Data Dictionary for mp2intfu

Number of Blaise fields: 683

Seq # Var Question Data Type/Coding
1 ivisit visit
2 projid MAP 2001 FOLLOW-UP Interview (v6.0 02/21/2022) Enter project ID number. String[8]
3 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 31 = 30th F/U ... 50 = 50th F/U String[2]
4 baseyear Enter year of baseline from face sheet: 1993 .. 2025
5 formno INTRODUCTION Form Number String[8]
6 version version Number. String[4]
7 autodate Automatic Date. Date type
8 autotime Automatic Time. TimeType
9 autolog Automatic Logged Date. Date type
10 intid INTERVIEWER ID 100 .. 997
11 compid Laptop ID String[20]
12 dateint Date of interview Date type
13 datlas Date of previous MAP questionnaire Date type
14 gender 1. Record participant's sex. 1= Male 2= Female
15 phone Was this interview completed on telephone or in person? 1= In-person 2= Telephone
16 autotm [COMPUTER CLOCK TIME] String[8]
17 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
18 q5loc What is your social security number? 0 .. 999999999
19 q5aloc [ENTER R. SOCIAL SECURITY NUMBER AGAIN] 0 .. 999999999
20 q6loc What is your medicare number? Please show me your card. String[11]
21 q6aloc [ENTER R. MEDICARE NUMBER AGAIN] String[11]
22 validated
23 validateerror
24 errorposition
25 validated_hicn_cms
26 validated_rrb_pre1964
27 validated_rrb_post1964
28 hicnformats
29 hicn_alpha
30 hicn_numbers
31 strlen
32 hicn_trimmed
33 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
34 ssn What is your social security number? [INTERVIEWER: Please enter the SSN in 000-00-0000 format.] String[11]
35 ssn_c [ENTER R. SOCIAL SECURITY NUMBER AGAIN] String[11]
36 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
37 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]
38 hicn_c [ENTER R. MEDICARE NUMBER(HICN) AGAIN] String[11]
39 hicn_type HICN Type: ^hicnFormats String[15]
40 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
41 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]
42 mbi_c [ENTER R. MEDICARE NUMBER(MBI) AGAIN] String[13]
43 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
44 multiple 1a. Did you have only one or more than one? 1= Only one 2= More than one
45 inhosp 1b Were you hospitalized overnight or longer for this (last one)? 1= Yes 2= No
46 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
47 chfhosp Were you hospitalized overnight or longer for this? 1= Yes 2= No
48 chfnum How many times have you been hospitalized for this since your last interview on [last interview date]? 0 .. 10
49 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
50 ca1a 1a. Where was it? [OR: Where was the most recent cancer that you had?] [SPECIFY] String[20]
51 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
52 db1 2. Has a doctor, nurse or therapist, told you to take insulin or injections for your high blood sugar? 1= Yes 2= No
53 db3 3. Has a doctor, nurse, or therapist told you to take medicine by mouth for your high blood sugar? 1= Yes 2= No
54 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
55 bp3 2 Has a doctor, nurse, or therapist told you to take medicine by mouth for your high blood pressure? 1= Yes 2= No
56 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
57 brokenhp BROKEN HIP (Since your interview on [last interview date], have you been told by a doctor, nurse or therapist that you had ...) 1. A broken or fractured hip? 1= Yes 2= Suspect or possible 3= No
58 hip6afix 1a. Were you hospitalized overnight or longer for this? 1= Yes 2= No
59 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
60 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
61 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
62 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
63 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
64 pill Were these estrogen or progesterone hormones in the form of a pill, injection, vaginal cream or suppository, or skin patch? 2. pill or other oral dosage form 1= Yes 2= Suspect 3= No
65 shot 3. injection (shot) 1= Yes 2= Suspect 3= No
66 cos 4. vaginal cream or suppository 1= Yes 2= Suspect 3= No
67 patch 5. skin patch 1= Yes 2= Suspect 3= No
68 current 6. Are you currently taking this/these medications? 1= Yes 2= No
69 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
70 pressure 1a. Do you get pressure or heaviness in your chest? 1= Yes 2= No
71 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
72 level0 3. Do you get this pain (or discomfort) when you walk at an ordinary pace on level ground? 1= Yes 2= No
73 legpain CLAUDICATION Now some questions about pains in your legs. 1. Do you get pain in either leg while walking? 1= Yes 2= No
74 standsit 2. Does this pain ever begin when you are standing still or sitting? 1= Yes 2= No
75 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
76 shrtbrth 9. Do you get short of breath at night if you sleep flat or only on one pillow? 1= Yes 2= No
77 pillows 9a. How many pillows do you need to sleep on to not be short of breath? 1 .. 9
78 grspbrth 9b. Do you wake up at night gasping for breath? 1= Yes 2= No
79 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
80 joints JOINTS Now a few questions about your joints. 1. Since your last interview on [last interview date] have you had pain or aching in any of your joints on most days for at least one month? 1= Yes 2= No
81 neckpain 2. ...Pain in your neck or back on most days for at least one month? 1= Yes 2= No
82 neckpain2 2. ...Pain in your neck on most days for at least one month? 1= Yes 2= No
83 backpain 2a. ...Pain in your back on most days for at least one month? 1= Yes 2= No
84 hippain 3. ...Pain in or around either hip joint including the buttock, groin, and side of the upper thigh on most days for at least one month? 1= Yes 2= No
85 kneepain 4. ...Pain in or around the knees including the back of the knee on most days for at least one month? 1= Yes 2= No
