Data Dictionary for marintfu

Number of Blaise fields: 688

Seq # Var Question Data Type/Coding
1 projid MARS FOLLOW-UP Interview (v5.1 Rev 05/07/2021) Enter project ID number. String[8]
2 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]
3 baseyear Enter year of baseline from face sheet: 1993 .. 2025
4 formno INTRODUCTION Form Number String[8]
5 version version Number. String[4]
6 autodate Automatic Date. Date type
7 autotime Automatic Time. TimeType
8 autolog Automatic Logged Date. Date type
9 intid INTERVIEWER ID 100 .. 997
10 compid Laptop ID String[20]
11 dateint Date of interview Date type
12 datlas Date of previous MARS questionnaire Date type
13 gender 1. Record participant's sex. 1= Male 2= Female
14 phone Was this interview completed on telephone or in person? 1= In-person 2= Telephone
15 autotm [COMPUTER CLOCK TIME] String[8]
16 ssnmedneeded Do we need to obtain SSN and/or Medicare# from this participant? [INTERVIEWER: Check the face sheet. Enter NO if both SSN and Medicare# have been collected. Enter NO if participant refuses to provide both SSN and Medicare#. Enter 'Yes, both' if participant is able to provide both SSN and Medicare#. Enter 'Yes, SSN only' if participant is able to provide only the SSN. Enter 'Yes, Medicare# only' if participant is able to provide only the Medicare#.] 2= No 1= Yes, both 3= Yes, SSN only 4= Yes, Medicare# only
17 q5loc What is your social security number? 0 .. 999999999
18 q5aloc [ENTER R. SOCIAL SECURITY NUMBER AGAIN] 0 .. 999999999
19 q6loc What is your medicare number? Please show me your card. String[11]
20 q6aloc [ENTER R. MEDICARE NUMBER AGAIN] String[11]
21 validated
22 validateerror
23 errorposition
24 validated_hicn_cms
25 validated_rrb_pre1964
26 validated_rrb_post1964
27 hicnformats
28 hicn_alpha
29 hicn_numbers
30 strlen
31 hicn_trimmed
32 ssn_br Do we need to obtain SSN from this participant? [INTERVIEWER: Check the face sheet. Enter YES if participant is able to provide the SSN. Enter NO if SSN is not to be collected.] 1= Yes 2= No, already collected 3= No, face sheet stated NOT to ask Pt 4= No, Pt does not have it available or is not eligible 5= No, Pt has mild reluctance 6= No, Pt has moderate reluctance 7= No, Pt has strong reluctance
33 ssn What is your social security number? [INTERVIEWER: Please enter the SSN in 000-00-0000 format.] String[11]
34 ssn_c [ENTER R. SOCIAL SECURITY NUMBER AGAIN] String[11]
35 hicn_br Do we need to obtain the old Medicare#(HICN) from this participant? [INTERVIEWER: Check the face sheet. Enter YES if participant is able to provide the HICN. Enter NO if HICN is not to be collected.] 1= Yes 2= No, already collected 3= No, face sheet stated NOT to ask Pt 4= No, Pt does not have it available or is not eligible 5= No, Pt has mild reluctance 6= No, Pt has moderate reluctance 7= No, Pt has strong reluctance
36 hicn What is your old medicare number(HICN) ? Please show me your card. [INTERVIEWER: valid HICN formats include 000000000A, 000000000C1, A000000000 or A000000.] String[11]
37 hicn_c [ENTER R. MEDICARE NUMBER(HICN) AGAIN] String[11]
38 hicn_type HICN Type: ^hicnFormats String[15]
39 mbi_br Do we need to obtain the new Medicare#(MBI) from this participant? [INTERVIEWER: Check the face sheet. Enter YES if participant is able to provide the MBI. Enter NO if MBI is not to be collected.] 1= Yes 2= No, already collected 3= No, face sheet stated NOT to ask Pt 4= No, Pt does not have it available or is not eligible 5= No, Pt has mild reluctance 6= No, Pt has moderate reluctance 7= No, Pt has strong reluctance
40 mbi What is your new medicare number(MBI) ? Please show me your card. [INTERVIEWER: Please enter the MBI in 01EG4-TE5-MK73 format.] String[13]
41 mbi_c [ENTER R. MEDICARE NUMBER(MBI) AGAIN] String[13]
42 heart MEDICAL HISTORY - CARDIOVASCULAR DISEASE Now, I have some questions about a number of specific medical conditions. 1. Since your last study interview on [last interview date], have you 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
43 multiple 1a. Did you have only one or more than one? 1= Only one 2= More than one
44 inhosp 1b Were you hospitalized overnight or longer for this (last one)? 1= Yes 2= No
45 chf CONGESTIVE HEART FAILURE Since your last interview on [last interview date], have you been told by a doctor, nurse, or therapist that you had.....congestive heart failure? 1= Yes 2= Suspect or possible 3= No
46 chfhosp Were you hospitalized overnight or longer for this? 1= Yes 2= No
47 chfnum How many times have you been hospitalized for this since your last interview on [last interview date]? 0 .. 10
48 cancer CANCER OR MALIGNANCY 1. Since your last interview on [last interview date], have you 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
49 ca1a 1a. Where was it? [OR: Where was the most recent cancer that you had?] [SPECIFY] String[20]
50 diabetes DIABETES 1. (Since your last interview on [last interview date], have you been told by a doctor, nurse or therapist that you had ...) 2. Diabetes, or sugar in the urine, or high blood sugar? 1= Yes 2= Suspect or possible 3= No
51 db1 2. Has a doctor, nurse or therapist, told you to take insulin or injections for your high blood sugar? 1= Yes 2= No
52 db3 3. Has a doctor, nurse, or therapist told you to take medicine by mouth for your high blood sugar? 1= Yes 2= No
53 highbp HIGH BLOOD PRESSURE (Since your interview on [last interview date], have you been told by a doctor, nurse or therapist that you had...) 1. High blood pressure? 1= Yes 2= Suspect or possible 3= No
54 bp3 2 Has a doctor, nurse, or therapist told you to take medicine by mouth for your high blood pressure? 1= Yes 2= No
55 thyroid THYROID DISEASE (Since your interview on [last interview date], have you been told by a doctor, nurse or therapist that you had...) 1. Thyroid disease? 1= Yes 2= Suspect or possible 3= No
56 th3 2. Has a doctor, nurse, or therapist told you to take medicine by mouth for your thyroid condition? 1= Yes 2= No
57 arthritis Arthritis Since your last study interview on ^IntroBlock_datlas, have you been told by a doctor, nurse or therapist that you had osteoarthritis? 1= Yes 2= Suspect or possible 3= No
58 gout Since your last study interview on ^IntroBlock_datlas, have you been told by a doctor, nurse or therapist that you had gout? 1= Yes 2= Suspect or possible 3= No
59 osteoporosis Since your last study interview on ^IntroBlock_datlas, have you been told by a doctor, nurse or therapist that you had osteoporosis? 1= Yes 2= Suspect or possible 3= No
