it happening to someone close to me 3= I witnessed it happening to someone else 4= It happened to me |
| 121 | injury | Life threatening illness or injury | 1= Doesn't apply to me 2= Learned about it happening to someone close to me 3= I witnessed it happening to someone else 4= It happened to me |
| 122 | suffer | Severe human suffering | 1= Doesn't apply to me 2= Learned about it happening to someone close to me 3= I witnessed it happening to someone else 4= It happened to me |
| 123 | violent | Sudden, violent death (e.g., homicide or suicide) | 1= Doesn't apply to me 2= Learned about it happening to someone close to me 3= I witnessed it happening to someone else 4= It happened to me |
| 124 | sudden | Sudden, unexpected death of someone close to you | 1= Doesn't apply to me 2= Learned about it happening to someone close to me 3= I witnessed it happening to someone else 4= It happened to me |
| 125 | youcause | Serious injury, harm, or death you caused someone else | 1= Doesn't apply to me 2= Learned about it happening to someone close to me 3= I witnessed it happening to someone else 4= It happened to me |
| 126 | stress | Any other stressful event or experience | 1= Doesn't apply to me 2= Learned about it happening to someone close to me 3= I witnessed it happening to someone else 4= It happened to me |
| 127 | mti | PCL-C (PTSD Questionnaire) Below is a list of problems and complaints that people sometimes have in response to stressful life experiences. Please indicate how much you have been bothered by the problem in the past month. Repeated, disturbing memories, thoughts, or images of a stressful experience from the past. | 1= Not at all 2= A little bit 3= Moderately 4= Quite a bit 5= Extremely |
| 128 | dreams | Repeated, disturbing dreams of a stressful experience from the past. | 1= Not at all 2= A little bit 3= Moderately 4= Quite a bit 5= Extremely |
| 129 | happen | Suddenly acting or feeling as if a stressful experience were happening again (as if you were reliving it) | 1= Not at all 2= A little bit 3= Moderately 4= Quite a bit 5= Extremely |
| 130 | upset | Feeling very upset when something reminded you of a stressful experience from the past | 1= Not at all 2= A little bit 3= Moderately 4= Quite a bit 5= Extremely |
| 131 | physreac | Having physical reactions (e.g., heart pounding, trouble breathing, sweating) when something reminded you of a stressful experience from the past | 1= Not at all 2= A little bit 3= Moderately 4= Quite a bit 5= Extremely |
| 132 | avdthink | Avoiding thinking about or talking about a stressful experience from the past or avoiding feelings related to it? | 1= Not at all 2= A little bit 3= Moderately 4= Quite a bit 5= Extremely |
| 133 | avdactiv | Avoiding activities or situations because they reminded you of a stressful experience from the past | 1= Not at all 2= A little bit 3= Moderately 4= Quite a bit 5= Extremely |
| 134 | remember | Trouble remembering important parts of a stressful experience from the past | 1= Not at all 2= A little bit 3= Moderately 4= Quite a bit 5= Extremely |
| 135 | lossint | Loss of interest in activities that you used to enjoy | 1= Not at all 2= A little bit 3= Moderately 4= Quite a bit 5= Extremely |
| 136 | distant | Feeling distant or cut off from other people | 1= Not at all 2= A little bit 3= Moderately 4= Quite a bit 5= Extremely |
| 137 | numb | Feeling emotionally numb or being unable to have loving feelings for those close to you | 1= Not at all 2= A little bit 3= Moderately 4= Quite a bit 5= Extremely |
| 138 | short | Feeling as if your future will somehow be cut short | 1= Not at all 2= A little bit 3= Moderately 4= Quite a bit 5= Extremely |
| 139 | sleep | Trouble falling or staying asleep | 1= Not at all 2= A little bit 3= Moderately 4= Quite a bit 5= Extremely |
| 140 | irritable | Feeling irritable or having angry outbursts | 1= Not at all 2= A little bit 3= Moderately 4= Quite a bit 5= Extremely |
| 141 | concentr | Having difficulty concentrating | 1= Not at all 2= A little bit 3= Moderately 4= Quite a bit 5= Extremely |
| 142 | onguard | Being 'super-alert' or watchful or on guard | 1= Not at all 2= A little bit 3= Moderately 4= Quite a bit 5= Extremely |
| 143 | jumpy | Feeling jumpy or easily startled | 1= Not at all 2= A little bit 3= Moderately 4= Quite a bit 5= Extremely |
| 144 | poorfunc | To what extent have these symptoms made you function more poorly at home, at work, or in your relationships? | 1= Not at all 2= A little bit 3= Moderately 4= Quite a bit 5= Extremely |
| 145 | prison | Have you ever been incarcerated? | 1= Yes 2= No |
| 146 | prisdura | How long was the longest time? | 1= Less than 90 days 2= 90 days to 1 year 3= 1 year to 5 years 4= More than 5 years |
| 147 | reada | PRESENT TIME Now I have some questions about how you spend your time currently. 1. About how much time do you spend reading each day? | 1= None 2= Less than one hour 3= One to less than two hours 4= Two to less than three hours 5= Three or more hours |
| 148 | diarya | In the last ten years, did you ever keep a diary or journal? | 1= Yes 2= No |
| 149 | museum | In the last ten years, how many times did you visit a museum? | 1= Never 2= 1-2 times 3= 3-9 times 4= 10-19 times 5= More than 20 times |
| 150 | concer | In the last ten years, how many times did you attend a concert, play, or musical? | 1= Never 2= 1-2 times 3= 3-9 times 4= 10-19 times 5= More than 20 times |
| 151 | lib | In the last ten years, how often did you visit a library? Would you say every day or almost every day, several times a week, several times a month, several times a year, or once a year or less? | 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less |
| 152 | newpap | Thinking of the last year, how often do you read newspapers? Would you say every day or almost every day, several times a week, several times a month, several times a year, or once a year or less? | 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less |
| 153 | magaz | During the past year, how often did you read magazines? Would you say every day or almost every day, several times a week, several times a month, several times a year, or once a year or less? | 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less |
| 154 | readc | During the past year, how often did you read books? Would you say every day or almost every day, several times a week, several times a month, several times a year, or once a year or less? | 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less |
| 155 | letter | During the past year, how often did you write letters? Would you say every day or almost every day, several times a week, several times a month, several times a year, or once a year or less? | 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less |
| 156 | usepc | During the past year, how often did you use a personal computer (for example, for e-mail, to search the internet or other reasons)? Would you say every day or almost every day, several times a week, several times a month, several times a year, or once a year or less? | 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less |
| 157 | games | During the past year, how often did you play games like checkers or other board games, cards, puzzles, word games, mind teasers, or any other similar games? Would you say every day or almost every day, several times a week, several times a month, several times a year, or once a year or less? | 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less |
| 158 | q9act | During the past year, how often did you go to restaurants, sporting events or teletract, or play bingo? | 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less |
| 159 | q10act | During the past year, how often did you go on day trips or overnight trips? | 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less |
| 160 | q11act | During the past year, how often did you do unpaid community/volunteer work? | 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less |
| 161 | q12act | During the past year, how often did you do paid community work? | 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less |
| 162 | q13act | During the past year, how often did you visit at relatives' or friends' houses? | 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less |
| 163 | q16act | During the past year, how often did you participate in any groups such as senior center, church related groups, charity, public services, or community groups? | 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less |
| 164 | q15act | During the past year, how often did you attend church or religious services? | 1= Every day or almost every day 2= Several times a week 3= Several times a month 4= Several times a year 5= Once a year or less |
| 165 | presence | SPIRITUALITY/RELIGIOUSITY The next questions are about spiritual feelings that you may experience in your daily life. I feel God's presence. Would you say that you feel this way many times a day, everyday, most days, some days, once in a while, or never or almost never? | 1= Many times a day 2= Everyday 3= Most days 4= Some days 5= Once in a while 6= Never or almost never |
| 166 | comfort | I find comfort in my religion or spirituality. (Would you say that you feel this way--many times a day, everyday, most days, some days, once in a while, or never or almost never?) | 1= Many times a day 2= Everyday 3= Most days 4= Some days 5= Once in a while 6= Never or almost never |
| 167 | inpeace | I feel deep inner peace or harmony. (Would you say that you feel this way--many times a day, everyday, most days, some days, once in a while, or never or almost never?) | 1= Many times a day 2= Everyday 3= Most days 4= Some days 5= Once in a while 6= Never or almost never |
| 168 | godlove | I feel God's love for me directly. (Would you say that you feel this way many times a day, everyday, most days, some days, once in a while, or never or almost never?) | 1= Many times a day 2= Everyday 3= Most days 4= Some days 5= Once in a while 6= Never or almost never |
| 169 | closegod | I desire to be closer to God or in union with Him. (Would you say that you feel this way many times a day, everyday, most days, some days, once in a while, or never or almost never?) | 1= Many times a day 2= Everyday 3= Most days 4= Some days 5= Once in a while 6= Never or almost never |
| 170 | oftpray | How often do you pray or meditate? (Would you say--many times a day, everyday, most days, some days, once in a while, or never or almost never?) | 1= Many times a day 2= Everyday 3= Most days 4= Some days 5= Once in a while 6= Never or almost never |
| 171 | glasses | EYESIGHT [If subject uses glasses, instruct him or her to wear them during test.] 1. Test taken with: | 1= Glasses 2= Contact lenses 3= Neither |
| 172 | trial1 | Now I would like to check your eyesight. [INTERVIEWER: Visual acuity should be checked with both eyes open. Hold card 14 inches from subject and ask him or her to read the number on the card. Record number of correct responses.] 2. First trial: 20/70 | 1= All three correct 2= Two correct 3= One correct 4= None correct |
| 173 | trial1a | 2a. Second trial: 20/100 | 1= All three correct 2= Two correct 3= One correct 4= None correct |
| 174 | trial1b | 2b. Third trial: 20/200 | 1= All three correct 2= Two correct 3= One correct 4= None correct |
| 175 | trial1c | 2c. Fourth trial: 20/400 | 1= All three correct 2= Two correct 3= One correct 4= None correct |
| 176 | trial2 | 3. Second trial: 20/50 | 1= All three correct 2= Two correct 3= One correct 4= None correct |
| 177 | trial3 | 3a. Third trial: 20/40 | 1= All three correct 2= Two correct 3= One correct 4= None correct |
| 178 | bp11 | BLOODPRESSURE Now I would like to take some arm, height and weight measurements, and blood pressure readings. 6. FIRST SITTING BLOOD PRESSURE READING [INTERVIEWER: The subject should be seated for five minutes prior to obtaining the seated blood pressure readings. ENTER SYSTOLIC/DIASTOLIC] | String[7] |
| 179 | midleg | 1b. MID LEG CIRCUMFERENCE [IN cm] | 15.0 .. 99.0 |
| 180 | bp2 | 7. SECOND SITTING BLOOD PRESSURE READING [INTERVIEWER: ENTER SYSTOLIC/DIASTOLIC] | String[7] |
| 181 | midfore | 1a. MID FOREARM CIRCUMFERENCE [IN cm] | 10.0 .. 78.0 |
| 182 | midarm | 1. MID-ARM CIRCUMFERENCE [IN cm] | 15.0 .. 78.0 |
| 183 | tricep1 | 2. FIRST TRICEPS SKINFOLD MEASUREMENT [IN mm] CODE 72 IF MEASUREMENT >= 67 mm] | 1 .. 72 |
| 184 | tricep2 | 4. SECOND TRICEPS SKINFOLD MEASUREMENT [IN mm] [CODE 72 IF MEASUREMENT >=67mm] | 1 .. 72 |
| 185 | bp31 | 8. STANDING BLOOD PRESSURE READING [INTERVIEWER: ASK THE SUBJECT TO STAND. WAIT 60 SECONDS THEN REPEAT BLOOD PRESSURE READING. ENTER SYSTOLIC/DIASTOLIC] | String[7] |