86 swelling 5. ...Swelling at a joint, with pain present in the joint when touched, on most days for at least one month? 1= Yes 2= No
87 stiff 6. ...Stiffness in the joints and muscles when getting out of bed in the morning lasting for at least 15 minutes? 1= Yes 2= No
88 feetpain 7. ...Pain or aching in either of your feet on most days for at least one month? 1= Yes 2= No
89 handpain 8. ...Pain or aching in either of your hands, wrists or fingers on most days for at least one month? 1= Yes 2= No
90 q1neur NEUROPATHY Now I have some questions about numbness and tingling. In the past month, have you had numbness or tingling [or asleep or burning] feeling of your feet or toes? 1= Yes 2= Suspect 3= No
91 q2neur Was this ___ on the right side, left side, or both sides? 1= Right 2= Left 3= Both
92 q3neur In the past month, have you had numbness or tingling [or asleep or burning] feeling of your hands or fingers? 1= Yes 2= Suspect 3= No
93 q4neur Was this ___ on the right side, left side, or both sides? 1= Right 2= Left 3= Both
94 q5neur CERVICAL RADICULAPATHY Now I have some questions about neck pain. Since your interview on [last interview date], have you had neck pain that lasted days weeks, or months? 1= Yes 2= Suspect 3= No
95 q6neur At a time while you were having pain in the neck, did you also have pain, numbness or tingling, or weakness in the arms or hands? 1= Yes 2= Suspect 3= No
96 q7neur1 Which of these problems did you have, pain, numbness or tingling, or weakness? [LIST ALL THAT APPLY] 1= Pain 2= Numbness or tingling 3= Weakness
97 q7neur2 Which of these problems did you have, pain, numbness or tingling, or weakness? [LIST ALL THAT APPLY] See previous question
98 q7neur3 Which of these problems did you have, pain, numbness or tingling, or weakness? [LIST ALL THAT APPLY] See previous question
99 q8neur Did this ___ occur on the right side, left side, or both sides? 1= Right 2= Left 3= Both
100 q9neur Now, when you have neck pain, how long, on average, does the neck pain typically last? Would you say less than a week, between one week and one month, between one and two months, between two and six months, or greater than six months? 1= < a week 2= 1 week - 1 month 3= > 1 month - 2 months 4= > 2 months - 6 months 5= > 6 months
101 q10neur How many different times have you had neck pain? 1 .. 50
102 q11neur How severe, on average, is the neck pain? Would you say it is usually not severe at all, slightly severe, somewhat severe, very severe, or extremely severe? 1= Not severe at all 2= Slightly severe 3= Somewhat severe 4= Very severe 5= Extremely severe
103 q12neur Have you seen a doctor because of neck pain since your last interview on [last interview date]? 1= Yes 2= No
104 q13neur Have you had an x-ray or scan [CT or MRI] of the neck because of the pain since your last interview on [last interview date]? 1= Yes 2= No
105 q14neur When was the last time? [ENTER YEAR] @ @ @ @ 1900 .. 2040
106 q15neur What was the name of the place (doctor's office, hospital or other place) at which the scan was performed? [ENTER NAME] String[40]
107 q16neur [ENTER LOCATION] String[40]
108 q17neur LUMBAR RADICULOPATHY Now I have some questions about low back pain. Since your last interview on [last interview date], have you had low back pain that lasted days to months? 1= Yes 2= Suspect 3= No
109 q18neur At a time while you were having low back pain, did you also have pain, numbness or tingling, or weakness in the feet or toes? 1= Yes 2= Suspect 3= No
110 q19neur1 Which of these problems did you have, pain, numbness or tingling, or weakness? [LIST ALL THAT APPLY] 1= Pain 2= Numbness or tingling 3= Weakness
111 q19neur2 Which of these problems did you have, pain, numbness or tingling, or weakness? [LIST ALL THAT APPLY] See previous question
112 q19neur3 Which of these problems did you have, pain, numbness or tingling, or weakness? [LIST ALL THAT APPLY] See previous question
113 q20neur Did this ___ occur on the right side, left side, or both sides? 1= Right 2= Left 3= Both
114 q21neur Now, when you have low back pain, how long, on average, does the back pain typically last? Would you say less than a week, between one week and one month, between one and two months, between two and six months, or greater than six months? 1= < a week 2= 1 week - 1 month 3= > 1 month - 2 months 4= > 2 months - 6 months 5= > 6 months
115 q22neur How many different times have you had low back pain? 1 .. 50
116 q23neur How severe, on average, is the low back pain? Would you say it is usually not severe at all, slightly severe, somewhat severe, very severe, or extremely severe? 1= Not severe at all 2= Slightly severe 3= Somewhat severe 4= Very severe 5= Extremely severe
117 q24neur Have you seen a doctor because of low back pain since your last interview on [last interview date]? 1= Yes 2= No
118 q25neur Have you had an x-ray or scan [CT or MRI] of the low back because of the pain since your last interview on [last interview date]? 1= Yes 2= No
119 q26neur When was the last time? [ENTER YEAR] @ @ @ @ 1900 .. 2040
120 q27neur What was the name of the place (doctor's office, hospital or other place) at which the scan was performed? [ENTER NAME] String[40]
121 q28neur [ENTER LOCATION] String[40]
122 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
123 q2md 2. My sleep was restless. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
124 q3md 3. I felt depressed. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
125 q4md 4. I was happy. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
126 q5md 5. I felt lonely. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
127 q6md 6. People were unfriendly. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
128 q7md 7. I enjoyed life. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
129 q8md 8. I felt sad. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
130 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