60 joint_disease Since your last study interview on ^IntroBlock_datlas, have you been told by a doctor, nurse or therapist that you had other joint disease (excluding cancer)? 1= Yes 2= Suspect or possible 3= No
61 hormones HORMONE REPLACEMENT Now I'd like to ask you about hormonal medications you may have used. Hormones are sometimes used by women around the time of their change of life, after surgery on their ovaries, to control heavy or irregular menstrual periods, or for prevention of disease such as bone loss. These medications include pills, injections, vaginal creams or suppositories, or skin patches. 1. Since [last interview date], have you taken any type of estrogen hormonal medication, for example Premarin, Ogen or Estrace, or progesterone hormonal medication, for example, Provera? 1= Yes 2= Suspect 3= No
62 current 6. Are you currently taking this/these medications? 1= Yes 2= No
63 chespain CHEST PAIN Now some questions about pains in your chest. 1. Do you get pain or discomfort in your chest? 1= Yes 2= No
64 pressure 1a. Do you get pressure or heaviness in your chest? 1= Yes 2= No
65 uphill0 2. Do you get this pain (or discomfort) when you walk uphill or hurry? 1= Yes 2= No 3= Never walks uphill or hurries
66 level0 3. Do you get this pain (or discomfort) when you walk at an ordinary pace on level ground? 1= Yes 2= No
67 legpain CLAUDICATION Now some questions about pains in your legs. 1. Do you get pain in either leg while walking? 1= Yes 2= No
68 standsit 2. Does this pain ever begin when you are standing still or sitting? 1= Yes 2= No
69 calf 3. In what part of your leg do you feel it? [IF CALVES NOT MENTIONED ASK: `Anywhere else?' IF STILL NOT MENTIONED, CODE 2] 1= Pain includes calf/calves 2= Pain does not include calf
70 shrtbrth 9. Do you get short of breath at night if you sleep flat or only on one pillow? 1= Yes 2= No
71 pillows 9a. How many pillows do you need to sleep on to not be short of breath? 1 .. 9
72 grspbrth 9b. Do you wake up at night gasping for breath? 1= Yes 2= No
73 hoftshrt 9c. About how often did you have shortness of breath at night in the last month? 1= Several times/week 2= Once every night 3= A few times a week 4= Less often than once a week
74 headinj HEAD INJURY Now I have some questions about injuries. 1. Since [last interview date], have you had a head injury? 1= Yes 2= No
75 lostcons 3. Have you lost consciousness because of a head injury that occurred since [last interview date]? 1= Yes 2= Suspect or possible 3= No
76 howlong0 3c. How long were you unconscious for this (last) head injury? Would you say less than 5 seconds, between 5 seconds and 5 minutes, between 5 minutes and 1 hour, between 1 hour and 2 days, or more than 2 days? 1= < 5 seconds 2= 5 seconds - 5 minutes 3= > 5 minutes - 1 hour 4= > 1 hour - 2 days 5= > 2 days
77 hdrvehicle
78 hdrhitbyobject
79 hdrfalling
80 hdrsports
81 hdrabuse
82 hdrmilitary
83 hdrother
84 prevbisqdone BRAIN INJURY SCREENING QUESTIONNAIRE Have the BISQ questions been previously completed for this participant? ^prevBisqDoneText 1= Yes 2= No
85 bisqveh BRAIN INJURY SCREENING QUESTIONNAIRE Now I have some questions about head injuries. ^lastInterviewText0en 1. Vehicle accident?(ex: MVA, pedestrian accident, motorcycle/ATV crash) 1= Yes 2= No
86 bisqvehnum ^hdrVehicle How many times did you receive a blow to the head, in a vehicle accident? 1 .. 30
87 bisqvehloc ^hdrVehicle Did you lose consciousness? 1= Yes 2= No
88 bisqvehlocnum ^hdrVehicle How many times have you lost consciousness? 1 .. 30
89 bisqvehlocdur ^hdrVehicle What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
90 bisqvehlocyr1 ^hdrVehicle In what year did this occur (1)? 1900 .. 2050
91 bisqvehlocyr2 ^hdrVehicle In what year did this occur (2)? 1900 .. 2050
92 bisqvehlocyr3 ^hdrVehicle In what year did this occur (3)? 1900 .. 2050
93 bisqvehlocyr4 ^hdrVehicle In what year did this occur (4)? 1900 .. 2050
94 bisqvehlocyr5 ^hdrVehicle In what year did this occur (5)? 1900 .. 2050
95 bisqvehdaze ^hdrVehicle Were you dazed or confused? 1= Yes 2= No
96 bisqvehdazenum ^hdrVehicle How many times have you been dazed or confused? 1 .. 30
97 bisqvehdazedur ^hdrVehicle What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
98 bisqvehdazeyr1 ^hdrVehicle In what year did this occur (1)? 1900 .. 2050
99 bisqvehdazeyr2 ^hdrVehicle In what year did this occur (2)? 1900 .. 2050
100 bisqvehdazeyr3 ^hdrVehicle In what year did this occur (3)? 1900 .. 2050
101 bisqvehdazeyr4 ^hdrVehicle In what year did this occur (4)? 1900 .. 2050
102 bisqvehdazeyr5 ^^hdrVehicle In what year did this occur (5)? 1900 .. 2050
103 bisqhit ^lastInterviewText1en 2. Hit by an object?(ex: equipment, falling object) 1= Yes 2= No
104 bisqhitnum ^hdrHitByObject How many times did you receive a blow to the head, from a falling object? 1 .. 30
105 bisqhitloc ^hdrHitByObject Did you lose consciousness? 1= Yes 2= No
106 bisqhitlocnum ^hdrHitByObject How many times have you lost consciousness? 1 .. 30
107 bisqhitlocdur ^hdrHitByObject What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
108 bisqhitlocyr1 ^hdrHitByObject In what year did this occur (1)? 1900 .. 2050
109 bisqhitlocyr2 ^hdrHitByObject In what year did this occur (2)? 1900 .. 2050
110 bisqhitlocyr3 ^hdrHitByObject In what year did this occur (3)? 1900 .. 2050
111 bisqhitlocyr4 ^hdrHitByObject In what year did this occur (4)? 1900 .. 2050
112 bisqhitlocyr5 ^hdrHitByObject In what year did this occur (5)? 1900 .. 2050
113 bisqhitdaze ^hdrHitByObject Were you dazed or confused? 1= Yes 2= No
114 bisqhitdazenum ^hdrHitByObject How many times have you been dazed or confused? 1 .. 30
115 bisqhitdazedur ^hdrHitByObject What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
116 bisqhitdazeyr1 ^hdrHitByObject In what year did this occur (1)? 1900 .. 2050
117 bisqhitdazeyr2 ^hdrHitByObject In what year did this occur (2)? 1900 .. 2050
118 bisqhitdazeyr3 ^hdrHitByObject In what year did this occur (3)? 1900 .. 2050
119 bisqhitdazeyr4 ^hdrHitByObject In what year did this occur (4)? 1900 .. 2050
120 bisqhitdazeyr5 ^hdrHitByObject In what year did this occur (5)? 1900 .. 2050
121 bisqfall ^lastInterviewText2en 3. Falling? (ex: down stairs, during a fainting spell, from a high place) 1= Yes 2= No
122 bisqfallnum ^hdrFalling How many times did you receive a blow to the head, in a fall? 1 .. 30
123 bisqfallloc ^hdrFalling Did you lose consciousness? 1= Yes 2= No
124 bisqfalllocnum ^hdrFalling How many times have you lost consciousness? 1 .. 30
125 bisqfalllocdur ^hdrFalling What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
126 bisqfalllocyr1 ^hdrFalling In what year did this occur (1)? 1900 .. 2050