| 186 | weight | 9. MEASURED WEIGHT [IN LBS] [CODE 333 IF MEASUREMENT IS >=300 lbs. CODE 888 IF PHYSICALLY UNABLE TO WEIGH] | 30 .. 888 |
| 187 | height | 10. MEASURED HEIGHT [IN FEET & INCHES] [CODE 888 IF PHYSICALLY UNABLE TO MEASURE HEIGHT] | String[5] |
| 188 | gaitremind2 | For each exercise: Say, 'Remember to look straight ahead and stay as still as possible until I say, Begin. Ready? Begin.' Say, 'Begin' and press the forward button on the remote to start the measurement (time will start on the program) Count Steps (when applicable) Say, 'Stop' and press the Forward button a second time to end the measurement. Stop Stopwatch (when applicable) If the measurement was accurately performed, press the Slideshow button on the remote to move onto the next measurement (once Slideshow button is pressed, you CANNOT repeat the measurement) If the measurement needs to be repeated, press the Back button on the remote or select 'cancel current trial' on the computer screen. Check device to ensure green light is still flashing. [Press enter to continue] | |
| 189 | dynaintro2 | Say I'm going to place this belt around your waist. The belt contains a recording device that will track your movements. I'm going to press a button on a remote before and after each task. It is important that you don't begin the task until I say 'Begin' and don't stop until I say 'stop'. Before starting each task I want you to look straight ahead and stay as still as possibel until I say 'Begin' [Press enter to continue] | |
| 190 | walkint3 | 8 foot walk (trial 1) Place the DynaPort device around the waist of the participant, like a belt. DynaPort device should be located on the waistline, in center of the participant's back. Insert the scan disk with the participant's ID number labeled on it into the DynaPort device. Check that the green light on the DynaPort is on and then slide the device into the belt. Open the Dyrector MT program on your computer. Select the Perform tab. Make sure the COM port is selected and you have selected 'gait' under protocol. When you are ready to begin the gait test, select 'Start Measurement'. Check that the green light on the DynaPort is blinking. [Press enter to continue] | |
| 191 | walkint4 | 8 foot walk (trial 1) Now I am going to observe how you walk at your normal pace. This is our walking course. I want you to walk to the other end of the course at your usual speed, just as if you were walking to the store. I want you to walk all the way past this line until I say 'Stop.' Let me show you what my normal pace would be if I were to walk the course. [Demonstrate and then ask the participant:] Do you feel it would be safe for you to walk this course with me? [Have the participant stand with both feet together on top of the line.] Remember to look straight ahead and stay as still as possible until I say 'Begin'. Ready? Begin. [Press enter to continue] | |
| 192 | sidebysintro2 | POSTURAL STANDS: SIDE BY SIDE STAND-EYES OPEN For the next exercise, I would like you to place one foot beside the other in a comfortable position in front of this line. [Demonstrate the position.] [Optional prompt if needed:] You may use your arms, bend your knees, or move your body to maintain your balance, but try not to move your feet. Now you try it. [Extend hands palm side up for the participant to use for balance.] I'm going to support your arms while you get into the position. Try to hold this position until I say 'Stop'. [Once the position is attained, the examiner's place is to the side and slightly behind the participant.] [Press enter to continue] | |
| 193 | turn1intro2 | 360° TURN Now I would like you to make a complete turn at your normal walking pace and turn until you reach your starting point. [Demonstrate] Now you try it. Line your feet on top of the tape and begin turning when I say 'Begin' and turn until you reach your starting point. Remember to look straight ahead and stay as still as possible until I say 'Begin'. Ready? Begin. [Press enter to continue] | |
| 194 | poststndintro2 | POSTURAL STANDS: SIDE BY SIDE STAND-EYES CLOSED Now I want you to do this again, but this time I want you to do it with your eyes closed. I'm going to support your arms while you get into the position. Try to hold the position until I say 'Stop.' [Press enter to continue] | |
| 195 | getup1intro2 | GET UP AND GO (trial 1) Place a chair behind the start line for the eight foot walk. Now I'm going to have you walk this course again but this time you're going to be seated in this chair with your back rested agains the back of the chair. Then, you're going to stand up from this chair, walk to the other end of the course at your normal pace past the line, turn around, walk back to the chair and sit down. [Demonstrate exercise] [Press enter to continue] | |
| 196 | tandemintro2 | TANDEM WALK (HEEL-TOE WALK) Now I want you to walk this course again but this time I want you to place one foot in front of the other with the heel touching the toe of the other foot like this, alternating feet. [Demonstrate exercise.] If you feel you are losing your balance, step out like this and then resume walking again. I want you to continue this walk all the way past this line before you stop. Participant should start with both feet on top of the line of tape. Remind participant to stay as still as possible until you say 'begin'. Ready? Begin [Press enter to continue] | |
| 197 | walk8intro2 | BACK AND FORTH 8 FOOT WALK TWICE I would like you to walk this course again. I want you to walk to the other end of the course at your usual speed, just as if you were walking to the store. This time, however, I want you to walk all the way past this line, turn around and walk back to the starting line. When you pass the starting line I want you to turn around and walk to the other end of the course, turn around and walk back. [Demonstrate] Do you feel it would be safe for you to walk this course with me? Participant should start with both feet on top of the line of tape. Remeber to look straight ahead and stay as still as possible until I say 'Begin'. Ready? Begin. [Press enter to continue] | |
| 198 | gaitquip2 | Is the Gait Test Equipment Available? | 1= Yes 2= No |
| 199 | domove3 | [Interviewer, Is the Gait Test Equipment being worn by the participant during these exercises?] | 1= Yes 2= No |
| 200 | dynaid2 | DynaPort Device id | String[10] |
| 201 | diskid2 | Disk ID | String[10] |
| 202 | walk3 | 8 foot Walk (trial 1) Press M on the DynaPort device to start recording Say, 'Ready? Begin.' Start Stopwatch Count Steps Say, 'Stop'. Press M to stop recording Check device to ensure green light is still flashing. Is test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 203 | move7b2 | Time (seconds): | 1.0 .. 60.0 |
| 204 | move7c2 | Number of steps taken: | 1 .. 60 |
| 205 | walk4 | 8 foot Walk (trial 2) Is test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 206 | move7d2 | Time (seconds): | 1.0 .. 60.0 |
| 207 | move7e2 | Number of steps taken: | 1 .. 60 |
| 208 | move7a2 | Record Aid used for 8 foot walk: | 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair as walking aid 6= Other |
| 209 | move7a3 | [SPECIFY] | String[20] |
| 210 | sidebys2 | POSTURAL STANDS: SIDE BY SIDE STAND-EYES OPEN Press M on the DynaPort device to start recording Say, 'Ready? Begin.' Start timing with the stopwatch Say, 'Stop'. Stop the stopwatch after 20 seconds or participant falls out of position. Press M on the DynaPort device when move has ended. Check device to ensure green light is still flashing. Is the test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 211 | turn3 | 360° TURN Press M on the DynaPort device to start recording Say, 'Ready? Begin.' Start timing with the stopwatch Say, 'Stop'. Press M on the DynaPort device when the turn is completed. Check device to ensure green light is still flashing. Is the test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 212 | move6f2 | Number of steps taken: | 1 .. 60 |
| 213 | move6e2 | Time (seconds): | 1.0 .. 60.0 |
| 214 | turn4 | 360° TURN Second trial Is test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 215 | move6h2 | Number of steps: | 1 .. 60 |
| 216 | move6g2 | Time (seconds): | 1.0 .. 60.0 |
| 217 | move6i2 | Record Aid used for 360 turn: | 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other |
| 218 | move6i3 | [SPECIFY] | String[20] |
| 219 | poststnd2 | POSTURAL STANDS: SIDE BY SIDE STAND-EYES CLOSED Press M on the DynaPort device to start recording Say, 'Ready? Begin.' Start timing with the stopwatch Say, 'Stop'. Stop the stopwatch after 20 seconds or participant falls out of position. Press M on the DynaPort device when move has ended. Check device to ensure green light is still flashing. Is the test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 220 | getup3 | GET UP AND GO (trial 1) Press M on the DynaPort device to begin recording Say, 'Ready? Begin.' Press M on the DynaPort device when the participant has returned and sat back down in the chair. Check device to ensure green light is still flashing. Is the test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 221 | getup4 | GET UP AND GO (trial 2) Is the test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 222 | getaid2 | Record Aid used for GET UP AND GO: | 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other |
| 223 | getaid_specify2 | [SPECIFY] | String[20] |
| 224 | tandem2 | TANDEM WALK (HEEL-TOE WALK) Press M on the DynaPort device to begin recording Say, 'Ready? Begin.' Say, 'Stop' when participant has returned to starting point Press M on the DynaPort to stop recording Check device to ensure green light is still flashing. Is the test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 225 | move9 | Interviewer: Record number of errors, e.g. Sidesteps: | 0 .. 60 |
| 226 | tandaid2 | Record Aid used for Tandem Walk: | 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other |
| 227 | tandaid_specify2 | [SPECIFY] | String[20] |
| 228 | walk9 | BACK AND FORTH 8 FOOT WALK TWICE Press M on the DynaPort device to begin recording Say, 'Ready? Begin.' Say, 'Stop' when participant has returned to starting point Press M on the DynaPort to stop recording Check device to ensure green light is still flashing. Is the test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 229 | walk8aid2 | Record Aid used for BACK AND FORTH WALK: | 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other |
| 230 | walk8aid_specify2 | [SPECIFY] | String[20] |
| 231 | sttoeopen2 | Toe Stand (Eyes Open) Describe the position while demonstraiting. Once the participant is ready: Press M on the DynaPort device to begin recording Say, 'Ready? Begin.' Start timing with stopwatch Stop timing if the participant falls out of position or max time of 10 seconds is reached. Press M on the DynaPort device Maximum time is 10 seconds. Is the test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 232 | move7 | Time (seconds) : | 1.0 .. 10.0 |
| 233 | strlopen2 | Standing on Right Leg (Eyes Open) Describe the position and demonstrate. Once the participant is ready: Press M on the DynaPort device to begin recording Say, 'Ready? Begin.' Start timing with stopwatch Stop timing if the participant falls out of position or max time of 10 seconds is reached. Press M on the DynaPort device Maximum time is 10 seconds. Is the test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 234 | move6a2 | Time (seconds) : | 1.0 .. 10.0 |
| 235 | stllopen2 | Standing on Left Leg (Eyes Open) Describe the position and demonstrate. Once the participant is ready: Press M on the DynaPort device to begin recording Say, 'Ready? Begin.' Start timing with stopwatch Stop timing if the participant falls out of position or max time of 10 seconds is reached. Press M on the DynaPort device Maximum time is 10 seconds. Is the test performed? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 236 | move6c2 | Time (seconds) : | 1.0 .. 10.0 |
| 237 | pegboardrt2 | PURDUE PEGBOARD Is the test performed with right hand? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 238 | pegboardlt2 | PURDUE PEGBOARD Is the test performed with left hand? | 1= Yes (Pt. completed gait test) 2= Refused (Pt is able, but refused to complete test), 3= Unable (Pt. is physically/mentally unable to complete test) |
| 239 | admin5 | PURDUE PEGBOARD -- ADMINISTRATION: [PLACE PEGBOARD IN FRONT OF R, WITH WELLS AT TOP AND PEGS IN FIRST AND LAST WELLS. SAY:] `I want to see how quickly you can place these pegs [POINT] into these holes [POINT] - like this without skipping any holes. [EXAMINER PLACES 4 PEGS WITH RIGHT HAND IN RIGHT-HAND COLUMN.] Now for practice you try it with your right hand.' [ALLOW SUBJECT TO PLACE 4 PEGS IN RIGHT COLUMN; ENCOURAGE WITH `good;' REPEAT PROCESS IF SUBJECT DOES NOT COMPLETE PRACTICE ITEMS SATISFACTORILY. THEN REPLACE PEGS.] >>>>> PRESS ENTER TO CONTINUE <<<<< | String[1] |