131 q10md 10. I could not get 'going'. (Have you felt this way much of the time during the past week?) 1= Yes 2= No
132 q1slp SLEEP Now I would like to get some information about how well you sleep. 1. How often do you have trouble falling asleep? Would you say it is - very often, often, sometimes, rarely or never? 1= Very Often 2= Often 3= Sometimes 4= Rarely 5= Never
133 q2slp 2. How often are you troubled by waking up during the night? 1= Very Often 2= Often 3= Sometimes 4= Rarely 5= Never
134 q4slp 3. How often do you get so sleepy during the day or evening that you have to take a nap? 1= Very Often 2= Often 3= Sometimes 4= Rarely 5= Never
135 q5slp 4. How often do you feel really rested when you wake up in the morning? 1= Very Often 2= Often 3= Sometimes 4= Rarely 5= Never
136 q6slp 5. In the past month, how many hours do you usually sleep at night? [ENTER AVERAGE HOURS] 0 .. 24
137 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
138 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
139 sleep 3. A change in your pattern of sleeping. 1= Yes 2= No
140 enrgy 4. A decrease in your energy level. 1= Yes 2= No
141 concen 5. Trouble concentrating. 1= Yes 2= No
142 guilt 6. Felt extremely guilty or worthless. 1= Yes 2= No
143 restls 7. Felt extremely restless or agitated. 1= Yes 2= No
144 activt 8. Lost your interest in favorite activities. 1= Yes 2= No
145 living 9. Felt that life was not worth living. 1= Yes 2= No
146 teldoc 9a. Did you tell a doctor or any other professional about it? 1= Yes 2= No
147 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
148 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
149 howmany 3a. How many times? 1 .. 50
150 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
151 hihosp 4. Since your interview on [last interview date], were you hospitalized overnight or longer for a head injury? 1= Yes 2= No
152 same1 4a. Was this the same event we just spoke about? 1= Yes 2= No
153 hihospnm 4c. What was the name of the (last) hospital? [HOSPITAL NAME] String[40]
154 hihosloc [LOCATION:] String[40]
155 memory0 Were any of the following signs/symptoms associated with this (last) event? [INTERVIEWER: `Last' event refers to the most recent hospitalization, or, if not hospitalized, most recent event with loss of consciousness.] 1. Memory loss or forgetfulness? 1= Yes 2= Suspect 3= No
156 speech0 2. Language or speech change? 1= Yes 2= Suspect 3= No
157 weaknes0 3. Weakness or paralysis of face, arms or legs? 1= Yes 2= Suspect 3= No
158 side0 3a. Which side(s)? 1= right only 2= left only 3= both
159 othspec0 4. Specify any other signs or symptoms associated with this (last) event? [PRESS ENTER IF NONE.] String[40]
160 leftove0 6. Specify left over troubles from your head injury(s)? [PRESS ENTER IF NONE.] String[40]
161 hiscan 5. Since [last interview date], did you have a CT, MRI or other type of brain scan because of a head injury? 1= Yes 2= No
162 same2 Was this the same event we just spoke about? 1= Yes 2= No
163 hiscanam 5b. What was the name of the place (doctor's office, hospital or other place) at which the scan was performed? [NAME:] String[40]
164 memory1 Were any of the following signs/symptoms associated with this (last) event? [INTERVIEWER: `Last' event refers to the event associated with the CT, MRI, or brain scan.] 1. Memory loss or forgetfulness? 1= Yes 2= Suspect 3= No
165 speech1 2. Language or speech change? 1= Yes 2= Suspect 3= No
166 weaknes1 3. Weakness or paralysis of face, arms or legs? 1= Yes 2= Suspect 3= No
167 side1 3a. Which side(s)? 1= right only 2= left only 3= both
168 othspec1 4. Specify any other signs or symptoms associated with this (last) event? [PRESS ENTER IF NONE.] String[40]
169 leftove1 6. Specify left over troubles from your head injury(s)? [PRESS ENTER IF NONE.] String[40]
170 specify 6. Specify left over troubles from your head injury(s)? [PRESS ENTER IF NONE.] String[40]
171 hdrvehicle
172 hdrhitbyobject
173 hdrfalling
174 hdrsports
175 hdrabuse
176 hdrmilitary
177 hdrother
178 prevbisqdone BRAIN INJURY SCREENING QUESTIONNAIRE Have the BISQ questions been previously completed for this participant? ^prevBisqDoneText 1= Yes 2= No
179 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
180 bisqvehnum ^hdrVehicle How many times did you receive a blow to the head, in a vehicle accident? 1 .. 30
181 bisqvehloc ^hdrVehicle Did you lose consciousness? 1= Yes 2= No
182 bisqvehlocnum ^hdrVehicle How many times have you lost consciousness? 1 .. 30
183 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.
184 bisqvehlocyr1 ^hdrVehicle In what year did this occur (1)? 1900 .. 2050
185 bisqvehlocyr2 ^hdrVehicle In what year did this occur (2)? 1900 .. 2050
186 bisqvehlocyr3 ^hdrVehicle In what year did this occur (3)? 1900 .. 2050
187 bisqvehlocyr4 ^hdrVehicle In what year did this occur (4)? 1900 .. 2050
188 bisqvehlocyr5 ^hdrVehicle In what year did this occur (5)? 1900 .. 2050
189 bisqvehdaze ^hdrVehicle Were you dazed or confused? 1= Yes 2= No
190 bisqvehdazenum ^hdrVehicle How many times have you been dazed or confused? 1 .. 30
191 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.
192 bisqvehdazeyr1 ^hdrVehicle In what year did this occur (1)? 1900 .. 2050
193 bisqvehdazeyr2 ^hdrVehicle In what year did this occur (2)? 1900 .. 2050
194 bisqvehdazeyr3 ^hdrVehicle In what year did this occur (3)? 1900 .. 2050
195 bisqvehdazeyr4 ^hdrVehicle In what year did this occur (4)? 1900 .. 2050
196 bisqvehdazeyr5 ^^hdrVehicle In what year did this occur (5)? 1900 .. 2050
197 bisqhit ^lastInterviewText1en 2. Hit by an object?(ex: equipment, falling object) 1= Yes 2= No
198 bisqhitnum ^hdrHitByObject How many times did you receive a blow to the head, from a falling object? 1 .. 30
199 bisqhitloc ^hdrHitByObject Did you lose consciousness? 1= Yes 2= No
200 bisqhitlocnum ^hdrHitByObject How many times have you lost consciousness? 1 .. 30
201 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.