127 bisqfalllocyr2 ^hdrFalling In what year did this occur (2)? 1900 .. 2050
128 bisqfalllocyr3 ^hdrFalling In what year did this occur (3)? 1900 .. 2050
129 bisqfalllocyr4 ^hdrFalling In what year did this occur (4)? 1900 .. 2050
130 bisqfalllocyr5 ^hdrFalling In what year did this occur (5)? 1900 .. 2050
131 bisqfalldaze ^hdrFalling Were you dazed or confused? 1= Yes 2= No
132 bisqfalldazenum ^hdrFalling How many times have you been dazed or confused? 1 .. 30
133 bisqfalldazedur ^hdrFalling What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
134 bisqfalldazeyr1 ^hdrFalling In what year did this occur (1)? 1900 .. 2050
135 bisqfalldazeyr2 ^hdrFalling In what year did this occur (2)? 1900 .. 2050
136 bisqfalldazeyr3 ^hdrFalling In what year did this occur (3)? 1900 .. 2050
137 bisqfalldazeyr4 ^hdrFalling In what year did this occur (4)? 1900 .. 2050
138 bisqfalldazeyr5 ^hdrFalling In what year did this occur (5)? 1900 .. 2050
139 bisqsprt ^lastInterviewText3en 4. Sports/Leisure?(ex: sports, biking, skiing, on the playground) 1= Yes 2= No
140 bisqsprtnum ^hdrSports How many times did you receive a blow to the head, during a sports or leisure activity? 1 .. 30
141 bisqsprtloc ^hdrSports Did you lose consciousness? 1= Yes 2= No
142 bisqsprtlocnum ^hdrSports How many times have you lost consciousness? 1 .. 30
143 bisqsprtlocdur ^hdrSports What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
144 bisqsprtlocyr1 ^hdrSports In what year did this occur (1)? 1900 .. 2050
145 bisqsprtlocyr2 ^hdrSports In what year did this occur (2)? 1900 .. 2050
146 bisqsprtlocyr3 ^hdrSports In what year did this occur (3)? 1900 .. 2050
147 bisqsprtlocyr4 ^hdrSports In what year did this occur (4)? 1900 .. 2050
148 bisqsprtlocyr5 ^hdrSports In what year did this occur (5)? 1900 .. 2050
149 bisqsprtdaze ^hdrSports Were you dazed or confused? 1= Yes 2= No
150 bisqsprtdazenum ^hdrSports How many times have you been dazed or confused? 1 .. 30
151 bisqsprtdazedur ^hdrSports What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
152 bisqsprtdazeyr1 ^hdrSports In what year did this occur (1)? 1900 .. 2050
153 bisqsprtdazeyr2 ^hdrSports In what year did this occur (2)? 1900 .. 2050
154 bisqsprtdazeyr3 ^hdrSports In what year did this occur (3)? 1900 .. 2050
155 bisqsprtdazeyr4 ^hdrSports In what year did this occur (4)? 1900 .. 2050
156 bisqsprtdazeyr5 ^hdrSports In what year did this occur (5)? 1900 .. 2050
157 bisqphys ^lastInterviewText4en 5. Physical Abuse/Assault?(ex: mugged) 1= Yes 2= No
158 bisqphysnum ^hdrAbuse How many times did you receive a blow to the head, from abuse or assault? 1 .. 30
159 bisqphysloc ^hdrAbuse Did you lose consciousness? 1= Yes 2= No
160 bisqphyslocnum ^hdrAbuse How many times have you lost consciousness? 1 .. 30
161 bisqphyslocdur ^hdrAbuse What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
162 bisqphyslocyr1 ^hdrAbuse In what year did this occur (1)? 1900 .. 2050
163 bisqphyslocyr2 ^hdrAbuse In what year did this occur (2)? 1900 .. 2050
164 bisqphyslocyr3 ^hdrAbuse In what year did this occur (3)? 1900 .. 2050
165 bisqphyslocyr4 ^hdrAbuse In what year did this occur (4)? 1900 .. 2050
166 bisqphyslocyr5 ^hdrAbuse In what year did this occur (5)? 1900 .. 2050
167 bisqphysdaze ^hdrAbuse Were you dazed or confused? 1= Yes 2= No
168 bisqphysdazenum ^hdrAbuse How many times have you been dazed or confused? 1 .. 30
169 bisqphysdazedur ^hdrAbuse What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
170 bisqphysdazeyr1 ^hdrAbuse In what year did this occur (1)? 1900 .. 2050
171 bisqphysdazeyr2 ^hdrAbuse In what year did this occur (2)? 1900 .. 2050
172 bisqphysdazeyr3 ^hdrAbuse In what year did this occur (3)? 1900 .. 2050
173 bisqphysdazeyr4 ^hdrAbuse In what year did this occur (4)? 1900 .. 2050
174 bisqphysdazeyr5 ^hdrAbuse In what year did this occur (5)? 1900 .. 2050
175 bisqmil ^lastInterviewText5en 6. Military Service?(ex: training, blast injury) 1= Yes 2= No
176 bisqmilnum ^hdrMilitary How many times did you receive a blow to the head, during military service? 1 .. 30
177 bisqmilloc ^hdrMilitary Did you lose consciousness? 1= Yes 2= No
178 bisqmillocnum ^hdrMilitary How many times have you lost consciousness? 1 .. 30
179 bisqmillocdur ^hdrMilitary What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
180 bisqmillocyr1 ^hdrMilitary In what year did this occur (1)? 1900 .. 2050
181 bisqmillocyr2 ^hdrMilitary In what year did this occur (2)? 1900 .. 2050
182 bisqmillocyr3 ^hdrMilitary In what year did this occur (3)? 1900 .. 2050
183 bisqmillocyr4 ^hdrMilitary In what year did this occur (4)? 1900 .. 2050
184 bisqmillocyr5 ^hdrMilitary In what year did this occur (5)? 1900 .. 2050
185 bisqmildaze ^hdrMilitary Were you dazed or confused? 1= Yes 2= No
186 bisqmildazenum ^hdrMilitary How many times have you been dazed or confused? 1 .. 30
187 bisqmildazedur ^hdrMilitary What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
188 bisqmildazeyr1 ^hdrMilitary In what year did this occur (1)? 1900 .. 2050
189 bisqmildazeyr2 ^hdrMilitary In what year did this occur (2)? 1900 .. 2050
190 bisqmildazeyr3 ^hdrMilitary In what year did this occur (3)? 1900 .. 2050
191 bisqmildazeyr4 ^hdrMilitary In what year did this occur (4)? 1900 .. 2050
192 bisqmildazeyr5 ^hdrMilitary In what year did this occur (5)? 1900 .. 2050
193 bisqoth ^lastInterviewText6en 7. In any other circumstances? 1= Yes 2= No
194 bisqothsp ^hdrOther Please specify: String[255]
195 bisqothnum ^hdrOther How many times did you receive a blow to the head, in a situation I have not mentioned? 1 .. 30
196 bisqothloc ^hdrOther Did you lose consciousness? 1= Yes 2= No
197 bisqothlocnum ^hdrOther How many times have you lost consciousness? 1 .. 30
198 bisqothlocdur ^hdrOther What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
199 bisqothlocyr1 ^hdrOther In what year did this occur (1)? 1900 .. 2050
200 bisqothlocyr2 ^hdrOther In what year did this occur (2)? 1900 .. 2050
201 bisqothlocyr3 ^hdrOther In what year did this occur (3)? 1900 .. 2050
202 bisqothlocyr4 ^hdrOther In what year did this occur (4)? 1900 .. 2050
203 bisqothlocyr5 ^hdrOther In what year did this occur (5)? 1900 .. 2050
204 bisqothdaze ^hdrOther Were you dazed or confused? 1= Yes 2= No
205 bisqothdazenum ^hdrOther How many times have you been dazed or confused? 1 .. 30
206 bisqothdazedur ^hdrOther What was the longest duration? 1= Don't know 2= Less than 5 seconds. 3= Less than 1 min. 4= 1-5 mins. 5= 6-10 mins. 6= 11-20 mins. 7= 21-30 mins. 8= 31-45 mins. 9= 46-60 mins. 10= 1 hour-23 hours 11= 1-2 days 12= 2 days-1 week 13= 1 week-1 month 14= More than 1 mo.