| 240 | admin6 | [SAY: ]`Good. You have the idea. Now, when I tell you to begin, pick up the pegs one at a time and place them in this column [POINT TO RIGHT-HAND COLUMN] with your RIGHT HAND as quickly as you can. Again, please do not skip any holes. Ready? Begin. '[START TIMER AS YOU SAY `BEGIN;' EACH TRIAL IS *30 SECONDS*. WATCH R; PROMPT TO PICK UP ONLY ONE PEG AT A TIME, TO USE ONLY ONE HAND AT A TIME, AND NOT TO SKIPHOLES, AS NECESSARY; IF R MAKES SIGNIFICANT ERRORS DURING TRIAL (E.G., USING BOTH HANDS, PLACING PEGS IN WRONG COLUMN, SKIPPING HOLES, ETC.) **IT IS PERMISSIBLE TO REPEAT 1 TRIAL**. IF NECESSARY, COVER ONE COLUMN OF HOLES WITH THE PANEL THAT SLIDES OVER THE WELLS. ONLY VERBALLY REMIND BEYOND THIS, HOWEVER. AT 30 SECONDS SAY:] `stop'. >>>>> PRESS ENTER FOR FIRST TRIAL <<<<< | String[1] |
| 241 | admin7 | PURDUE PEGBOARD -- ADMINISTRATION: [PLACE PEGBOARD IN FRONT OF R, WITH WELLS AT TOP AND PEGS IN FIRST AND LAST WELLS. SAY:] `I want to see how quickly you can place these pegs [POINT] into these holes [POINT] - like this without skipping any holes. [EXAMINER PLACES 4 PEGS WITH LEFT HAND IN LEFT-HAND COLUMN.] Now for practice you try it with your left hand.' [ALLOW SUBJECT TO PLACE 4 PEGS IN RIGHT COLUMN; ENCOURAGE WITH `good;' REPEAT PROCESS IF SUBJECT DOES NOT COMPLETE PRACTICE ITEMS SATISFACTORILY. THEN REPLACE PEGS.] >>>>> PRESS ENTER TO CONTINUE <<<<< | String[1] |
| 242 | admin8 | [SAY: ]`Good. You have the idea. Now, when I tell you to begin, pick up the pegs one at a time and place them in this column [POINT TO LEFT-HAND COLUMN] with your LEFT HAND as quickly as you can. Again, please do not skip any holes. Ready? Begin. '[START TIMER AS YOU SAY `BEGIN;' EACH TRIAL IS *30 SECONDS*. WATCH R; PROMPT TO PICK UP ONLY ONE PEG AT A TIME, TO USE ONLY ONE HAND AT A TIME, AND NOT TO SKIPHOLES, AS NECESSARY; IF R MAKES SIGNIFICANT ERRORS DURING TRIAL (E.G., USING BOTH HANDS, PLACING PEGS IN WRONG COLUMN, SKIPPING HOLES, ETC.) **IT IS PERMISSIBLE TO REPEAT 1 TRIAL**. IF NECESSARY, COVER ONE COLUMN OF HOLES WITH THE PANEL THAT SLIDES OVER THE WELLS. ONLY VERBALLY REMIND BEYOND THIS, HOWEVER. AT 30 SECONDS SAY:] `stop'. >>>>> PRESS ENTER FOR FIRST TRIAL <<<<< | String[1] |
| 243 | trial12 | 1. Trial 1, Right Hand [ENTER NUMBER OF PEGS CORRECTLY PLACED] | 0 .. 25 |
| 244 | trial22 | [AT COMPLETION OF TRIAL 1, REPLACE PEGS AND SAY:] `Now I want you to do the same thing with your LEFT HAND. Pick up the pegs one at a time and place them in this column [POINT TO LEFT-HAND COLUMN] with your left hand. Work as quickly as you can and do not skip any holes. Ready? Begin.' [TRIAL IS 30 SECONDS WITH SAME PROCEDURES AS TRIAL 1.] 2. Trial 2, Left Hand [ENTER NUMBER OF PEGS CORRECTLY PLACED] | 0 .. 25 |
| 245 | trial302 | [AT COMPLETION OF TRIAL 2, REPLACE PEGS AND SAY:] `Now I want you to do this again with your RIGHT HAND. Place the pegs one at a time in this column [POINT TO RIGHT-HAND COLUMN COLUMN] with your right hand. Work as quickly as you can and do not skip any holes. Ready? Begin.' [TRIAL IS 30 SECONDS WITH SAME PROCEDURES AS TRIAL 1.] 3. Trial 3, Right Hand [ENTER NUMBER OF PEGS CORRECTLY PLACED] | 0 .. 25 |
| 246 | trial5 | [AT COMPLETION OF TRIAL 3, REPLACE PEGS AND SAY:] `Now I want you to do this again with your LEFT HAND. Place the pegs one at a time in this column [POINT TO LEFT-HAND COLUMN] with your left hand. Work as quickly as you can and do not skip any holes. Ready? Begin.' [TRIAL IS 30 SECONDS WITH SAME PROCEDURES AS TRIAL 1.] 4. Trial 4, Left Hand [ENTER NUMBER OF PEGS CORRECTLY PLACED] | 0 .. 25 |
| 247 | spiroqs | Will spirometry data be entered directly into Blaise form? | 1= Yes 2= No |
| 248 | fev11 | RESET Spirometry device FEV1 Trial 1 [Enter 95.5 for tried but unable.] _____ liters | 0.00 .. 95.50 |
| 249 | pvc1 | PVC Trial 1 _____ liters | 0.00 .. 10.00 |
| 250 | fer1 | FER Trial 1 _____ percent | 0 .. 100 |
| 251 | pef1 | PEF Trial 1 _____ liters/minute [If greater than 999, enter 999.] | 0 .. 999 |
| 252 | fev12 | RESET Spirometry device FEV1 Trial 2 [Enter 95.5 for tried but unable.] _____ liters | 0.00 .. 95.50 |
| 253 | pvc2 | PVC Trial 2 _____ liters | 0.00 .. 10.00 |
| 254 | fer2 | FER Trial 2 _____ percent | 0 .. 100 |
| 255 | pef2 | PEF Trial 2 _____ liters/minute [If greater than 999, enter 999.] | 0 .. 999 |
| 256 | spcom | Spirometry Enter any comment. [Press enter to continue if none.] | String[250] |
| 257 | q8atap | FINGER TAPPING [DEPRESS BUTTON UNTIL '--' APPEARS.] 1. Right index finger. 'I want to see how quickly you can tap this key. When I tell you to begin, tap this key as quickly as you can until I tell you to stop.' Record first trial. ______Taps completed in 10 seconds. 97 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] | 1 .. 97 |
| 258 | q8ana | Specify reason. | String[40] |
| 259 | q8btap | FINGER TAPPING [RESET TAPPER] Left index finger. Record first trial. ______Taps completed in 10 seconds. 97 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] | 1 .. 97 |
| 260 | q8bna | Specify reason. | String[40] |
| 261 | q8ctap | FINGER TAPPING [RESET TAPPER] Right index finger. Record second trial. ______Taps completed in 10 seconds. 97 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] | 1 .. 97 |
| 262 | q8cna | Specify reason. | String[40] |
| 263 | q8dtap | FINGER TAPPING [RESET TAPPER] Left index finger. Record second trial. ______Taps completed in 10 seconds. 97 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] | 1 .. 97 |
| 264 | q8dna | Specify reason. | String[40] |
| 265 | rhand1 | HAND DYNAMOMETRY [SET RED NEEDLE TO 0.] 'I want to see how strongly you can squeeze this handle. When I say go, squeeze the handle as hard as you can until I tell you to stop.' Right Hand Trial 1 [RECORD IN POUNDS.] 777 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] | 0 .. 777 |
| 266 | rhand1na | Specify reason. | String[40] |
| 267 | lhand1 | HAND DYNAMOMETRY [RESET NEEDLE TO 0.] Left Hand Trial 1 [RECORED IN POUNDS]. 777 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] | 0 .. 777 |
| 268 | lhand1na | Specify reason. | String[40] |
| 269 | rhand2 | HAND DYNAMOMETRY [RESET NEEDLE TO 0.] Right Hand Trial 2 [RECORD IN POUNDS]. 777 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] | 0 .. 777 |
| 270 | rhand2na | Specify reason. | String[40] |
| 271 | lhand2 | HAND DYNAMOMETRY [RESET NEEDLE TO 0.] Left Hand Trial 2 [RECORD IN POUNDS]. 777 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] | 0 .. 777 |
| 272 | lhand2na | Specify reason. | String[40] |
| 273 | rthand1 | PINCH DYNAMOMETRY [SET RED NEEDLE TO 0.] 'I want to see how strongly you can pinch this plate. When I say go, squeeze the plate as hard as you can until I tell you to stop.' Right Hand Trial 1 [RECORD IN POUNDS]. 77 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] | 0 .. 77 |
| 274 | rthand1n | Specify reason. | String[40] |
| 275 | lthand1 | PINCH DYNAMOMETRY [RESET NEEDLE TO 0.] Left Hand Trial 1 [RECORD IN POUNDS]. 77 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] | 0 .. 77 |
| 276 | lthand1n | Specify reason. | String[40] |
| 277 | rthand2 | PINCH DYNAMOMETRY [RESET NEEDLE TO 0.] Right Hand Trial 2 [RECORD IN POUNDS]. 77 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] | 0 .. 77 |
| 278 | rthand2n | Specify reason. | String[40] |
| 279 | lthand2 | PINCH DYNAMOMETRY [RESET NEEDLE TO 0.] Left Hand Trial 2 [RECORD IN POUNDS]. 77 : Tried but unable, Specify reason________________________ ] Don't Know, Specify reason________________________ ] Refusal - Not Attempted, Specify reason________________________ ] | 0 .. 77 |
| 280 | lthand2n | Specify reason. | String[40] |
| 281 | rtoe | Tuning Fork - Right toe [Enter 0 for absent] | 0 .. 100 |
| 282 | ltoe | Tuning Fork - Left toe [Enter 0 for absent] | 0 .. 100 |
| 283 | rankle | Tuning Fork - Right ankle [Enter 0 for absent] | 0 .. 100 |
| 284 | lankle | Tuning Fork - Left ankle [Enter 0 for absent] | 0 .. 100 |
| 285 | introp | PHYSICAL ACTIVITIY We are also interested in any physical activities that you do. I have a list of different types of activities that we ask of everyone, but most people do only one or two. [PRESS ENTER TO CONTINUE.] | String[1] |
| 286 | q1phy | In the past 14 days, have you done any of the following exercises, sports, or physically active hobbies: 1. Walking for exercise? | 1= Yes 2= No |
| 287 | q1aphy | 1a. How many times in the past 14 days did you go walking for exercise? [ENTER NUMBER OF TIMES] | 1 .. 87 |
| 288 | q1bphy | 1b. On average, about how many minutes did you actually spend on each occasion? [ENTER NUMBER OF MINUTES] [CODE 1 Hour=60 min;1.5 Hour=90 min; 2 Hours=120 min;2.5 Hours=150 min; 3 Hours=180 min;3.5 Hours=210 min; 4 Hours=240 min] | 1 .. 300 |
| 289 | q11phy | In addition to walking for exercise, in the past 14 days, have you done any other walking, for example, to go to the store, to visit someone in the neighborhood, or to go to church? | 1= Yes 2= No |
| 290 | q11aphy | 2a. How many times in the past 14 days did you go walking like that? [ENTER NUMBER OF TIMES] | 1 .. 87 |
| 291 | q11bphy | 2b. On average, about how many minutes did you actually spend on each occasion? [ENTER NUMBER OF MINUTES] [CODE 1 Hour=60 min;1.5 Hour=90 min; 2 Hours=120 min;2.5 Hours=150 min; 3 Hours=180 min;3.5 Hours=210 min; 4 Hours=240 min] | 1 .. 300 |
| 292 | q3phy | (In the past 14 days have you done) 3. Gardening or yard work? | 1= Yes 2= No |
| 293 | q3aphy | 3a. How many times in the past 14 days did you do gardening or yard work? [ENTER NUMBER OF TIMES] | 1 .. 87 |
| 294 | q3bphy | 3b. On average, about how many minutes did you actually spend on each occasion? [ENTER NUMBER OF MINUTES] [CODE 1 Hour=60 min;1.5 Hour=90 min; 2 Hours=120 min;2.5 Hours=150 min; 3 Hours=180 min;3.5 Hours=210 min; 4 Hours=240 min] | 1 .. 300 |
| 295 | q5phy | (In the past 14 days have you done) 5. Calisthenics or general exercise? | 1= Yes 2= No |
| 296 | q5aphy | 5a. How many times in the past 14 days did you do calisthenics or general exercise? [ENTER NUMBER OF TIMES] | 1 .. 87 |
| 297 | q5bphy | 5b. On average, about how many minutes did you actually spend on each occasion? [ENTER NUMBER OF MINUTES] [CODE 1 Hour=60 min;1.5 Hour=90 min; 2 Hours=120 min;2.5 Hours=150 min; 3 Hours=180 min;3.5 Hours=210 min; 4 Hours=240 min] | 1 .. 300 |
| 298 | q8phy | (In the past 14 days have you done) 8. Bicycle riding (including stationary bikes)? | 1= Yes 2= No |
| 299 | q8aphy | 8a. How many times in the past 14 days did you go bicycle riding? [ENTER NUMBER OF TIMES] | 1 .. 87 |
| 300 | q8bphy | 8b. On average, about how many minutes did you actually spend on each occasion? [ENTER NUMBER OF MINUTES] [CODE 1 Hour=60 min;1.5 Hour=90 min; 2 Hours=120 min;2.5 Hours=150 min; 3 Hours=180 min;3.5 Hours=210 min; 4 Hours=240 min] | 1 .. 300 |
| 301 | q9phy | (In the past 14 days have you done) 9. Swimming or water exercises? | 1= Yes 2= No |
| 302 | q9aphy | 9a. How many times in the past 14 days did you go swimming or do water exercises? [ENTER NUMBER OF TIMES] | 1 .. 87 |
| 303 | q9bphy | 9b. On average, about how many minutes did you actually spend on each occasion? [ENTER NUMBER OF MINUTES] [CODE 1 Hour=60 min;1.5 Hour=90 min; 2 Hours=120 min;2.5 Hours=150 min; 3 Hours=180 min;3.5 Hours=210 min; 4 Hours=240 min] | 1 .. 300 |
| 304 | q10phy | 10. Have you done any other exercises, sports, or physically active hobbies in the past 2 weeks other than the ones listed above? | 1= Yes 2= No |
| 305 | q101phy | 10.1 [SPECIFY] | String[40] |
| 306 | q10aphy | 10a. How many times in the past 14 days did you do this? [ENTER NUMBER OF TIMES] | 1 .. 87 |
| 307 | q10bphy | 10b. On average, about how many minutes did you actually spend on each occasion? [ENTER NUMBER OF MINUTES] [CODE 1 Hour=60 min;1.5 Hour=90 min; 2 Hours=120 min;2.5 Hours=150 min; 3 Hours=180 min;3.5 Hours=210 min; 4 Hours=240 min] | 1 .. 300 |
| 308 | q1drg | Now I would like to ask you about medicines. 1. During the past two weeks, HAVE YOU TAKEN ANY MEDICINE PRESCRIBED by a doctor? | 1= Yes 2= No |
| 309 | q2drg | 2. Now, about supplements not usually prescribed by a doctor such as vitamin preparations including multivitamins, vitamin C, vitamin A, vitamin D, or vitamin E . . . During the past two weeks have you taken any of these or any other vitamin preparations? | 1= Yes 2= No |
| 310 | q3drg | 3. We are also interested in other medicines or supplements not prescribed by a doctor such as aspirin, Tylenol, Bufferin, Anacin, headache pills or pain killers, laxatives or bowel medicines, cold medicines, cough medicines, sleep medicines, antacids or stomach medicines, ointments or salves . . . During the past two weeks have you taken any of these or any other medicines from the drug store? | 1= Yes 2= No |