202 bisqhitlocyr1 ^hdrHitByObject In what year did this occur (1)? 1900 .. 2050
203 bisqhitlocyr2 ^hdrHitByObject In what year did this occur (2)? 1900 .. 2050
204 bisqhitlocyr3 ^hdrHitByObject In what year did this occur (3)? 1900 .. 2050
205 bisqhitlocyr4 ^hdrHitByObject In what year did this occur (4)? 1900 .. 2050
206 bisqhitlocyr5 ^hdrHitByObject In what year did this occur (5)? 1900 .. 2050
207 bisqhitdaze ^hdrHitByObject Were you dazed or confused? 1= Yes 2= No
208 bisqhitdazenum ^hdrHitByObject How many times have you been dazed or confused? 1 .. 30
209 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.
210 bisqhitdazeyr1 ^hdrHitByObject In what year did this occur (1)? 1900 .. 2050
211 bisqhitdazeyr2 ^hdrHitByObject In what year did this occur (2)? 1900 .. 2050
212 bisqhitdazeyr3 ^hdrHitByObject In what year did this occur (3)? 1900 .. 2050
213 bisqhitdazeyr4 ^hdrHitByObject In what year did this occur (4)? 1900 .. 2050
214 bisqhitdazeyr5 ^hdrHitByObject In what year did this occur (5)? 1900 .. 2050
215 bisqfall ^lastInterviewText2en 3. Falling? (ex: down stairs, during a fainting spell, from a high place) 1= Yes 2= No
216 bisqfallnum ^hdrFalling How many times did you receive a blow to the head, in a fall? 1 .. 30
217 bisqfallloc ^hdrFalling Did you lose consciousness? 1= Yes 2= No
218 bisqfalllocnum ^hdrFalling How many times have you lost consciousness? 1 .. 30
219 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.
220 bisqfalllocyr1 ^hdrFalling In what year did this occur (1)? 1900 .. 2050
221 bisqfalllocyr2 ^hdrFalling In what year did this occur (2)? 1900 .. 2050
222 bisqfalllocyr3 ^hdrFalling In what year did this occur (3)? 1900 .. 2050
223 bisqfalllocyr4 ^hdrFalling In what year did this occur (4)? 1900 .. 2050
224 bisqfalllocyr5 ^hdrFalling In what year did this occur (5)? 1900 .. 2050
225 bisqfalldaze ^hdrFalling Were you dazed or confused? 1= Yes 2= No
226 bisqfalldazenum ^hdrFalling How many times have you been dazed or confused? 1 .. 30
227 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.
228 bisqfalldazeyr1 ^hdrFalling In what year did this occur (1)? 1900 .. 2050
229 bisqfalldazeyr2 ^hdrFalling In what year did this occur (2)? 1900 .. 2050
230 bisqfalldazeyr3 ^hdrFalling In what year did this occur (3)? 1900 .. 2050
231 bisqfalldazeyr4 ^hdrFalling In what year did this occur (4)? 1900 .. 2050
232 bisqfalldazeyr5 ^hdrFalling In what year did this occur (5)? 1900 .. 2050
233 bisqsprt ^lastInterviewText3en 4. Sports/Leisure?(ex: sports, biking, skiing, on the playground) 1= Yes 2= No
234 bisqsprtnum ^hdrSports How many times did you receive a blow to the head, during a sports or leisure activity? 1 .. 30
235 bisqsprtloc ^hdrSports Did you lose consciousness? 1= Yes 2= No
236 bisqsprtlocnum ^hdrSports How many times have you lost consciousness? 1 .. 30
237 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.
238 bisqsprtlocyr1 ^hdrSports In what year did this occur (1)? 1900 .. 2050
239 bisqsprtlocyr2 ^hdrSports In what year did this occur (2)? 1900 .. 2050
240 bisqsprtlocyr3 ^hdrSports In what year did this occur (3)? 1900 .. 2050
241 bisqsprtlocyr4 ^hdrSports In what year did this occur (4)? 1900 .. 2050
242 bisqsprtlocyr5 ^hdrSports In what year did this occur (5)? 1900 .. 2050
243 bisqsprtdaze ^hdrSports Were you dazed or confused? 1= Yes 2= No
244 bisqsprtdazenum ^hdrSports How many times have you been dazed or confused? 1 .. 30
245 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.
246 bisqsprtdazeyr1 ^hdrSports In what year did this occur (1)? 1900 .. 2050
247 bisqsprtdazeyr2 ^hdrSports In what year did this occur (2)? 1900 .. 2050
248 bisqsprtdazeyr3 ^hdrSports In what year did this occur (3)? 1900 .. 2050
249 bisqsprtdazeyr4 ^hdrSports In what year did this occur (4)? 1900 .. 2050
250 bisqsprtdazeyr5 ^hdrSports In what year did this occur (5)? 1900 .. 2050
251 bisqphys ^lastInterviewText4en 5. Physical Abuse/Assault?(ex: mugged) 1= Yes 2= No
252 bisqphysnum ^hdrAbuse How many times did you receive a blow to the head, from abuse or assault? 1 .. 30
253 bisqphysloc ^hdrAbuse Did you lose consciousness? 1= Yes 2= No
254 bisqphyslocnum ^hdrAbuse How many times have you lost consciousness? 1 .. 30
255 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.