207 bisqothdazeyr1 ^hdrOther In what year did this occur (1)? 1900 .. 2050
208 bisqothdazeyr2 ^hdrOther In what year did this occur (2)? 1900 .. 2050
209 bisqothdazeyr3 ^hdrOther In what year did this occur (3)? 1900 .. 2050
210 bisqothdazeyr4 ^hdrOther In what year did this occur (4)? 1900 .. 2050
211 bisqothdazeyr5 ^hdrOther In what year did this occur (5)? 1900 .. 2050
212 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
213 q2md 2. My sleep was restless. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
214 q3md 3. I felt depressed. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
215 q4md 4. I was happy. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
216 q5md 5. I felt lonely. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
217 q6md 6. People were unfriendly. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
218 q7md 7. I enjoyed life. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
219 q8md 8. I felt sad. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
220 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
221 q10md 10. I could not get 'going'. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
222 howfeel DEPRESSION Now I have a few more questions about how you feel. 1. In the past month, has there been a period of two weeks or more during which you felt sad, blue, depressed, or when you lost interest and pleasure in things you usually cared about or enjoyed? 1= Yes 2= No
223 aptite During this period during which you felt depressed, did you experience any of the following problems? 2. A change in your appetite 1= Yes 2= No
224 sleep 3. A change in your pattern of sleeping. 1= Yes 2= No
225 enrgy 4. A decrease in your energy level. 1= Yes 2= No
226 concen 5. Trouble concentrating. 1= Yes 2= No
227 guilt 6. Felt extremely guilty or worthless. 1= Yes 2= No
228 restls 7. Felt extremely restless or agitated. 1= Yes 2= No
229 activt 8. Lost your interest in favorite activities. 1= Yes 2= No
230 living 9. Felt that life was not worth living. 1= Yes 2= No
231 teldoc 9a. Did you tell a doctor or any other professional about it? 1= Yes 2= No
232 gds1 GDS Scale 1. Are you basically satisfied with your life? 1= Yes 2= No
233 gds2 2. Have you dropped many of your activities and interests? 1= Yes 2= No
234 gds3 3. Do you feel that your life is empty? 1= Yes 2= No
235 gds4 4. Do you often get bored? 1= Yes 2= No
236 gds5 5. Are you in good spirits most of the time? 1= Yes 2= No
237 gds6 6. Are you afraid that something bad is going to happen to you? 1= Yes 2= No
238 gds7 7. Do you feel happy most of the time? 1= Yes 2= No
239 gds8 8. Do you often feel helpless? 1= Yes 2= No
240 gds9 9. Do you prefer to stay at home, rather than going out and doing new things? 1= Yes 2= No
241 gds10 10. Do you feel that you have more problems with memory than most? 1= Yes 2= No
242 gds11 11. Do you think it is wonderful to be alive? 1= Yes 2= No
243 gds12 12. Do you feel pretty worthless the way you are now? 1= Yes 2= No
244 gds13 13. Do you feel full of energy? 1= Yes 2= No
245 gds14 14. Do you feel that your situation is hopeless? 1= Yes 2= No
246 gds15 15. Do you think that most people are better off than you are? 1= Yes 2= No
247 reada Present Time Now I have some questions about how you spend your time. 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
248 diary2 10. Since your last interview on [last interview date], have you kept a diary or journal? 1= Yes 2= No
249 museum2 11. Since your last interview on [last interview date], have you visited a museum? 1= Yes 2= No
250 concer2 12. Since your last interview on [last interview date], have you attended a concert, play, or musical? 1= Yes 2= No
251 lib2001 13. Thinking of the last year, 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
252 newpap 14. During the past year, how often did 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
253 magaz 15. 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
254 readc 16. 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
255 letter 17. 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
256 usepc 18. 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
257 games 18. 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
258 q9act 9. 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
259 q10act 10. 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
260 q11act 11. 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
261 q12act 12. 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
262 q13act 13. 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
263 q16act 16. 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
264 q15act 15. 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
265 q17act 17. During the past year, how often did you go shopping with friends (like to a mall)? 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
266 q18act 18. During the past year, how often did you go to parties or other social events (e.g., senior dances, nightclubs)? 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
267 comfort The next questions are about spiritual feelings that you may experience in your daily life. 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
268 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
269 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
270 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
271 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
272 recogfr1 VISION/HEARING Now I have some questions about your vision and hearing. 1. (When wearing eyeglasses/contact lenses) Can you see well enough to recognize a friend across a room? 1= Yes 2= No
273 recogfr2 2. (When wearing eyeglasses/contact lenses) Can you see well enough to recognize a friend across the street? 1= Yes 2= No
274 hearing1 3. (With/without a hearing aid) Can you usually hear and understand what a person says without seeing his face if that person talks in a normal voice to you in a quiet room? 1= Yes 2= No
275 hearing2 4. (With/without a hearing aid) How often do you have difficulty understanding people over the telephone? 1= Almost always 2= Occasionally 3= Rarely or never
276 glasses [If subject uses glasses, instruct him or her to wear them during test.] 1. Test taken with: 1= Glasses 2= Contact lenses 3= Neither
277 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
278 trial1a 2a. Second trial: 20/100 1= All three correct 2= Two correct 3= One correct 4= None correct
279 trial1b 2b. Third trial: 20/200 1= All three correct 2= Two correct 3= One correct 4= None correct
280 trial1c 2c. Fourth trial: 20/400 1= All three correct 2= Two correct 3= One correct 4= None correct
281 trial2 3. Second trial: 20/50 1= All three correct 2= Two correct 3= One correct 4= None correct
282 trial3 3a. Third trial: 20/40 1= All three correct 2= Two correct 3= One correct 4= None correct
283 midarm BLOODPRESSURE Now I would like to take some measurements of your arm, hips, and waist, as well as height, weight and blood pressure. 1. MID-ARM CIRCUMFERENCE [IN cm] 15.0 .. 78.0
284 midfore 1a. MID FOREARM CIRCUMFERENCE [IN cm] 10.0 .. 78.0
285 midleg 1b. MID LEG CIRCUMFERENCE [IN cm] 15.0 .. 99.0
286 tricep1 2. FIRST TRICEPS SKINFOLD MEASUREMENT [IN mm] CODE 72 IF MEASUREMENT >= 67 mm] 1 .. 72
287 cuff 3. IS CUFF SIZE AVAILABLE? [IF CUFF NOT AVAILABLE, AT END OF INTERVIEW SET UP TIME TO RETURN FOR BLOOD PRESSURE MEASUREMENT] 1= Yes 2= No
288 tricep2 4. SECOND TRICEPS SKINFOLD MEASUREMENT [IN mm] [CODE 72 IF MEASUREMENT >=67mm] 1 .. 72
289 pulsept 5. PULSE OBLITERATION POINT [IN mmHg] 50 .. 270
290 pul THE PEAK INFLATION LEVEL IS ^pulse [HIT ENTER FOR NEXT QUESTION] 80 .. 300
291 bp11 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]
292 bp2 7. SECOND SITTING BLOOD PRESSURE READING [INTERVIEWER: ENTER SYSTOLIC/DIASTOLIC] String[7]
293 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]
294 weight 9. MEASURED WEIGHT [IN LBS] [CODE 333 IF MEASUREMENT IS >=300 lbs. CODE 888 IF PHYSICALLY UNABLE TO WEIGH] 30 .. 888
295 height 10. MEASURED HEIGHT [IN FEET & INCHES] [CODE 888 IF PHYSICALLY UNABLE TO MEASURE HEIGHT] String[5]
296 waist Measured waist circumference [IN cm] [To measure waist circumference (WC), place a measuring tape in a horizontal plane around the abdomen ? midway between the bottom of the rib cage and the top of the iliac crest.] [Code 333 IF MEASUREMENT >= 125 cm. CODE 888 IF PHYSICALLY UNABLE TO measure] 50 .. 888
297 hipcirc Measured hip circumference [IN cm] [To measure hip circumference (HC), place a measuring tape in a horizontal plane around the largest part of the hips ? the widest part of the buttocks.] [Code 333 IF MEASUREMENT >= 125 cm. Code 888 IF PHYSICALLY UNABLE TO measure] 50 .. 888