| 311 | q4drg | 4. May I please see all these medicines for the past two weeks? [INTERVIEWER RECORD ALL MEDICINES TAKEN WITHIN THE PAST 2 WEEKS WHETHER AVAILABLE FOR INSPECTION OR NOT] [ENTER TOTAL NUMBER OF MEDICINES TO BE RECORDED] | 0 .. 50 |
| 312 | type00 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 313 | name00 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 314 | stren00 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 315 | drgnm00 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 316 | seen00 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 317 | dosage00 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 318 | recd00 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 319 | type01 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 320 | name01 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 321 | stren01 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 322 | drgnm01 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 323 | seen01 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 324 | dosage01 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 325 | recd01 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 326 | type02 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 327 | name02 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 328 | stren02 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 329 | drgnm02 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 330 | seen02 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 331 | dosage02 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 332 | recd02 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 333 | type03 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 334 | name03 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 335 | stren03 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 336 | drgnm03 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 337 | seen03 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 338 | dosage03 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 339 | recd03 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 340 | type04 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 341 | name04 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 342 | stren04 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 343 | drgnm04 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 344 | seen04 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 345 | dosage04 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 346 | recd04 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 347 | type05 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 348 | name05 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 349 | stren05 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 350 | drgnm05 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 351 | seen05 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 352 | dosage05 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 353 | recd05 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 354 | type06 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 355 | name06 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 356 | stren06 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 357 | drgnm06 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 358 | seen06 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 359 | dosage06 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 360 | recd06 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 361 | type07 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 362 | name07 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 363 | stren07 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 364 | drgnm07 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 365 | seen07 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 366 | dosage07 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 367 | recd07 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 368 | type08 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 369 | name08 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 370 | stren08 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 371 | drgnm08 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 372 | seen08 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 373 | dosage08 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 374 | recd08 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 375 | type09 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 376 | name09 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 377 | stren09 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 378 | drgnm09 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 379 | seen09 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 380 | dosage09 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 381 | recd09 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 382 | type10 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 383 | name10 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 384 | stren10 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 385 | drgnm10 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 386 | seen10 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 387 | dosage10 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 388 | recd10 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 389 | type11 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 390 | name11 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 391 | stren11 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 392 | drgnm11 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 393 | seen11 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 394 | dosage11 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 395 | recd11 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 396 | type12 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 397 | name12 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 398 | stren12 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 399 | drgnm12 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 400 | seen12 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 401 | dosage12 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 402 | recd12 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 403 | type13 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 404 | name13 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 405 | stren13 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 406 | drgnm13 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 407 | seen13 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 408 | dosage13 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 409 | recd13 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 410 | type14 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 411 | name14 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 412 | stren14 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 413 | drgnm14 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 414 | seen14 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 415 | dosage14 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 416 | recd14 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 417 | type15 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 418 | name15 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 419 | stren15 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 420 | drgnm15 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 421 | seen15 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 422 | dosage15 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 423 | recd15 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 424 | type16 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 425 | name16 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 426 | stren16 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 427 | drgnm16 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 428 | seen16 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 429 | dosage16 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 430 | recd16 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 431 | type17 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 432 | name17 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 433 | stren17 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 434 | drgnm17 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 435 | seen17 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 436 | dosage17 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 437 | recd17 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 438 | type18 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 439 | name18 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 440 | stren18 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 441 | drgnm18 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 442 | seen18 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 443 | dosage18 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 444 | recd18 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 445 | type19 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 446 | name19 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 447 | stren19 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 448 | drgnm19 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 449 | seen19 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 450 | dosage19 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 451 | recd19 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 452 | type20 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 453 | name20 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 454 | stren20 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 455 | drgnm20 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 456 | seen20 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 457 | dosage20 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 458 | recd20 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 459 | type21 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 460 | name21 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 461 | stren21 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 462 | drgnm21 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 463 | seen21 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 464 | dosage21 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 465 | recd21 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 466 | type22 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 467 | name22 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 468 | stren22 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 469 | drgnm22 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 470 | seen22 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 471 | dosage22 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 472 | recd22 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 473 | type23 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 474 | name23 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 475 | stren23 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 476 | drgnm23 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 477 | seen23 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 478 | dosage23 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 479 | recd23 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 480 | type24 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 481 | name24 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 482 | stren24 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 483 | drgnm24 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 484 | seen24 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 485 | dosage24 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 486 | recd24 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 487 | type25 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 488 | name25 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 489 | stren25 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 490 | drgnm25 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 491 | seen25 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 492 | dosage25 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 493 | recd25 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 494 | type26 