256 bisqphyslocyr1 ^hdrAbuse In what year did this occur (1)? 1900 .. 2050
257 bisqphyslocyr2 ^hdrAbuse In what year did this occur (2)? 1900 .. 2050
258 bisqphyslocyr3 ^hdrAbuse In what year did this occur (3)? 1900 .. 2050
259 bisqphyslocyr4 ^hdrAbuse In what year did this occur (4)? 1900 .. 2050
260 bisqphyslocyr5 ^hdrAbuse In what year did this occur (5)? 1900 .. 2050
261 bisqphysdaze ^hdrAbuse Were you dazed or confused? 1= Yes 2= No
262 bisqphysdazenum ^hdrAbuse How many times have you been dazed or confused? 1 .. 30
263 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.
264 bisqphysdazeyr1 ^hdrAbuse In what year did this occur (1)? 1900 .. 2050
265 bisqphysdazeyr2 ^hdrAbuse In what year did this occur (2)? 1900 .. 2050
266 bisqphysdazeyr3 ^hdrAbuse In what year did this occur (3)? 1900 .. 2050
267 bisqphysdazeyr4 ^hdrAbuse In what year did this occur (4)? 1900 .. 2050
268 bisqphysdazeyr5 ^hdrAbuse In what year did this occur (5)? 1900 .. 2050
269 bisqmil ^lastInterviewText5en 6. Military Service?(ex: training, blast injury) 1= Yes 2= No
270 bisqmilnum ^hdrMilitary How many times did you receive a blow to the head, during military service? 1 .. 30
271 bisqmilloc ^hdrMilitary Did you lose consciousness? 1= Yes 2= No
272 bisqmillocnum ^hdrMilitary How many times have you lost consciousness? 1 .. 30
273 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.
274 bisqmillocyr1 ^hdrMilitary In what year did this occur (1)? 1900 .. 2050
275 bisqmillocyr2 ^hdrMilitary In what year did this occur (2)? 1900 .. 2050
276 bisqmillocyr3 ^hdrMilitary In what year did this occur (3)? 1900 .. 2050
277 bisqmillocyr4 ^hdrMilitary In what year did this occur (4)? 1900 .. 2050
278 bisqmillocyr5 ^hdrMilitary In what year did this occur (5)? 1900 .. 2050
279 bisqmildaze ^hdrMilitary Were you dazed or confused? 1= Yes 2= No
280 bisqmildazenum ^hdrMilitary How many times have you been dazed or confused? 1 .. 30
281 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.
282 bisqmildazeyr1 ^hdrMilitary In what year did this occur (1)? 1900 .. 2050
283 bisqmildazeyr2 ^hdrMilitary In what year did this occur (2)? 1900 .. 2050
284 bisqmildazeyr3 ^hdrMilitary In what year did this occur (3)? 1900 .. 2050
285 bisqmildazeyr4 ^hdrMilitary In what year did this occur (4)? 1900 .. 2050
286 bisqmildazeyr5 ^hdrMilitary In what year did this occur (5)? 1900 .. 2050
287 bisqoth ^lastInterviewText6en 7. In any other circumstances? 1= Yes 2= No
288 bisqothsp ^hdrOther Please specify: String[255]
289 bisqothnum ^hdrOther How many times did you receive a blow to the head, in a situation I have not mentioned? 1 .. 30
290 bisqothloc ^hdrOther Did you lose consciousness? 1= Yes 2= No
291 bisqothlocnum ^hdrOther How many times have you lost consciousness? 1 .. 30
292 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.
293 bisqothlocyr1 ^hdrOther In what year did this occur (1)? 1900 .. 2050
294 bisqothlocyr2 ^hdrOther In what year did this occur (2)? 1900 .. 2050
295 bisqothlocyr3 ^hdrOther In what year did this occur (3)? 1900 .. 2050
296 bisqothlocyr4 ^hdrOther In what year did this occur (4)? 1900 .. 2050
297 bisqothlocyr5 ^hdrOther In what year did this occur (5)? 1900 .. 2050
298 bisqothdaze ^hdrOther Were you dazed or confused? 1= Yes 2= No
299 bisqothdazenum ^hdrOther How many times have you been dazed or confused? 1 .. 30
300 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.
301 bisqothdazeyr1 ^hdrOther In what year did this occur (1)? 1900 .. 2050
302 bisqothdazeyr2 ^hdrOther In what year did this occur (2)? 1900 .. 2050
303 bisqothdazeyr3 ^hdrOther In what year did this occur (3)? 1900 .. 2050
304 bisqothdazeyr4 ^hdrOther In what year did this occur (4)? 1900 .. 2050
305 bisqothdazeyr5 ^hdrOther In what year did this occur (5)? 1900 .. 2050
306 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
307 diary2 10. Since your last interview on [last interview date], have you kept a diary or journal? 1= Yes 2= No
308 museum2 11. Since your last interview on [last interview date], have you visited a museum? 1= Yes 2= No
309 concer2 12. Since your last interview on [last interview date], have you attended a concert, play, or musical? 1= Yes 2= No
310 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
311 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
312 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
313 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
314 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
315 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
316 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
317 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
318 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
319 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
320 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
321 q14act 14. During the past year, how often did you participate in groups (such as senior center, VFW, Knights of Columbus, Rosary Society or something similar)? 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
322 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
323 introp PHYSICAL ACTIVITIY We are also interested in any physical activities that you do. I have a list of different types of activities that we ask of everyone, but most people do only one or two. [PRESS ENTER TO CONTINUE.] String[1]
324 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
325 q1aphy 1a. How many times in the past 14 days did you go walking for exercise? [ENTER NUMBER OF TIMES] 1 .. 87
326 q1bphy 1b. On average, about how many minutes did you actually spend on each occasion? [ENTER NUMBER OF MINUTES] [CODE 1 Hour=60 min; 1.5 Hour=90 min; 2 Hours=120 min; 2.5 Hours=150 min; 3 Hours=180 min; 3.5 Hours=210 min; 4 Hours=240 min] 1 .. 300
327 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
328 q11aphy 2a. How many times in the past 14 days did you go walking like that? [ENTER NUMBER OF TIMES] 1 .. 87
329 q11bphy 2b. On average, about how many minutes did you actually spend on each occasion? [ENTER NUMBER OF MINUTES] [CODE 1 Hour=60 min; 1.5 Hour=90 min; 2 Hours=120 min; 2.5 Hours=150 min; 3 Hours=180 min; 3.5 Hours=210 min; 4 Hours=240 min] 1 .. 300
330 q3phy (In the past 14 days have you done) 3. Gardening or yard work? 1= Yes 2= No
331 q3aphy 3a. How many times in the past 14 days did you do gardening or yard work? [ENTER NUMBER OF TIMES] 1 .. 87
332 q3bphy 3b. On average, about how many minutes did you actually spend on each occasion? [ENTER NUMBER OF MINUTES] [CODE 1 Hour=60 min; 1.5 Hour=90 min; 2 Hours=120 min; 2.5 Hours=150 min; 3 Hours=180 min; 3.5 Hours=210 min; 4 Hours=240 min] 1 .. 300
333 q5phy (In the past 14 days have you done) 5. Calisthenics or general exercise? 1= Yes 2= No
334 q5aphy 5a. How many times in the past 14 days did you do calisthenics or general exercise? [ENTER NUMBER OF TIMES] 1 .. 87