298 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]
299 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]
300 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]
301 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]
302 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]
303 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]
304 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]
305 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]
306 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]
307 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]
308 gaitquip Is the Gait Test Equipment Available? 1= Yes 2= No
309 domove2 [Interviewer, Is the Gait Test Equipment being worn by the participant during these exercises?] 1= Yes 2= No
310 dynaid DynaPort Device id String[10]
311 diskid Disk ID String[10]
312 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)
313 move7b Time (seconds): 1.0 .. 60.0
314 move7c Number of steps taken: 1 .. 60
315 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)
316 move7d Time (seconds): 1.0 .. 60.0
317 move7e Number of steps taken: 1 .. 60
318 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
319 move7a1 [SPECIFY] String[20]
320 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)
321 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)
322 move6f Number of steps taken: 1 .. 60
323 move6e Time (seconds): 1.0 .. 60.0
324 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)
325 move6h Number of steps: 1 .. 60
326 move6g Time (seconds): 1.0 .. 60.0
327 move6i Record Aid used for 360 turn: 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other
328 move6i1 [SPECIFY] String[20]
329 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)
330 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)
331 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)
332 getaid Record Aid used for GET UP AND GO: 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other
333 getaid_specify [SPECIFY] String[20]
334 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)
335 move8 Interviewer: Record number of errors, e.g. Sidesteps: 0 .. 60
336 tandaid Record Aid used for Tandem Walk: 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other
337 tandaid_specify [SPECIFY] String[20]
338 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)
339 walk8aid Record Aid used for BACK AND FORTH WALK: 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other
340 walk8aid_specify [SPECIFY] String[20]
341 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)
342 move6 Time (seconds) : 1.0 .. 10.0
343 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)
344 move6a Time (seconds) : 1.0 .. 10.0
345 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)
346 move6c Time (seconds) : 1.0 .. 10.0
347 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)
348 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)
349 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]
350 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]
351 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]
352 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]
353 trial11 1. Trial 1, Right Hand [ENTER NUMBER OF PEGS CORRECTLY PLACED] 0 .. 25
354 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
355 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
356 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
357 introp PHYSICAL ACTIVITY 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]
358 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
359 q1aphy 1a. How many times in the past 14 days did you go walking for exercise? [ENTER NUMBER OF TIMES] 1 .. 87
360 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
361 q11aphy 2a. How many times in the past 14 days did you go walking like that? [ENTER NUMBER OF TIMES] 1 .. 87
362 q3phy (In the past 14 days have you done) 3. Gardening or yard work? 1= Yes 2= No
363 q3aphy 3a. How many times in the past 14 days did you do gardening or yard work? [ENTER NUMBER OF TIMES] 1 .. 87
364 q5phy (In the past 14 days have you done) 5. Calisthenics or general exercise? 1= Yes 2= No
365 q5aphy 5a. How many times in the past 14 days did you do calisthenics or general exercise? [ENTER NUMBER OF TIMES] 1 .. 87
366 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
367 q101phy 10.1 [SPECIFY] String[40]
368 q10aphy 10a. How many times in the past 14 days did you do this? [ENTER NUMBER OF TIMES] 1 .. 87
369 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
370 q2func 2. Are you able to walk up and down stairs to the second floor without help? 1= Yes 2= No
371 q3func 3. Are you able to walk a half mile without help? 1= Yes 2= No
372 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
373 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
374 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
375 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
376 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
377 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
378 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
379 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
380 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
381 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
382 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
383 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
384 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
385 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
386 q1urin Next we would like to ask a few questions about common problems that people have as they grow older. We would appreciate your answers to these questions even though you may not have any problems. URINARY INCONTINENCE 1. How often during the last month have you leaked urine or lost control of your urine - almost everyday (5-7 days/week), several times a week (2-4 days/week), several times a month (2-4 days/month), once a month less than once a month, or never? 1= Almost everyday (5-7 days/week) 2= Several times a week (2-4 days/week) 3= Several times a month (2-4 days/month) 4= Once a month 5= Less than once a month 6= Never
387 fecal1 FECAL INCONTINENCE 1. How would you describe your usual bowel pattern? 1= Normal 2= Constipated 3= Diarrhea 4= Alternating constipation and diarrhea
388 fecal2 2. In the past few months, have you ever lost control of your bowels when you did not want to? 1= Yes 2= Suspect 3= No
389 fecal3 3. How often in the past year have you seen your doctor for problems with your bowels? 1= None 2= 1-2 times 3= More than 3 times
390 married SOCIAL NETWORK Now some questions about your social network. I know that we asked you these questions last year, but we need to ask again for our records. Have you ever been married? 1= Yes 2= No
391 marrnum How many times have you been married? [Enter a number between 1-10.] 1 .. 10
392 married2 Are you now married, separated, divorced, or widowed? 1= Married 2= Separated 3= Divorced 4= Widowed
393 livewith Does your ^huswife live with you? 1= Yes 2= No
394 q1sn How many living children do you have? Please include adopted children as well as children you have raised. [ENTER No. OF CHILDREN] 0 .. 30
395 q2sn How many of your children do you see at least once a month? [ENTER No. OF CHILDREN] 0 .. 30
396 q2asn Do you see your child at least once a month? 1= Yes 2= No
397 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
398 q3asn How many of these close relatives do you usually see at least once a month? [ENTER No. OF CLOSE RELATIVES] 0 .. 76
399 q3bsn Do you see your close relative at least once a month? 1= Yes 2= No
400 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
401 q4asn How many of these close friends do you see at least once a month? [ENTER No. OF CLOSE FRIENDS] 0 .. 15
402 q4bsn Do you see your close friend at least once a month? 1= Yes 2= No
403 spanishbr Is the participant of Spanish/Hispanic origin? [CHECK RELEASE SHEET] 1= Yes 2= No
404 spanish_fluent Is the participant fluent in Spanish? [CHECK RELEASE SHEET] 1= Yes 2= No
405 safe_accult_6 Ask question #6 in the SAFE - Acculturation Stress Scale 1= Yes 2= No
406 description_acc Acculturation Although you may speak many languages, the following questions refer to only English and Spanish. [PRESS ENTER TO CONTINUE]
407 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
408 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
409 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
410 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