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 495 | name26 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 496 | stren26 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 497 | drgnm26 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 498 | seen26 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 499 | dosage26 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 500 | recd26 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 501 | type27 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 502 | name27 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 503 | stren27 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 504 | drgnm27 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 505 | seen27 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 506 | dosage27 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 507 | recd27 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 508 | type28 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 509 | name28 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 510 | stren28 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 511 | drgnm28 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 512 | seen28 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 513 | dosage28 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 514 | recd28 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 515 | type29 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 516 | name29 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 517 | stren29 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 518 | drgnm29 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 519 | seen29 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 520 | dosage29 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 521 | recd29 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 522 | type30 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 523 | name30 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 524 | stren30 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 525 | drgnm30 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 526 | seen30 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 527 | dosage30 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 528 | recd30 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 529 | type31 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 530 | name31 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 531 | stren31 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 532 | drgnm31 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 533 | seen31 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 534 | dosage31 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 535 | recd31 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 536 | type32 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 537 | name32 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 538 | stren32 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 539 | drgnm32 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 540 | seen32 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 541 | dosage32 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 542 | recd32 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 543 | type33 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 544 | name33 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 545 | stren33 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 546 | drgnm33 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 547 | seen33 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 548 | dosage33 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 549 | recd33 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 550 | type34 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 551 | name34 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 552 | stren34 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 553 | drgnm34 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 554 | seen34 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 555 | dosage34 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 556 | recd34 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 557 | type35 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 558 | name35 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 559 | stren35 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 560 | drgnm35 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 561 | seen35 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 562 | dosage35 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 563 | recd35 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 564 | type36 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 565 | name36 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 566 | stren36 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 567 | drgnm36 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 568 | seen36 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 569 | dosage36 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 570 | recd36 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 571 | type37 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 572 | name37 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 573 | stren37 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 574 | drgnm37 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 575 | seen37 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 576 | dosage37 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 577 | recd37 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 578 | type38 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 579 | name38 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 580 | stren38 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 581 | drgnm38 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 582 | seen38 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 583 | dosage38 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 584 | recd38 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 585 | type39 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 586 | name39 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 587 | stren39 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 588 | drgnm39 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 589 | seen39 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 590 | dosage39 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 591 | recd39 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 592 | type40 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 593 | name40 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 594 | stren40 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 595 | drgnm40 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 596 | seen40 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 597 | dosage40 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 598 | recd40 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 599 | type41 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 600 | name41 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 601 | stren41 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 602 | drgnm41 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 603 | seen41 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 604 | dosage41 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 605 | recd41 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 606 | type42 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 607 | name42 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 608 | stren42 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 609 | drgnm42 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 610 | seen42 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 611 | dosage42 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 612 | recd42 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 613 | type43 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 614 | name43 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 615 | stren43 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 616 | drgnm43 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 617 | seen43 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 618 | dosage43 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 619 | recd43 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 620 | type44 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 621 | name44 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 622 | stren44 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 623 | drgnm44 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 624 | seen44 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 625 | dosage44 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 626 | recd44 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 627 | type45 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 628 | name45 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 629 | stren45 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 630 | drgnm45 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 631 | seen45 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 632 | dosage45 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 633 | recd45 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 634 | type46 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 635 | name46 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 636 | stren46 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 637 | drgnm46 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 638 | seen46 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 639 | dosage46 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 640 | recd46 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 641 | type47 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 642 | name47 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 643 | stren47 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 644 | drgnm47 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 645 | seen47 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 646 | dosage47 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 647 | recd47 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 648 | type48 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 649 | name48 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 650 | stren48 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 651 | drgnm48 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 652 | seen48 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 653 | dosage48 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 654 | recd48 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 655 | type49 | a0. [INTERVIEWER: CATEGORY OF MEDICINE] | 1= Protease Inhibitors 2= Non-Nucleoside Reverse Transcriptase Inhibitors 3= Other HIV 4= Non-HIV |
| 656 | name49 | a1. [INTERVIEWER: NAME OF MEDICINE] | String[50] |
| 657 | stren49 | a2. [INTERVIEWER: ENTER STRENGTH] | String[10] |
| 658 | drgnm49 | b. [INTERVIEWER: IS DRUG NAME FROM CONTAINER?] | 1= Yes 2= No |
| 659 | seen49 | c. [INTERVIEWER: IS DRUG SEEN?] | 1= Yes 2= No |
| 660 | dosage49 | d. On average, how many pills (capsules or other dosage units) did you take per day during the past two weeks? [CODE 66 IF TAKEN LESS THAN 01 PER DAY] | 1 .. 66 |
| 661 | recd49 | e. [INTERVIEWER: ENTER NAME OF PHARMACY AND PRESCRIPTION NO. TYPE `OTC' IF MEDICINE IS NOT PRESCRIBED] | String[40] |
| 662 | q1md | MOODS Now let me ask some questions about your current moods and feelings. The next few questions are about your feelings during the past week. For each of the following statements, please tell me if you felt that way much of the time during the past week. 1. I felt that everything I did was an effort. Have you felt this way much of the time during the past week? | 1= Yes 2= No |
| 663 | q2md | 2. My sleep was restless. (Have you felt this way much of the time during the past week?) | 1= Yes 2= No |
| 664 | q3md | 3. I felt depressed. (Have you felt this way much of the time during the past week?) | 1= Yes 2= No |
| 665 | q4md | 4. I was happy. (Have you felt this way much of the time during the past week?) | 1= Yes 2= No |
| 666 | q5md | 5. I felt lonely. (Have you felt this way much of the time during the past week?) | 1= Yes 2= No |
| 667 | q6md | 6. People were unfriendly. (Have you felt this way much of the time during the past week?) | 1= Yes 2= No |
| 668 | q7md | 7. I enjoyed life. (Have you felt this way much of the time during the past week?) | 1= Yes 2= No |
| 669 | q8md | 8. I felt sad. (Have you felt this way much of the time during the past week?) | 1= Yes 2= No |