335 q5bphy 5b. On average, about how many minutes did you actually spend on each occasion? [ENTER NUMBER OF MINUTES] [CODE 1 Hour=60 min; 1.5 Hour=90 min; 2 Hours=120 min; 2.5 Hours=150 min; 3 Hours=180 min; 3.5 Hours=210 min; 4 Hours=240 min] 1 .. 300
336 q8phy (In the past 14 days have you done) 8. Bicycle riding (including stationary bikes)? 1= Yes 2= No
337 q8aphy 8a. How many times in the past 14 days did you go bicycle//riding? [ENTER NUMBER OF TIMES] 1 .. 87
338 q8bphy 8b. On average, about how many minutes did you actually spend on each occasion? [ENTER NUMBER OF MINUTES] [CODE 1 Hour=60 min; 1.5 Hour=90 min; 2 Hours=120 min; 2.5 Hours=150 min; 3 Hours=180 min; 3.5 Hours=210 min; 4 Hours=240 min] 1 .. 300
339 q9phy (In the past 14 days have you done) 9. Swimming or water exercises? 1= Yes 2= No
340 q9aphy 9a. How many times in the past 14 days did you go swimming or do water exercises? [ENTER NUMBER OF TIMES] 1 .. 87
341 q9bphy 9b. On average, about how many minutes did you actually spend on each occasion? [ENTER NUMBER OF MINUTES] [CODE 1 Hour=60 min; 1.5 Hour=90 min; 2 Hours=120 min; 2.5 Hours=150 min; 3 Hours=180 min; 3.5 Hours=210 min; 4 Hours=240 min] 1 .. 300
342 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
343 q101phy 10.1 [SPECIFY] String[40]
344 q10aphy 10a. How many times in the past 14 days did you do this? [ENTER NUMBER OF TIMES] 1 .. 87
345 q10bphy 10b. On average, about how many minutes did you actually spend on each occasion? [ENTER NUMBER OF MINUTES] [CODE 1 Hour=60 min; 1.5 Hour=90 min; 2 Hours=120 min; 2.5 Hours=150 min; 3 Hours=180 min; 3.5 Hours=210 min; 4 Hours=240 min] 1 .. 300
346 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
347 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
348 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
349 recogfr2 2. (When wearing eyeglasses/contact lenses) Can you see well enough to recognize a friend across the street? 1= Yes 2= No
350 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
351 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
352 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
353 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
354 trial1a 2a. Second trial: 20/100 1= All three correct 2= Two correct 3= One correct 4= None correct
355 trial1b 2b. Third trial: 20/200 1= All three correct 2= Two correct 3= One correct 4= None correct
356 trial1c 2c. Fourth trial: 20/400 1= All three correct 2= Two correct 3= One correct 4= None correct
357 trial2 3. Second trial: 20/50 1= All three correct 2= Two correct 3= One correct 4= None correct
358 trial3 3a. Third trial: 20/40 1= All three correct 2= Two correct 3= One correct 4= None correct
359 midarm BLOODPRESSURE Now I would like to take some arm, height and weight measurements, and blood pressure readings. 1. MID-ARM CIRCUMFERENCE [IN cm] 15.0 .. 78.0
360 midfore 1a. MID FOREARM CIRCUMFERENCE [IN cm] 10.0 .. 78.0
361 midleg 1b. MID LEG CIRCUMFERENCE [IN cm] 15.0 .. 99.0
362 tricep1 2. FIRST TRICEPS SKINFOLD MEASUREMENT [IN mm] CODE 72 IF MEASUREMENT >= 67 mm] 1 .. 72
363 cuff BLOODPRESSURE Now I would like to take some height and weight measurements, and blood pressure readings. 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
364 tricep2 4. SECOND TRICEPS SKINFOLD MEASUREMENT [IN mm] [CODE 72 IF MEASUREMENT >=67mm] 1 .. 72
365 pulsept 5. PULSE OBLITERATION POINT [IN mmHg] 50 .. 270
366 pul THE PEAK INFLATION LEVEL IS ^pulse [HIT ENTER FOR NEXT QUESTION] 80 .. 300
367 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]
368 bp2 7. SECOND SITTING BLOOD PRESSURE READING [INTERVIEWER: ENTER SYSTOLIC/DIASTOLIC] String[7]
369 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]
370 weight 9. MEASURED WEIGHT [IN LBS] [CODE 333 IF MEASUREMENT IS >=300 lbs. CODE 888 IF PHYSICALLY UNABLE TO WEIGH] 30 .. 888
371 height 10. MEASURED HEIGHT [IN FEET & INCHES] [CODE 888 IF PHYSICALLY UNABLE TO MEASURE HEIGHT] String[5]
372 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]
373 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]
374 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]
375 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]
376 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]
377 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]
378 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]
379 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]
380 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]
381 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]
382 gaitquip Is the Gait Test Equipment Available? 1= Yes 2= No
383 domove2 [Interviewer, Is the Gait Test Equipment being worn by the participant during these exercises?] 1= Yes 2= No
384 dynaid DynaPort Device id String[10]
385 diskid Disk ID String[10]
386 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)
387 move7b Time (seconds): 1.0 .. 60.0
388 move7c Number of steps taken: 1 .. 60
389 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)
390 move7d Time (seconds): 1.0 .. 60.0
391 move7e Number of steps taken: 1 .. 60
392 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
393 move7a1 [SPECIFY] String[20]
394 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)
395 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)
396 move6f Number of steps taken: 1 .. 60
397 move6e Time (seconds): 1.0 .. 60.0
398 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)
399 move6h Number of steps: 1 .. 60
400 move6g Time (seconds): 1.0 .. 60.0
401 move6i Record Aid used for 360 turn: 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other
402 move6i1 [SPECIFY] String[20]
403 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)
404 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)
405 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)
406 getaid Record Aid used for GET UP AND GO: 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other
407 getaid_specify [SPECIFY] String[20]
408 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)
409 move8 Interviewer: Record number of errors, e.g. Sidesteps: 0 .. 60
410 tandaid Record Aid used for Tandem Walk: 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other
411 tandaid_specify [SPECIFY] String[20]
412 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)
413 walk8aid Record Aid used for BACK AND FORTH WALK: 1= No Aid 2= Quad Cane 3= Other Cane 4= Walker 5= Wheelchair 6= Other
414 walk8aid_specify [SPECIFY] String[20]
415 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)
416 move6 Time (seconds) : 1.0 .. 10.0
417 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)
418 move6a Time (seconds) : 1.0 .. 10.0
419 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)
420 move6c Time (seconds) : 1.0 .. 10.0
421 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)
422 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)
423 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]
424 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]