411 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
412 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
413 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
414 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
415 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
416 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
417 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]
418 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
419 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
420 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
421 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
422 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
423 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
424 pnes_description PNES Perception I'm going to read you a list of statements about neighborhoods. Please tell me how much you agree or disagree with each statement as it relates to the neighborhood you live in now. In answering these questions, please think of your neighborhood as the area within about a 20 minute walk (or about a mile) from your house. [PRESS ENTER TO CONTINUE]
425 pnes_wellmaintain 1. In my neighborhood the buildings and homes are well-maintained. 1= Strongly Agree 2= Agree 3= Neutral (neither agree or disagree) 4= Disagree 5= Strongly Disagree
426 pnes_attractive 2. My neighborhood is attractive. 1= Strongly Agree 2= Agree 3= Neutral (neither agree or disagree) 4= Disagree 5= Strongly Disagree
427 pnes_noise 3. There is a lot of noise in my neighborhood. 1= Strongly Agree 2= Agree 3= Neutral (neither agree or disagree) 4= Disagree 5= Strongly Disagree
428 pnes_freshproduce 4. A large selection of fresh fruits and vegetables is available in my neighborhood. 1= Strongly Agree 2= Agree 3= Neutral (neither agree or disagree) 4= Disagree 5= Strongly Disagree
429 pnes_fastfood 5. There are many opportunities to purchase fast foods in my neighborhood. 1= Strongly Agree 2= Agree 3= Neutral (neither agree or disagree) 4= Disagree 5= Strongly Disagree
430 pnes_active 6. My neighborhood offers many opportunities to be physically active. 1= Strongly Agree 2= Agree 3= Neutral (neither agree or disagree) 4= Disagree 5= Strongly Disagree
431 pnes_facilities 7. Local sports clubs and other facilities in my neighborhood offer many opportunities to get exercise. 1= Strongly Agree 2= Agree 3= Neutral (neither agree or disagree) 4= Disagree 5= Strongly Disagree
432 pnes_walk 8. It is pleasant to walk in my neighborhood. 1= Strongly Agree 2= Agree 3= Neutral (neither agree or disagree) 4= Disagree 5= Strongly Disagree
433 pnes_traffic 9. My neighborhood has heavy traffic. 1= Strongly Agree 2= Agree 3= Neutral (neither agree or disagree) 4= Disagree 5= Strongly Disagree
434 pnes_help 10. People around here are willing to help their neighbors. 1= Strongly Agree 2= Agree 3= Neutral (neither agree or disagree) 4= Disagree 5= Strongly Disagree
435 pnes_getalong 11. People in my neighborhood generally get along with each other. 1= Strongly Agree 2= Agree 3= Neutral (neither agree or disagree) 4= Disagree 5= Strongly Disagree
436 pnes_trusted 12. People in my neighborhood can be trusted. 1= Strongly Agree 2= Agree 3= Neutral (neither agree or disagree) 4= Disagree 5= Strongly Disagree
437 pnes_howlong_year How long have you lived in your neighborhood? _____ years, 0 .. 199
438 pnes_howlong_month and/or _____ months 0 .. 11
439 pnes_howlong1_year How long have you lived at your current address? _____ years, 0 .. 199
440 pnes_howlong1_month and/or _____ months 0 .. 11
441 safe_description I'm going to read you a list of statements describing some potentially stressful experiences. Regardless of whether you've experienced these situations yourself, please tell me how stressful you might find each situation. [PRESS ENTER TO CONTINUE]
442 safe_pressure 1. People pressuring you to fit in. 1= Not stressful 2= Mildly stressful 3= Neutral (neither stressful or stress free) 4= Stressful 5= Extremely Stressful
443 safe_stereo 2. People having stereotypes about your culture or ethnic group and treating you as if they are true. 1= Not stressful 2= Mildly stressful 3= Neutral (neither stressful or stress free) 4= Stressful 5= Extremely Stressful
444 safe_credit 3. Not getting enough credit for the work you do. 1= Not stressful 2= Mildly stressful 3= Neutral (neither stressful or stress free) 4= Stressful 5= Extremely Stressful
445 safe_exlude 4. Being excluded from participating in things. 1= Not stressful 2= Mildly stressful 3= Neutral (neither stressful or stress free) 4= Stressful 5= Extremely Stressful
446 safe_custom 5. Being looked down upon for practicing customs of your culture 1= Not stressful 2= Mildly stressful 3= Neutral (neither stressful or stress free) 4= Stressful 5= Extremely Stressful
447 safe_english 6. People thinking you are unfriendly when in fact you have trouble communicating in English. 1= Not stressful 2= Mildly stressful 3= Neutral (neither stressful or stress free) 4= Stressful 5= Extremely Stressful
448 safe_loosen 7. People pressuring you to loosen ties with your cultural background. 1= Not stressful 2= Mildly stressful 3= Neutral (neither stressful or stress free) 4= Stressful 5= Extremely Stressful
449 safe_ignore 8. Feeling ignored by people who are supposed to assist you. 1= Not stressful 2= Mildly stressful 3= Neutral (neither stressful or stress free) 4= Stressful 5= Extremely Stressful
450 drive2 Have you driven in the past 12 months? 1= Yes 2= No
451 purpos1 PURPOSE IN LIFE 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? 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
452 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
453 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
454 purpos4 4. I have a sense of direction and purpose in life. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
455 purpos5 5. My daily activities often seem trivial and unimportant to me. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
456 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
457 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
458 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
459 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
460 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
461 cope1 COPING AND RESILIENCE SCALE 1. I've always felt that I could make of my life pretty much what I wanted to make of it. 0= Not true at all 1= A little true 2= Quite true 3= Completely true
462 cope2 2. Once I make up my mind to do something, I stay with it until the job is completely done. 0= Not true at all 1= A little true 2= Quite true 3= Completely true
463 cope3 3. I don't let my personal feelings get in the way of getting a job done. 0= Not true at all 1= A little true 2= Quite true 3= Completely true
464 cope4 4. It's important for me to be able to do things in the way I want to do them rather than in the way other people want me to do them. 0= Not true at all 1= A little true 2= Quite true 3= Completely true
465 cope5 5. Sometimes I feel that if anything is going to be done right, I have to do it myself. 0= Not true at all 1= A little true 2= Quite true 3= Completely true
466 cope6 6. I like doing things that other people thought could not be done. 0= Not true at all 1= A little true 2= Quite true 3= Completely true
467 cope7 7. I feel that I am the kind of person who stands up for what he/she believes in, regardless of the consequences. 0= Not true at all 1= A little true 2= Quite true 3= Completely true
468 cope8 8. Hard work is the best possible way for a person to get ahead in life. 0= Not true at all 1= A little true 2= Quite true 3= Completely true
469 cope9 9. When things don't go the way I want them to, that just makes me work even harder. 0= Not true at all 1= A little true 2= Quite true 3= Completely true
470 cope10 10. Most of my life gets spent doing things that are worthwhile. 0= Not true at all 1= A little true 2= Quite true 3= Completely true
471 cope11 11. Planning ahead can help avoid most future problems. 0= Not true at all 1= A little true 2= Quite true 3= Completely true
472 cope12 12. What happens to me tomorrow depends on what I do today. 0= Not true at all 1= A little true 2= Quite true 3= Completely true
473 cope13 13. No matter how hard I try, my efforts usually accomplish nothing. 0= Not true at all 1= A little true 2= Quite true 3= Completely true
474 cope14 14. I don't like to make changes in my everyday schedule. 0= Not true at all 1= A little true 2= Quite true 3= Completely true
475 cope15 15. It's hard to imagine anyone getting excited about working. 0= Not true at all 1= A little true 2= Quite true 3= Completely true