| 670 | q9md | 9. I felt that people disliked me. (Have you felt this way much of the time during the past week?) | 1= Yes 2= No |
| 671 | q10md | 10. I could not get 'going'. (Have you felt this way much of the time during the past week?) | 1= Yes 2= No |
| 672 | q1cc | COGNITIVE COMPLAINTS Now I have some questions about your memory. 1. People find that they sometimes have more trouble remembering things as they get older. About how often do you have trouble remembering things? Would you say it is very often, often, sometimes, rarely or never? | 1= Very often 2= Often 3= Sometimes 4= Rarely 5= Never |
| 673 | q2cc | 2. Compared to 10 years ago, would you say that your memory is much worse, a little worse, the same, a little better or much better? | 1= Much worse 2= A little worse 3= The same 4= A little better 5= Much better |
| 674 | q1func | FUNCTIONAL STATUS We would also like to know how well you are able to do some physical activities that are important in day-to-day living but which many people have problems doing. 1. Are you able to do heavy work around the house, like washing windows, walls, or floors without help? | 1= Yes 2= No |
| 675 | q2func | 2. Are you able to walk up and down stairs to the second floor without help? | 1= Yes 2= No |
| 676 | q3func | 3. Are you able to walk a half mile without help? | 1= Yes 2= No |
| 677 | q4func | Next, I would like to know if you need help doing some different kinds of activities. At the present time, do you need help either from another person or a special equipment or device... 4. Walking across a small room? | 1= No help 2= Help 3= Unable to do |
| 678 | q5func | 5. Do you need help, either from another person or a special equipment or device... Bathing, either a sponge bath, tub bath or shower? | 1= No help 2= Help 3= Unable to do |
| 679 | q6func | 6. Do you need help, either from another person or a special equipment or device... Dressing, like putting on a shirt, buttoning and zipping, or putting on shoes? | 1= No help 2= Help 3= Unable to do |
| 680 | q7func | Do you need help, either from another person or a special equipment or device... 7. Eating like holding a fork, cutting food, or drinking from a glass? | 1= No help 2= Help 3= Unable to do |
| 681 | q8func | Do you need help, either from another person or a special equipment or device... 8. Getting from a bed to a chair? | 1= No help 2= Help 3= Unable to do |
| 682 | q9func | Do you need help, either from another person or a special equipment or device... 9. Using the toilet? | 1= No help 2= Help 3= Unable to do |
| 683 | q10func | Now I have a few more questions about activities people may or may not do. Although some things may actually be performed by someone else, just tell me whether you think you are able to do them. 10. Are you able to use the telephone - including looking up numbers and dialing - completely by yourself or does someone else help you? | 1= No help 2= Help 3= Unable to do |
| 684 | q12func | 12. Are you able to prepare your own meals completely by yourself or does someone else help you? | 1= No help 2= Help 3= Unable to do |
| 685 | q13func | 13. Are you able to do routine light housekeeping completely by yourself or does someone else help you? | 1= No help 2= Help 3= Unable to do |
| 686 | q14func | 14. Are you able to do periodic heavy housekeeping completely by yourself or does someone else help you? | 1= No help 2= Help 3= Unable to do |
| 687 | q16func | 16. Are you able to take your own prescribed medicines completely by yourself or does someone else help you? | 1= No help 2= Help 3= Unable to do |
| 688 | q17func | 17. Are you able to take care of your own finances - including paying bills, writing checks, keeping track of income (but not necessarily preparing your own taxes) - completely by yourself or does someone else help you? | 1= No help 2= Help 3= Unable to do |
| 689 | q20func | 20. Are you able to do your own personal shopping, like for clothes, for personal things, or for household needs completely by yourself or does someone else help you? | 1= No help 2= Help 3= Unable to do |
| 690 | q21func | 21. Are you able to travel around in your community to the places you might want to go, like to church or just to be outside completely by yourself or does someone else help you? | 1= No help 2= Help 3= Unable to do |
| 691 | married | SOCIAL NETWORK Now some questions about your social network. Have you ever been married? | 1= Yes 2= No |
| 692 | marrnum | How many times have you been married? [Enter a number between 1-10.] | 1 .. 10 |
| 693 | married2 | Are you now married, separated, divorced, or widowed? | 1= Married 2= Separated 3= Divorced 4= Widowed |
| 694 | livewith | Does your ^huswife live with you? | 1= Yes 2= No |
| 695 | q1sn | Do you have any living children? If so, how many do you have? Please include adopted children as well as children you have raised. [ENTER No. OF CHILDREN] | 0 .. 30 |
| 696 | q2sn | How many of your children do you see at least once a month? [ENTER No. OF CHILDREN] | 0 .. 30 |
| 697 | q2asn | Do you see your child at least once a month? | 1= Yes 2= No |
| 698 | q3sn | Now I'd like to ask you about your other relatives (besides your spouse and children), people that you are related to by blood or marriage. Please include grandchildren, brothers, sisters, sons-in-law and daughters-in-law, parents, aunts and uncles, and cousins. How many relatives do you have that you feel really close to - people you feel at ease with, can talk to about private matters or call upon for help? [ENTER No. OF CLOSE RELATIVES] | 0 .. 76 |
| 699 | q3asn | How many of these close relatives do you usually see at least once a month? [ENTER No. OF CLOSE RELATIVES] | 0 .. 76 |
| 700 | q3bsn | Do you see your close relative at least once a month? | 1= Yes 2= No |
| 701 | q4sn | Besides people that you are related to, how many close friends do you have; that is, people that you feel at ease with, can talk to about private matters and can call upon for help? [ENTER No. OF CLOSE FRIENDS] | 0 .. 76 |
| 702 | q4asn | How many of these close friends do you see at least once a month? [ENTER No. OF CLOSE FRIENDS] | 0 .. 15 |
| 703 | q4bsn | Do you see your close friend at least once a month? | 1= Yes 2= No |
| 704 | spanishbr | Is the participant of Spanish/Hispanic origin? [CHECK RELEASE SHEET] | 1= Yes 2= No |
| 705 | description_acc | Acculturation Although you may speak many languages, the following questions refer to only English and Spanish. [PRESS ENTER TO CONTINUE] | |
| 706 | acc_langreadspeak | Although you may speak many languages, the following questions refer to only English and Spanish. 1. In general, what language(s) do you read and speak? | 1= Only Spanish 2= Spanish better 3= Both equally 4= English better than Spanish 5= Only English |
| 707 | acc_langchild | 2. What was the language(s) you used as a child? | 1= Only Spanish 2= More Spanish than English 3= Both equally 4= More English than Spanish 5= Only English |
| 708 | acc_langhome | 3. What language(s) do you usually speak at home? | 1= Only Spanish 2= More Spanish than English 3= Both equally 4= More English than Spanish 5= Only English |
| 709 | acc_langthink | 4. In which language(s) do you usually think? | 1= Only Spanish 2= More Spanish than English 3= Both equally 4= More English than Spanish 5= Only English |
| 710 | acc_langfriend | 5. What language(s) do you usually speak with your friends? | 1= Only Spanish 2= More Spanish than English 3= Both equally 4= More English than Spanish 5= Only English |
| 711 | acc_langmedia | 6. In general, what language(s) are the movies, T.V. and radio programs you prefer to watch and listen to? | 1= Only Spanish 2= More Spanish than English 3= Both equally 4= More English than Spanish 5= Only English |
| 712 | acc_friends | 7. Your close friends are... | 1= All Hispanic/Latino 2= More Hispanic/Latino than non-Hispanic/non-Latino 3= About half and half 4= More non-Hispanic/non-Latino than Hispanic/Latino 5= All non-Hispanic/non-Latino |
| 713 | acc_social | 8. You prefer going to social gatherings/parties at which people are... | 1= All Hispanic/Latino 2= More Hispanic/Latino than non-Hispanic/non-Latino 3= About half and half 4= More non-Hispanic/non-Latino than Hispanic/Latino 5= All non-Hispanic/non-Latino |
| 714 | acc_visitors | 9. The persons you visit or who visit you are... | 1= All Hispanic/Latino 2= More Hispanic/Latino than non-Hispanic/non-Latino 3= About half and half 4= More non-Hispanic/non-Latino than Hispanic/Latino 5= All non-Hispanic/non-Latino |
| 715 | acc_kidsfriend | 10. If you could choose your children's friends you would want them to be... | 1= All Hispanic/Latino 2= More Hispanic/Latino than non-Hispanic/non-Latino 3= About half and half 4= More non-Hispanic/non-Latino than Hispanic/Latino 5= All non-Hispanic/non-Latino |
| 716 | description_fam | Familism Please indicate how much you agree or disagree with these statements by choosing the answer from 1 (disagree a lot) to 5 (agree a lot) which best shows how you feel about each statement. [PRESS ENTER TO CONTINUE] | |
| 717 | fam_grandchild | 1. One should have the hope of living long enough to see his/her grandchildren grow up. | 1= Disagree a lot 2= Disagree 3= Don't disagree or agree 4= Agree 5= Agree a lot |
| 718 | fam_parliverel | 2. Aging parents should live with relatives. | 1= Disagree a lot 2= Disagree 3= Don't disagree or agree 4= Agree 5= Agree a lot |
| 719 | fam_helprel | 3. When someone has problems he/she can count on help from his/her relatives. | 1= Disagree a lot 2= Disagree 3= Don't disagree or agree 4= Agree 5= Agree a lot |
| 720 | fam_pleasepar | 4. Much of what a son or daughter does should be done to please the parents. | 1= Disagree a lot 2= Disagree 3= Don't disagree or agree 4= Agree 5= Agree a lot |
| 721 | fam_embrass | 5. One should be embarrassed about the bad things done by his/her brothers and sisters. | 1= Disagree a lot 2= Disagree 3= Don't disagree or agree 4= Agree 5= Agree a lot |
| 722 | fam_livepar | 6. Children should live in their parents' house until they get married. | 1= Disagree a lot 2= Disagree 3= Don't disagree or agree 4= Agree 5= Agree a lot |
| 723 | meduc | PARENTAL HISTORY 6. What was the highest grade or year of regular school your mother completed? Elementary 0 1 2 3 4 5 6 7 8 High School 9 10 11 12 College 13 14 15 16 Graduate Professional 17 18 19 20 21 ... | 0 .. 30 |
| 724 | meduc2 | 6a. Would you say that she had no schooling, a few years, finished grammar school, had any high school, or any college? | 1= No schooling 2= A few years 3= Finished grammar school 4= Any high school 5= Any college |
| 725 | fwork | 11. What kind of work did your father do most of his life?(What was his job called?) [SPECIFY] | String[30] |
| 726 | feduc | 12. What was the highest grade or year of regular school your father completed? Elementary 0 1 2 3 4 5 6 7 8 High School 9 10 11 12 College 13 14 15 16 Graduate Professional 17 18 19 20 21 ... | 0 .. 30 |
| 727 | feduc2 | 12a. Would you say that he had no schooling, a few years, finished grammar school, had any high school, or any college? | 1= No schooling 2= A few years 3= Finished grammar school 4= Any high school 5= Any college |
| 728 | drive1 | DRIVING Are you currently licensed to drive? | 1= Yes 2= No |
| 729 | drive2 | Have you driven in the past 12 months? | 1= Yes 2= No |
| 730 | drive3 | Approximately how many days during a typical week are you likely to drive? | 1= 6 or 7 days 2= 3 to 5 days 3= 1 or 2 days 4= less than once per week |