425 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]
426 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]
427 trial11 1. Trial 1, Right Hand [ENTER NUMBER OF PEGS CORRECTLY PLACED] 0 .. 25
428 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
429 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
430 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
431 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
432 q2func 2. Are you able to walk up and down stairs to the second floor without help? 1= Yes 2= No
433 q3func 3. Are you able to walk a half mile without help? 1= Yes 2= No
434 q4func Next, I would like to know if you need help do 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
435 q4bfunc 4b. How much difficulty, on average, do you have walking across a small room? 1= No difficulty at all 2= Some difficulty 3= A lot of difficulty 4= Refused 5= Dont know
436 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
437 q5bfunc 5b. How much difficulty, on average, do you have bathing? 1= No difficulty at all 2= Some difficulty 3= A lot of difficulty 4= Refused 5= Dont know
438 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
439 q6bfunc 6b. How much difficulty, on average, do you have dressing? 1= No difficulty at all 2= Some difficulty 3= A lot of difficulty 4= Refused 5= Dont know
440 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
441 q7bfunc 7b. How much difficulty, on average, do you have eating? 1= No difficulty at all 2= Some difficulty 3= A lot of difficulty 4= Refused 5= Dont know
442 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
443 q8bfunc 8b. How much difficulty, on average, do you have getting from a bed to a chair? 1= No difficulty at all 2= Some difficulty 3= A lot of difficulty 4= Refused 5= Dont know
444 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
445 q9bfunc 9b. How much difficulty, on average, do you have using the toilet? 1= No difficulty at all 2= Some difficulty 3= A lot of difficulty 4= Refused 5= Dont know
446 q10func Now I have a few more questions about activities people may or may not do. Although some things may acutually 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
447 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
448 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
449 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
450 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
451 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
452 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
453 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
454 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
455 falls FALLING 1. How many times would you say you have fallen over the past year? That is, how many times have you unintentionally come to rest on the ground or floor? 0 .. 99
456 fallinj 2. Did you suffer any injury that required you to go to your doctor, an emergency room or an urgent care center? 1= Yes 2= No
457 fallhelp 3. When you fell this past year were you ever not able to get up without help from someone? 1= Yes 2= No
458 fallnear 6. Have you had any near falls in the past year? That is, where you almost fell but were able to catch yourself or stop the fall? 1= Yes 2= No
459 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
460 married2 Are you now married, separated, divorced, or widowed? 1= Married 2= Separated 3= Divorced 4= Widowed
461 livewith Does your spouse/significant other live with you? 1= Yes 2= No
462 q2soci 1. How many members, other than yourself, are in your household? 0 .. 30
463 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
464 q2sn How many of your children do you see at least once a month? [ENTER No. OF CHILDREN] 0 .. 30
465 q2asn Do you see your child at least once a month? 1= Yes 2= No
466 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
467 q3asn How many of these close relatives do you usually see at least once a month? [ENTER No. OF CLOSE RELATIVES] 0 .. 76
468 q3bsn Do you see your close relative at least once a month? 1= Yes 2= No
469 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
470 q4asn How many of these close friends do you see at least once a month? [ENTER No. OF CLOSE FRIENDS] 0 .. 15
471 q4bsn Do you see your close friend at least once a month? 1= Yes 2= No
472 spanishbr Is the participant of Spanish/Hispanic origin? [CHECK RELEASE SHEET] 1= Yes 2= No
473 spanish_fluent Is the participant fluent in Spanish? [CHECK RELEASE SHEET] 1= Yes 2= No
474 safe_accult_6 Ask question #6 in the SAFE - Acculturation Stress Scale 1= Yes 2= No
475 description_acc Acculturation Although you may speak many languages, the following questions refer to only English and Spanish. [PRESS ENTER TO CONTINUE]
476 acc_langreadspeak 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
477 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
478 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
479 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
480 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
481 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
482 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
483 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
484 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
485 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
486 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]
487 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
488 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
489 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
490 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
491 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
492 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
493 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]
494 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 0= Does not apply (lives in group /retirement home setting)
495 pnes_attractive 2. My neighborhood is attractive. 1= Strongly Agree 2= Agree 3= Neutral (neither agree or disagree) 4= Disagree 5= Strongly Disagree 0= Does not apply (lives in group /retirement home setting)
496 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 0= Does not apply (lives in group /retirement home setting)
497 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 0= Does not apply (lives in group /retirement home setting)
498 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 0= Does not apply (lives in group /retirement home setting)
499 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 0= Does not apply (lives in group /retirement home setting)
500 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 0= Does not apply (lives in group /retirement home setting)
501 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 0= Does not apply (lives in group /retirement home setting)