476 cope16 16. Most of what happens in life is just meant to be. 0= Not true at all 1= A little true 2= Quite true 3= Completely true
477 cope17 17. It's exciting to learn something about myself. 0= Not true at all 1= A little true 2= Quite true 3= Completely true
478 cope18 18. It bothers me when my daily routine gets interrupted. 0= Not true at all 1= A little true 2= Quite true 3= Completely true
479 cope19 19. I like it when things are uncertain or unpredictable. 0= Not true at all 1= A little true 2= Quite true 3= Completely true
480 cope20 20. Thinking of yourself as a free person just leads to frustration. 0= Not true at all 1= A little true 2= Quite true 3= Completely true
481 cope21 21. Most days, life is really interesting and exciting for me. 0= Not true at all 1= A little true 2= Quite true 3= Completely true
482 emptins SOCIAL ISOLATION I experience a general sense of emptiness. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
483 misspeop I miss having people around. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
484 friends I feel like I don't have enough friends. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
485 abandon I often feel abandoned. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
486 missfrnd I miss having a really close friend. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
487 edanx53 Anxiety In the past 7 days ... 1. I felt uneasy. 1= Never 2= Rarely 3= Sometimes 4= Often 5= Always
488 edanx46 Anxiety 2. I felt nervous. 1= Never 2= Rarely 3= Sometimes 4= Often 5= Always
489 edanx48 Anxiety 3. Many situations made me worry. 1= Never 2= Rarely 3= Sometimes 4= Often 5= Always
490 edanx41 Anxiety 4. My worries overwhelmed me. 1= Never 2= Rarely 3= Sometimes 4= Often 5= Always
491 edanx54 Anxiety 5. I felt tense. 1= Never 2= Rarely 3= Sometimes 4= Often 5= Always
492 edanx55 Anxiety 6. I had difficulty calming down. 1= Never 2= Rarely 3= Sometimes 4= Often 5= Always
493 edanx18 Anxiety 7. I had sudden feelings of panic. 1= Never 2= Rarely 3= Sometimes 4= Often 5= Always
494 nqanx07 Anxiety 8. I felt nervous when my normal routine was disturbed. 1= Never 2= Rarely 3= Sometimes 4= Often 5= Always
495 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
496 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
497 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
498 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
499 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
500 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
501 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
502 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
503 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
504 q11mdb 11. The color of your skin is a problem for White people. [OPTIONAL: Would you say that you have had this experience...?] 1= Most of the time 2= Some of the time 3= Rarely 4= Never
505 q14mdb 14. White people act as if they are better than you. [OPTIONAL: Would you say that you have had this experience...?] 1= Most of the time 2= Some of the time 3= Rarely 4= Never
506 q18mdb 18. You are treated with less respect than a White person. [OPTIONAL: Would you say that you have had this experience...?] 1= Most of the time 2= Some of the time 3= Rarely 4= Never
507 q19mdb 19. White people try to avoid you in public, such as on elevators or on public transportation. [OPTIONAL: Would you say that you have had this experience...?] 1= Most of the time 2= Some of the time 3= Rarely 4= Never
508 q20mdb 20. White people act as if they are afraid of you. [OPTIONAL: Would you say that you have had this experience...?] 1= Most of the time 2= Some of the time 3= Rarely 4= Never
509 q21mdb 21. You are treated as if you fit a racial stereotype (e.g., Blacks are violent; Blacks are lazy). [OPTIONAL: Would you say that you have had this experience...?] 1= Most of the time 2= Some of the time 3= Rarely 4= Never
510 q28mdb 28. If I need legal or medical help, the fact that I am Black will not influence the type of help I receive. 1= Most of the time 2= Some of the time 3= Rarely 4= Never
511 q30mdb 30. Blacks have as many opportunities as Whites to live a middle class life. 1= Most of the time 2= Some of the time 3= Rarely 4= Never
512 q33mdb 33. Blacks have the same opportunities as Whites to get a college education. 1= Most of the time 2= Some of the time 3= Rarely 4= Never
513 q1smoreg 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 regularly smoke cigarettes now? 1= Yes 2= No
514 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. 2. In the past 12 months, did you have at least 12 drinks of any kind of alcoholic beverage? 1= Yes 2= No
515 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
516 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
517 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
518 robbed Now I would like to ask some questions about the neighborhood you live in. Neighborhood Stress a. In the last 12 months, in your neighborhood, have you heard of or do you know about a house which was robbed? 1= Yes, several times 2= Yes, once or twice 3= No
519 assault In the last 12 months, have you heard of or know about a person who was beat up or assaulted? 1= Yes, several times 2= Yes, once or twice 3= No
520 shot In the last 12 months, have you heard of or know about a person who was shot or killed? 1= Yes, several times 2= Yes, once or twice 3= No
521 safe1 Now we would like to ask you how safe you feel in your neighborhood, house, or apartment. How safe from crime would you say your neighborhood is? Would you say it is...... 1= Very safe 2= Fairly Safe 3= Somewhat safe 4= Not too safe 5= Not safe at all
522 safe2 Thinking about the building (house) you live in; how safe from crime would you say it is? 1= Very safe 2= Fairly Safe 3= Somewhat safe 4= Not too safe 5= Not safe at all
523 carenum 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
524 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
525 q1inc 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 ^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
526 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
527 q3inc How many people are supported in your household by the income circled above? [Interviewer: Include income provider in total number.] 1 .. 30
528 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
529 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
530 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
531 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
532 contr1 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
533 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
534 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
535 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
536 risk1 PERCEPTIONS ABOUT AD RISK FACTORS How important do you believe the following factors are in increasing one's chances of getting Alzheimer's disease? 1. Genetics or hereditary factors (passed down through your family). 0= Not at all important 1= Somewhat important 3= Very important 4= Extremely important
537 risk2 2. Mental illness. 0= Not at all important 1= Somewhat important 3= Very important 4= Extremely important
538 risk3 3. Stress. 0= Not at all important 1= Somewhat important 3= Very important 4= Extremely important
539 risk4 4. Old age. 0= Not at all important 1= Somewhat important 3= Very important 4= Extremely important
540 risk5 5. God's will. 0= Not at all important 1= Somewhat important 3= Very important 4= Extremely important
541 risk6 6. Head injury. 0= Not at all important 1= Somewhat important 3= Very important 4= Extremely important
542 risk7 7. Exposure to toxins, such as drinking out of Aluminum cans. 0= Not at all important 1= Somewhat important 3= Very important 4= Extremely important
543 risk8 8. Drinking too much alcohol. 0= Not at all important 1= Somewhat important 3= Very important 4= Extremely important
544 risk9 9. Smoking too much. 0= Not at all important 1= Somewhat important 3= Very important 4= Extremely important
545 lifesp1 LIFE SPACE For the next set of questions, please think of all the places you have been during the past week. During the past week, have you been to other rooms of your apartment (or home) besides the room where you sleep? 1= Yes 2= No
546 lifesp2 During the past week, have you been to an area immediately outside your apartment (or home) such as your porch, deck, or patio, hallway or garage? 1= Yes 2= No
547 lifesp3 During the past week, have you been to an area outside your apartment building (or home) such as the courtyard, yard, driveway, or parking lot? 1= Yes 2= No
