Number of Blaise fields: 36
Seq # | Var | Question | Data Type/Coding |
---|---|---|---|
1 | versiondate | Version Date | |
2 | formdescr | Form Description | |
3 | formno | Form Number | String[8] |
4 | version | Version Number | String[4] |
5 | projid | ^formdescr Form: ^formno Version: ^version (^versiondate) Enter project ID number. | String[8] |
6 | 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] |
7 | baseyear | Enter year of baseline from face sheet: | 1993 .. 2025 |
8 | autodate | Automatic Date. | Date type |
9 | autotime | Automatic Time. | TimeType |
10 | autolog | Automatic Logged Date. | Date type |
11 | intid | INTERVIEWER ID | 100 .. 997 |
12 | compid | Laptop id | String[7] |
13 | dateint | Date of interview | Date type |
14 | gender | Enter participant's gender. | 1= Male 2= Female 3= Transgender |
15 | igender | Which gender do you identify with? | 1= Male 2= Female |
16 | risc_adapt | CD-RISC 10 (Connor-Davidson Resilience Scale 10) [Introduction to participant:] Please indicate how much you agree with the following statements as they apply to you over the last month. If a particular situation has not occurred recently, answer according to how you think you would have felt. 1. I am able to adapt when changes occur. | 0= Not at all 1= Rarely true 2= Sometimes true 3= Often true 4= True nearly all the time |
17 | risc_deal | 2. I can deal with whatever comes my way. | 0= Not at all 1= Rarely true 2= Sometimes true 3= Often true 4= True nearly all the time |
18 | risc_humor | 3. I try to see the humorous side of things when I am faced with problems. | 0= Not at all 1= Rarely true 2= Sometimes true 3= Often true 4= True nearly all the time |
19 | risc_cope | 4. Having to cope with stress can make me stronger. | 0= Not at all 1= Rarely true 2= Sometimes true 3= Often true 4= True nearly all the time |
20 | risc_bounce | 5. I tend to bounce back after illness, injury, or other hardship. | 0= Not at all 1= Rarely true 2= Sometimes true 3= Often true 4= True nearly all the time |
21 | risc_believe | 6. I believe I can achieve my goals, even if there are obstacles. | 0= Not at all 1= Rarely true 2= Sometimes true 3= Often true 4= True nearly all the time |
22 | risc_pressure | 7. Under pressure, I stay focused and think clearly. | 0= Not at all 1= Rarely true 2= Sometimes true 3= Often true 4= True nearly all the time |
23 | risc_discourage | 8. I am not easily discouraged by failure. | 0= Not at all 1= Rarely true 2= Sometimes true 3= Often true 4= True nearly all the time |
24 | risc_strong | 9. I think of myself as a strong person when dealing with life's challenges and difficulties. | 0= Not at all 1= Rarely true 2= Sometimes true 3= Often true 4= True nearly all the time |
25 | risc_unpleasant | 10. I am able to handle unpleasant or painful feelings like sadness, fear and anger. | 0= Not at all 1= Rarely true 2= Sometimes true 3= Often true 4= True nearly all the time |
26 | 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 |
27 | hearimp | 2. Does the participant have a SUBSTANTIAL hearing impairment? | 1= Yes 2= No |
28 | visimp | 3. Does the participant have a SUBSTANTIAL visual impariment? | 1= Yes, completely blind 2= Yes, very poor 3= Yes, poor 4= No, not substantial |
29 | 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 |
30 | 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 |
31 | formpart | Was participant reluctant, and/or does participant have special needs? | 1= Yes 2= No |
32 | formcomm | Please explain reluctance or any other factors which may have affected this data. [Press enter if no comment needed.] | String[120] |
33 | statid | Please enter you staff id. | 100 .. 997 |
34 | formch | Has the form been modified? | 1= Yes 2= No |
35 | revidate | Enter the date that the form was modified. | Date type |
36 | revintd | Enter your staff id number. | 100 .. 997 |