| 731 | worrier | PERSONALITY-NEO Now I'd like to read some statements that may or may not describe you as a person. For each statement, please tell me how well you think the statement describes you. Please use this card to help with your responses. [READ FIRST STATEMENT, THEN ASK: Do you strongly disagree, disagree, neither agree nor disagree, agree, or strongly agree that this statement describes you? I am not a worrier. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 732 | inferior | I often feel inferior to others. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 733 | tense | I often feel tense and jittery. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 734 | getangry | I often get angry at the way people treat me. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 735 | discourg | Too often, when things go wrong, I get discouraged and feel like giving up. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 736 | helpless | I often feel helpless and want someone else to solve my problems. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 737 | neo18str | 18. When I'm under a great deal of stress, sometimes I feel like I'm going to pieces. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 738 | neo3lon | 3. I rarely feel lonely or blue. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 739 | neo9wrth | 9. Sometimes I feel completely worthless. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 740 | neo13anx | 13. I rarely feel fearful or anxious. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 741 | neo15sad | 15. I am seldom sad or depressed. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 742 | neo16ash | 16. At times I have been so ashamed I just wanted to hide. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 743 | people | I like to have a lot of people around me. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 744 | waste | I don't like to waste my time daydreaming. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 745 | courtes | I try to be courteous to everyone I meet. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 746 | belong | I keep my belongings neat and clean. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 747 | laugh | I laugh easily. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 748 | talking | I really enjoy talking to people. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 749 | alone | I usually prefer to do things alone. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 750 | cheerful | I am a cheerful, high-spirited person. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 751 | active | I am a very active person. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 752 | purpos1 | PURPOSE IN LIFE 1. I feel good when I think of what I've done in the past and what I hope to do in the future. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 753 | purpos2 | 2. I live life one day at a time and don't really think about the future. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 754 | purpos3 | 3. I tend to focus on the present, because the future nearly always brings me problems. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 755 | purpos4 | 4. I have a sense of direction and purpose in life. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 756 | purpos5 | 5. My daily activities often seem trivial and unimportant to me. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 757 | purpos6 | 6. I used to set goals for myself, but that now seems like a waste of time. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 758 | purpos7 | 7. I enjoy making plans for the future and working them to a reality. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 759 | purpos8 | 8. I am an active person in carrying out the plans I set for myself. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 760 | purpos9 | 9. Some people wander aimlessly through life, but I am not one of them. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 761 | purpos10 | 10. I sometimes feel as if I've done all there is to do in life. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 762 | emptins | SOCIAL ISOLATION I experience a general sense of emptiness. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 763 | misspeop | I miss having people around. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 764 | friends | I feel like I don't have enough friends. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 765 | abandon | I often feel abandoned. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 766 | missfrnd | I miss having a really close friend. | 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree |
| 767 | q1mdb | DISCRIMINATION Now I would like to ask you about certain experiences or feelings you have had in your daily life. In your daily life how often have you had the following experiences: 1. You are treated with less courtesy than other people. Would you say that you have had this experience...? | 1= Often 2= Sometimes 3= Rarely 4= Never |
| 768 | q2mdb | 2. You are treated with less respect than other people. [OPTIONAL: Would you say that you have had this experience...?] | 1= Often 2= Sometimes 3= Rarely 4= Never |
| 769 | q3mdb | 3. You receive poorer service than other people at restaurants or stores. [OPTIONAL: Would you say that you have had this experience...?] | 1= Often 2= Sometimes 3= Rarely 4= Never |
| 770 | q4mdb | 4. People act as if they think you are not smart. [OPTIONAL: Would you say that you have had this experience...?] | 1= Often 2= Sometimes 3= Rarely 4= Never |
| 771 | q5mdb | 5. People act as if they are afraid of you. [OPTIONAL: Would you say that you have had this experience...?] | 1= Often 2= Sometimes 3= Rarely 4= Never |
| 772 | q6mdb | 6. People act as if they think you are dishonest. [OPTIONAL: Would you say that you have had this experience...?] | 1= Often 2= Sometimes 3= Rarely 4= Never |
| 773 | q7mdb | 7. People act as if they're better than you are. [OPTIONAL: Would you say that you have had this experience...?] | 1= Often 2= Sometimes 3= Rarely 4= Never |
| 774 | q8mdb | 8. You or your family members are called names or insulted. [OPTIONAL: Would you say that you have had this experience...?] | 1= Often 2= Sometimes 3= Rarely 4= Never |
| 775 | q9mdb | 9. You are threatened or harassed. [OPTIONAL: Would you say that you have had this experience...?] | 1= Often 2= Sometimes 3= Rarely 4= Never |
| 776 | q40mdb | Overall, how much has discrimination interfered with you having a full and productive life? | 1= A lot 2= Some 3= A little 4= Not at all |
| 777 | q41mdb | Overall, how much harder has your life been because of discrimination? | 1= A lot 2= Some 3= A little 4= Not at all |
| 778 | q42mdb | Overall, how often do you think about your race? | 1= Never 2= Once in a while 3= Frequently 4= Constantly |
| 779 | q1smo | SMOKING We are interested in whether smoking or drinking beverages containing alcohol are linked to certain health problems and also whether they may have some beneficial effects. First, some questions about smoking. 1. Do you smoke cigarettes now? | 1= Yes 2= No |
| 780 | q1asmo | 1a. On average, how many cigarettes a day do you usually smoke? [ENTER NUMBER OF CIGARETTES: 1 PACK = 20 CIGARETTES] | 1 .. 200 |
| 781 | q1bsmo | 1b. How old were you when you first smoked cigarettes regularly? [ENTER AGE] | 0 .. 115 |
| 782 | q2smo | 2. Did you ever smoke cigarettes regularly? | 1= Yes 2= No |
| 783 | q2asmo | 2a. On the average, how many cigarettes a day did you usually smoke? [ENTER NUMBER OF CIGARETTES: 1 PACK = 20 CIGARETTES] | 1 .. 200 |
| 784 | q2bsmo | 2b. How old were you when you last smoked cigarettes regularly? [ENTER AGE] | 0 .. 115 |
| 785 | q2csmo | 2c. How old were you when you first smoked cigarettes regularly? [ENTER AGE] | 0 .. 115 |
| 786 | q3smo | 3. During that period of your life when you were smoking the most, about how many cigarettes a day did you usually smoke? [ENTER NUMBER OF CIGARETTES: 1 PACK = 20 CIGARETTES] | 1 .. 200 |
| 787 | q4smo | 4. Altogether, about how many years did you smoke this much? [ENTER YEARS: 01 = 1 YEAR OR LESS] | 1 .. 115 |
| 788 | q1alc | ALCOHOL USE We also have some questions on beverages that contain alcohol which may have good or bad effects on health. Included among alcoholic beverages are beer, wine and liquor, such as whiskey, rum, gin, or vodka, or any other type of alcoholic beverages. 1. In your entire life, have you had at least 12 drinks of any kind of alcoholic beverage? | 1= Yes 2= No |
| 789 | q2alc | 2. In the past 12 months, did you have at least 12 drinks of any kind of alcoholic beverage? | 1= Yes 2= No |
| 790 | q3alc | There are different types of alcoholic beverages and we would like to talk about one type at a time.3. During the past 12 months, on average, how much beer did you drink? Six or more bottles or cans per day, 4 to 5 bottles or cans per day, 2 to 3 bottles or cans per day, 1 bottle or can per day, 5 to 6 bottles or cans per WEEK, 2 to 4 bottles or cans per week, 1 bottle or can per week, 1 to 3 bottles or cans per MONTH, or less than one bottle or can per month? | 1= 6+ bottles or cans per day 2= 4-5 bottles or cans per day 3= 2-3 bottles or cans per day 4= 1 bottle or can per day 5= 5-6 bottles or cans per week 6= 2-4 bottles or cans per week 7= 1 bottle or can per week 8= 1-3 bottles or cans per month 9= Less than one bottle or can per month |
| 791 | q4alc | 4. During the past 12 months, on average, how much wine did you drink? Six or more 4-oz. glasses per day, 4 to 5 4-oz. glasses per day, 2 to 3 4-oz. glasses per day, 1 4-oz. glass per day, 5 to 6 4-oz. glasses per WEEK, 2 to 4 4-oz. glasses per week, 1 4- oz. glass per week, 1 to 3 4-oz. glasses per MONTH, or less than one 4-oz. glass per month? | 1= 6+ glasses per day 2= 4-5 glasses per day 3= 2-3 glasses per day 4= 1 glass per day 5= 5-6 glasses per week 6= 2-4 glasses per week 7= 1 glass per week 8= 1-3 glasses per month 9= Less than one glass per month |
| 792 | q5alc | 5. During the past 12 months, on average, how much liquor did you drink? That is, drinks made with whiskey, vodka, gin, brandy or liqueurs. | 1= 6+ drinks per day 2= 4-5 drinks per day 3= 2-3 drinks per day 4= 1 drink per day 5= 5-6 drinks per week 6= 2-4 drinks per week 7= 1 drink per week 8= 1-3 drinks per month 9= Less than one drink per month |
| 793 | q6alc | 6. In your entire life, when you drank the most, about how often did you drink any type of alcoholic beverage, including beer, wine and liquor? | 1= 6+ drinks per day 2= 4-5 drinks per day 3= 2-3 drinks per day 4= 1 drink per day 5= 5-6 drinks per week 6= 2-4 drinks per week 7= 1 drink per week 8= 1-3 drinks per month 9= Less than one drink per month |
| 794 | carenum | CAREGIVING Now I would like to ask you some questions about people you take care of. How many people are you currently taking care of (include children, grandchildren, spouse, sick relative or friend)? | 0 .. 10 |
| 795 | carediff | How often would you say that taking care of your family member(s) is very difficult? | 0= Never 1= Rarely 2= Sometimes 3= Much of the time 4= Always |
| 796 | q40inc | INCOME In order for us to have a clear understanding about what kinds of things affect our health, we need to get some information about income. This information will help us understand why some people do not get the health services they need. Please look at this card. Which of these income groups represents your household income at age 40? Just give me the letter that best represents your income category at that age.[ENTER LETTER] | 1= Q 2= R 3= S 4= T 5= U 6= V 7= W 8= X 9= Y 10= Z |
| 797 | q1inc | Which of these income groups represents ^husbwife2 personal income for the past year? Include income from all sources such as wages, salaries, social security or retirement benefits, help from relatives, rent from property, and so forth. Just give me the letter that represents your income category.[ENTER LETTER] | 1= Q 2= R 3= S 4= T 5= U 6= V 7= W 8= X 9= Y 10= Z |
| 798 | q2inc | Think of all the income from persons who live in the same home with you currently. Which of the following is closest to your total household income for the past year? Just give me the letter that represents your income category.[ENTER LETTER] | 1= Q 2= R 3= S 4= T 5= U 6= V 7= W 8= X 9= Y 10= Z |
| 799 | q3inc | How many people are supported in your household by the income circled above? [Interviewer: Include income provider in total number.] | 1 .. 30 |
| 800 | q4inc | How often does it happen that you do not have enough money to afford the kind of food you should have? | 1= Never 2= Once in a while 3= Fairly often 4= Very often |
| 801 | q5inc | How often does it happen that you do not have enough money to afford the kind of medical care you should have? | 1= Never 2= Once in a while 3= Fairly often 4= Very often |
| 802 | q6inc | How much difficulty do you have in meeting the monthly payments on your bills? | 1= Never 2= Once in a while 3= Fairly often 4= Very often |
| 803 | q7inc | In general, how do your finances usually work at the end of the month? Do you find that.... | 1= you ususally end up with money left over 2= you usually end with just enough money left over to make ends meet 3= you don't have enough money to make ends meet |
| 804 | contr1 | PERCEIVED LACK OF CONTROL These next questions ask you about your feelings and thoughts during the last month. 0 = never, 1 = almost never, 2 = sometimes, 3= fairly often, 4 = very often 234. In the last month, how often have you felt you were unable to control the important things in your life? | 0= Never 1= Almost Never 2= Sometimes 3= Fairly Often 4= Very Often |
| 805 | contr2 | 235. In the last month, how often have you felt confident about your ability to handle your personal problems? | 0= Never 1= Almost Never 2= Sometimes 3= Fairly Often 4= Very Often |