548 lifesp4 During the past week, have you been to places within your immediate neighborhood but beyond your own apartment building or property? 1= Yes 2= No
549 lifesp5 During the past week, have you been to places outside your immediate neighborhood, but within your own town or community? [INTERVIEWER: For persons living in CCRC's or other facilities with multiple buildings, this means beyond the buildings on the facility's property. We're looking for other places beyond walking distance, e.g., more than half a mile.] 1= Yes 2= No
550 lifesp6 During the past week, have you been to places outside your town or community? 1= Yes 2= No
551 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
552 hearimp 2. Does the participant have a substantial hearing impairment? 1= Yes 2= No
553 visimp 3. Does the participant have a SUBSTANTIAL visual impairment? 1= Yes, completely blind 2= Yes, very poor 3= Yes, poor 4= No, not substantial
554 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
555 comments Enter any comments. [PRESS ENTER IF NONE.] String[150]
556 vegsign 0 .. 8
557 mvegsign 0 .. 8
558 cesd 0 .. 10
559 mcesd 0 .. 10
564 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
565 formpart Was participant reluctant, and/or does participant have special needs? 1= Yes 2= No
566 formcomm Please explain reluctance or any other factors which may have affected this data. [Press enter if no comment needed.] String[120]
567 statid Please enter you staff id. 100 .. 997
568 formch Has the form been modified? 1= Yes 2= No
569 revidate Enter the date that the form was modified. Date type
570 revintd Enter your staff id number. 100 .. 997
571 anydev Are there any protocol deviations or missing data items to enter? 1= Yes 2= No
572 numdev How many total protocol deviations and tests with missing items to enter? 1 .. 20
573 reas00 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
574 test00 Enter test or procedure. String[15]
575 item00 List items involved. [SEPARATE BY A COMMA] String[20]
576 code00 Enter data code used. 1= Don't Know 2= Refusal 3= other
577 oth00 Enter other code used. String[20]
578 expl00 Explain what happened String[100]
579 reas01 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
580 test01 Enter test or procedure. String[15]
581 item01 List items involved. [SEPARATE BY A COMMA] String[20]
582 code01 Enter data code used. 1= Don't Know 2= Refusal 3= other
583 oth01 Enter other code used. String[20]
584 expl01 Explain what happened String[100]
585 reas02 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
586 test02 Enter test or procedure. String[15]
587 item02 List items involved. [SEPARATE BY A COMMA] String[20]
588 code02 Enter data code used. 1= Don't Know 2= Refusal 3= other
589 oth02 Enter other code used. String[20]
590 expl02 Explain what happened String[100]
591 reas03 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
592 test03 Enter test or procedure. String[15]
593 item03 List items involved. [SEPARATE BY A COMMA] String[20]
594 code03 Enter data code used. 1= Don't Know 2= Refusal 3= other
595 oth03 Enter other code used. String[20]
596 expl03 Explain what happened String[100]
597 reas04 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
598 test04 Enter test or procedure. String[15]
599 item04 List items involved. [SEPARATE BY A COMMA] String[20]
600 code04 Enter data code used. 1= Don't Know 2= Refusal 3= other
601 oth04 Enter other code used. String[20]
602 expl04 Explain what happened String[100]
603 reas05 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
604 test05 Enter test or procedure. String[15]
605 item05 List items involved. [SEPARATE BY A COMMA] String[20]
606 code05 Enter data code used. 1= Don't Know 2= Refusal 3= other
607 oth05 Enter other code used. String[20]
608 expl05 Explain what happened String[100]
609 reas06 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
610 test06 Enter test or procedure. String[15]
611 item06 List items involved. [SEPARATE BY A COMMA] String[20]
612 code06 Enter data code used. 1= Don't Know 2= Refusal 3= other
613 oth06 Enter other code used. String[20]
614 expl06 Explain what happened String[100]
615 reas07 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
616 test07 Enter test or procedure. String[15]
617 item07 List items involved. [SEPARATE BY A COMMA] String[20]
618 code07 Enter data code used. 1= Don't Know 2= Refusal 3= other
619 oth07 Enter other code used. String[20]
620 expl07 Explain what happened String[100]
621 reas08 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
622 test08 Enter test or procedure. String[15]
623 item08 List items involved. [SEPARATE BY A COMMA] String[20]
624 code08 Enter data code used. 1= Don't Know 2= Refusal 3= other
625 oth08 Enter other code used. String[20]
626 expl08 Explain what happened String[100]
627 reas09 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
628 test09 Enter test or procedure. String[15]
629 item09 List items involved. [SEPARATE BY A COMMA] String[20]
630 code09 Enter data code used. 1= Don't Know 2= Refusal 3= other
631 oth09 Enter other code used. String[20]
632 expl09 Explain what happened String[100]
633 reas10 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
634 test10 Enter test or procedure. String[15]
635 item10 List items involved. [SEPARATE BY A COMMA] String[20]
636 code10 Enter data code used. 1= Don't Know 2= Refusal 3= other
637 oth10 Enter other code used. String[20]
638 expl10 Explain what happened String[100]
639 reas11 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
640 test11 Enter test or procedure. String[15]
641 item11 List items involved. [SEPARATE BY A COMMA] String[20]
642 code11 Enter data code used. 1= Don't Know 2= Refusal 3= other
643 oth11 Enter other code used. String[20]
644 expl11 Explain what happened String[100]
645 reas12 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
646 test12 Enter test or procedure. String[15]
647 item12 List items involved. [SEPARATE BY A COMMA] String[20]
648 code12 Enter data code used. 1= Don't Know 2= Refusal 3= other
649 oth12 Enter other code used. String[20]
650 expl12 Explain what happened String[100]
651 reas13 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
652 test13 Enter test or procedure. String[15]
653 item13 List items involved. [SEPARATE BY A COMMA] String[20]
654 code13 Enter data code used. 1= Don't Know 2= Refusal 3= other
655 oth13 Enter other code used. String[20]
656 expl13 Explain what happened String[100]
657 reas14 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
658 test14 Enter test or procedure. String[15]
659 item14 List items involved. [SEPARATE BY A COMMA] String[20]
660 code14 Enter data code used. 1= Don't Know 2= Refusal 3= other
661 oth14 Enter other code used. String[20]
662 expl14 Explain what happened String[100]
663 reas15 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
664 test15 Enter test or procedure. String[15]
665 item15 List items involved. [SEPARATE BY A COMMA] String[20]
666 code15 Enter data code used. 1= Don't Know 2= Refusal 3= other
667 oth15 Enter other code used. String[20]
668 expl15 Explain what happened String[100]
669 reas16 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
670 test16 Enter test or procedure. String[15]
671 item16 List items involved. [SEPARATE BY A COMMA] String[20]
672 code16 Enter data code used. 1= Don't Know 2= Refusal 3= other
673 oth16 Enter other code used. String[20]
674 expl16 Explain what happened String[100]
675 reas17 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
676 test17 Enter test or procedure. String[15]
677 item17 List items involved. [SEPARATE BY A COMMA] String[20]
678 code17 Enter data code used. 1= Don't Know 2= Refusal 3= other
679 oth17 Enter other code used. String[20]
680 expl17 Explain what happened String[100]
681 reas18 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
682 test18 Enter test or procedure. String[15]
683 item18 List items involved. [SEPARATE BY A COMMA] String[20]
684 code18 Enter data code used. 1= Don't Know 2= Refusal 3= other
685 oth18 Enter other code used. String[20]
686 expl18 Explain what happened String[100]
687 reas19 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
688 test19 Enter test or procedure. String[15]
689 item19 List items involved. [SEPARATE BY A COMMA] String[20]
690 code19 Enter data code used. 1= Don't Know 2= Refusal 3= other
691 oth19 Enter other code used. String[20]
692 expl19 Explain what happened String[100]

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