| 806 | contr3 | 236. In the last month, how often have you felt that things were going your way? | 0= Never 1= Almost Never 2= Sometimes 3= Fairly Often 4= Very Often |
| 807 | contr4 | 237. In the last month, how often have you felt difficulties were piling up so high that you could not overcome them? | 0= Never 1= Almost Never 2= Sometimes 3= Fairly Often 4= Very Often |
| 808 | currjob | OCCUPATION 1. The kind of work we do can also affect our health, so we would like to get some information about your occupations. We would like to know if you are currently working at a job? | 1= Yes 2= No |
| 809 | ftpt | 2. Full-time or part-time? | 1= Part-time 2= Full-time |
| 810 | cjobname | 3. What kind of work are you doing? (What is your job called?) (For example, registered nurse, personnel manager, supervisor, a teacher...) [JOB NAME] | String[30] |
| 811 | retired | 5. Are you retired? (from a job?) | 1= Yes 2= No |
| 812 | yr_ret | 5a. In what year did you retire? | 1894 .. 2040 |
| 813 | qolcomp | QUALITY OF LIFE As compared to other people your own age, would you say that your health is | 1= excellent 2= good 3= fair 4= poor |
| 814 | qolphys | How many days during the past 30 days was your physical health not good | 0 .. 30 |
| 815 | qolment | How many days during the past 30 days was your mental health not good | 0 .. 30 |
| 816 | sexactiv | SEXUAL HISTORY The next set of questions are personal questions about your sexual history and history with drug use. Some of the questions may make you feel uncomfortable. You do not have to answer questions that you do not want to. Let's start with some questions about sexual history. Are you sexually active? | 1= Yes 2= No |
| 817 | sexwith | Who do you have sex with? | 1= Men 2= Women 3= Both |
| 818 | sexnum | NUMBER OF PARTNERS LAST MONTH | 0 .. 100 |
| 819 | marijaun | DRUG USE Now I would like to ask some questions about your experience with different types of illicit drugs. Have you ever used marijuana (weed, grass, reefer) | 1= Yes 2= No |
| 820 | meth | methamphetamines (e.g. crystal, meth, tina) | 1= Yes 2= No |
| 821 | sball | heroin and cocaine mixed together (speedball) | 1= Yes 2= No |
| 822 | crack | crack (smokable cocaine, rock) | 1= Yes 2= No |
| 823 | cocaine | powder cocaine (coke) | 1= Yes 2= No |
| 824 | heroin | heroin by itself | 1= Yes 2= No |
| 825 | opiods | opioids you didn't have a prescription for (Vicodin, Percocet, Demerol, Oxycontin, non prescription methadone, etc.)? | 1= Yes 2= No |
| 826 | sedative | sedatives you didn't have a prescription for (Xanax, Valium, Paxil, Elaril, Ativan, Ambien, Seconal, etc.) | 1= Yes 2= No |
| 827 | othdrug | Other drugs | 1= Yes 2= No |
| 828 | injected | Have you ever injected any drugs that were illegal or that you did not have a prescription for? | 1= Yes 2= No |
| 829 | du_psych | Did your drug use cause ? emotional or psychological problems | 1= Yes 2= No |
| 830 | du_fam | Did your drug use cause ? problems with family, friends, work, or police? | 1= Yes 2= No |
| 831 | du_phys | Did your drug use cause ? physical health or medical problems? | 1= Yes 2= No |
| 832 | du_avoidw | Did you ever keep taking a drug to avoid withdrawal symptoms or keep from getting sick? | 1= Yes 2= No |
| 833 | du_sickw | Did you get sick or have withdrawal symptoms when you quit or missed taking a drug? | 1= Yes 2= No |
| 834 | howwell | 1. INTERVIEWER OBSERVATIONS How well do you think the participant understood the questions? | 1= Quite well 2= Fairly well 3= Somewhat 4= Very Little 5= Not at all |
| 835 | hearimp | 2. Does the participant have a SUBSTANTIAL hearing impairment? | 1= Yes 2= No |
| 836 | visimp | 3. Does the participant have a SUBSTANTIAL visual impariment? | 1= Yes, completely blind 2= Yes, very poor 3= Yes, poor 4= No, not substantial |
| 837 | phyeffrt | 4. How great an effort do you think the participant put into the physical function items? | 1= A great deal 2= A considerable amount 3= A moderate amount 4= A little bit 5= Hardly any |
| 838 | formcode | Please enter status code. 11 = COMPLETE 13 = COMPLETE, portion with proxy 12 = INCOMPLETE, refused 14 = INCOMPLETE, too impaired 21 = INCOMPLETE interim, complete later 73 = NOT TESTED, out of town 31 = NOT TESTED, moved 33 = NOT TESTED, refused 75 = NOT TESTED, hospitalized 76 = NOT TESTED, other 42 = DECEASED 43 = WITHDRAWN 44 = WITHDRAWN, Autopsy OK | 11 .. 76 |
| 839 | formpart | Was participant reluctant, and/or does participant have special needs? | 1= Yes 2= No |
| 840 | formcomm | Please explain reluctance or any other factors which may have affected this data. [Press enter if no comment needed.] | String[120] |
| 841 | statid | Please enter you staff id. | 100 .. 997 |
| 842 | formch | Has the form been modified? | 1= Yes 2= No |
| 843 | revidate | Enter the date that the form was modified. | Date type |
| 844 | revintd | Enter your staff id number. | 100 .. 997 |
| 845 | anydev | Are there any protocol deviations or missing data items to enter? | 1= Yes 2= No |
| 846 | numdev | How many total protocol deviations and tests with missing items to enter? | 1 .. 20 |
| 847 | reas00 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 848 | test00 | Enter test or procedure. | String[15] |
| 849 | item00 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 850 | code00 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 851 | oth00 | Enter other code used. | String[20] |
| 852 | expl00 | Explain what happened | String[100] |
| 853 | reas01 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 854 | test01 | Enter test or procedure. | String[15] |
| 855 | item01 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 856 | code01 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 857 | oth01 | Enter other code used. | String[20] |
| 858 | expl01 | Explain what happened | String[100] |
| 859 | reas02 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 860 | test02 | Enter test or procedure. | String[15] |
| 861 | item02 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 862 | code02 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 863 | oth02 | Enter other code used. | String[20] |
| 864 | expl02 | Explain what happened | String[100] |
| 865 | reas03 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 866 | test03 | Enter test or procedure. | String[15] |
| 867 | item03 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 868 | code03 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 869 | oth03 | Enter other code used. | String[20] |
| 870 | expl03 | Explain what happened | String[100] |
| 871 | reas04 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 872 | test04 | Enter test or procedure. | String[15] |
| 873 | item04 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 874 | code04 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 875 | oth04 | Enter other code used. | String[20] |
| 876 | expl04 | Explain what happened | String[100] |
| 877 | reas05 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 878 | test05 | Enter test or procedure. | String[15] |
| 879 | item05 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 880 | code05 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 881 | oth05 | Enter other code used. | String[20] |
| 882 | expl05 | Explain what happened | String[100] |
| 883 | reas06 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 884 | test06 | Enter test or procedure. | String[15] |
| 885 | item06 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 886 | code06 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 887 | oth06 | Enter other code used. | String[20] |
| 888 | expl06 | Explain what happened | String[100] |
| 889 | reas07 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 890 | test07 | Enter test or procedure. | String[15] |
| 891 | item07 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 892 | code07 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 893 | oth07 | Enter other code used. | String[20] |
| 894 | expl07 | Explain what happened | String[100] |
| 895 | reas08 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 896 | test08 | Enter test or procedure. | String[15] |
| 897 | item08 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 898 | code08 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 899 | oth08 | Enter other code used. | String[20] |
| 900 | expl08 | Explain what happened | String[100] |
| 901 | reas09 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 902 | test09 | Enter test or procedure. | String[15] |
| 903 | item09 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 904 | code09 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 905 | oth09 | Enter other code used. | String[20] |
| 906 | expl09 | Explain what happened | String[100] |
| 907 | reas10 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 908 | test10 | Enter test or procedure. | String[15] |
| 909 | item10 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 910 | code10 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 911 | oth10 | Enter other code used. | String[20] |
| 912 | expl10 | Explain what happened | String[100] |
| 913 | reas11 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 914 | test11 | Enter test or procedure. | String[15] |
| 915 | item11 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 916 | code11 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 917 | oth11 | Enter other code used. | String[20] |
| 918 | expl11 | Explain what happened | String[100] |
| 919 | reas12 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 920 | test12 | Enter test or procedure. | String[15] |
| 921 | item12 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 922 | code12 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 923 | oth12 | Enter other code used. | String[20] |
| 924 | expl12 | Explain what happened | String[100] |
| 925 | reas13 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 926 | test13 | Enter test or procedure. | String[15] |
| 927 | item13 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 928 | code13 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 929 | oth13 | Enter other code used. | String[20] |
| 930 | expl13 | Explain what happened | String[100] |
| 931 | reas14 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 932 | test14 | Enter test or procedure. | String[15] |
| 933 | item14 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 934 | code14 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 935 | oth14 | Enter other code used. | String[20] |
| 936 | expl14 | Explain what happened | String[100] |
| 937 | reas15 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 938 | test15 | Enter test or procedure. | String[15] |
| 939 | item15 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 940 | code15 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 941 | oth15 | Enter other code used. | String[20] |
| 942 | expl15 | Explain what happened | String[100] |
| 943 | reas16 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 944 | test16 | Enter test or procedure. | String[15] |
| 945 | item16 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 946 | code16 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 947 | oth16 | Enter other code used. | String[20] |
| 948 | expl16 | Explain what happened | String[100] |
| 949 | reas17 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 950 | test17 | Enter test or procedure. | String[15] |
| 951 | item17 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 952 | code17 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 953 | oth17 | Enter other code used. | String[20] |
| 954 | expl17 | Explain what happened | String[100] |
| 955 | reas18 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 956 | test18 | Enter test or procedure. | String[15] |
| 957 | item18 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 958 | code18 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 959 | oth18 | Enter other code used. | String[20] |
| 960 | expl18 | Explain what happened | String[100] |
| 961 | reas19 | Protocol Deviation or Missing Data? | 1= Protocol Deviation 2= Missing Data |
| 962 | test19 | Enter test or procedure. | String[15] |
| 963 | item19 | List items involved. [SEPARATE BY A COMMA] | String[20] |
| 964 | code19 | Enter data code used. | 1= Don't Know 2= Refusal 3= other |
| 965 | oth19 | Enter other code used. | String[20] |
| 966 | expl19 | Explain what happened | String[100] |
| 967 | hivchanges | [Interviewer] Has there been a change in the HIV status? | 1= Yes 2= No |
| 968 | hivpositivebranch | [Interviewer] Is the participant HIV +? [Will ask viral loads and CD4 block]? | 1= Yes 2= No |