502 pnes_traffic 9. My neighborhood has heavy traffic. 1= Strongly Agree 2= Agree 3= Neutral (neither agree or disagree) 4= Disagree 5= Strongly Disagree 0= Does not apply (lives in group /retirement home setting)
503 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 0= Does not apply (lives in group /retirement home setting)
504 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 0= Does not apply (lives in group /retirement home setting)
505 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 0= Does not apply (lives in group /retirement home setting)
506 pnes_howlong_year How long have you lived in your neighborhood? _____ years, 0 .. 199
507 pnes_howlong_month and/or _____ months 0 .. 11
508 pnes_howlong1_year How long have you lived at your current address? _____ years, 0 .. 199
509 pnes_howlong1_month and/or _____ months 0 .. 11
510 pnes_safe1 13. How safe from crime would you say your neighborhood is? 1= Very Safe 2= Fairly Safe 3= Somewhat Safe 4= Not too safe 5= Not Safe at all 0= Does not apply
511 pnes_safe2 14. 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 0= Does not apply
512 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]
513 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
514 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
515 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
516 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
517 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
518 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
519 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
520 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
521 q1supx SOCIAL SUPPORT Now we are interested in knowing how you feel about the following statements. Please indicate how much you agree or disagree with each statement. 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? There is a special person who is around when I am in need. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
522 q2supx There is a special person with whom I can share joys and sorrows. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
523 q5supx I have a special person who is a real source of comfort to me. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
524 q10supx There is a special person in my life who cares about my feelings. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
525 purpos1 PURPOSE IN LIFE 1. I feel good when I think of what I've done in the past and what I hope to do in the future. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
526 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
527 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
528 purpos4 4. I have a sense of direction and purpose in life. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
529 purpos5 5. My daily activities often seem trivial and unimportant to me. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
530 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
531 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
532 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
533 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
534 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
535 emptins SOCIAL ISOLATION I experience a general sense of emptiness. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
536 misspeop I miss having people around. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
537 friends I feel like I don't have enough friends. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
538 abandon I often feel abandoned. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
539 missfrnd I miss having a really close friend. 1= Strongly disagree 2= Disagree 3= Neutral 4= Agree 5= Strongly Agree
540 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
541 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
542 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
543 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
544 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
545 lifesp6 During the past week, have you been to places outside your town or community? 1= Yes 2= No
546 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
547 hearimp 2. Does the participant have a substantial hearing impairment? 1= Yes 2= No
548 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
549 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
550 comments Enter any comments. [PRESS ENTER IF NONE.] String[150]
551 vegsign 0 .. 8
552 mvegsign 0 .. 8
553 cesd 0 .. 10
554 mcesd 0 .. 10
559 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
560 formpart Was participant reluctant, and/or does participant have special needs? 1= Yes 2= No
561 formcomm Please explain reluctance or any other factors which may have affected this data. [Press enter if no comment needed.] String[120]
562 statid Please enter you staff id. 100 .. 997
563 formch Has the form been modified? 1= Yes 2= No
564 revidate Enter the date that the form was modified. Date type
565 revintd Enter your staff id number. 100 .. 997
566 anydev Are there any protocol deviations or missing data items to enter? 1= Yes 2= No
567 numdev How many total protocol deviations and tests with missing items to enter? 1 .. 20
568 reas00 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
569 test00 Enter test or procedure. String[15]
570 item00 List items involved. [SEPARATE BY A COMMA] String[20]
571 code00 Enter data code used. 1= Don't Know 2= Refusal 3= other
572 oth00 Enter other code used. String[20]
573 expl00 Explain what happened String[100]
574 reas01 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
575 test01 Enter test or procedure. String[15]
576 item01 List items involved. [SEPARATE BY A COMMA] String[20]
577 code01 Enter data code used. 1= Don't Know 2= Refusal 3= other
578 oth01 Enter other code used. String[20]
579 expl01 Explain what happened String[100]
580 reas02 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
581 test02 Enter test or procedure. String[15]
582 item02 List items involved. [SEPARATE BY A COMMA] String[20]
583 code02 Enter data code used. 1= Don't Know 2= Refusal 3= other
584 oth02 Enter other code used. String[20]
585 expl02 Explain what happened String[100]
586 reas03 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
587 test03 Enter test or procedure. String[15]
588 item03 List items involved. [SEPARATE BY A COMMA] String[20]
589 code03 Enter data code used. 1= Don't Know 2= Refusal 3= other
590 oth03 Enter other code used. String[20]
591 expl03 Explain what happened String[100]
592 reas04 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
593 test04 Enter test or procedure. String[15]
594 item04 List items involved. [SEPARATE BY A COMMA] String[20]
595 code04 Enter data code used. 1= Don't Know 2= Refusal 3= other
596 oth04 Enter other code used. String[20]
597 expl04 Explain what happened String[100]
598 reas05 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
599 test05 Enter test or procedure. String[15]
600 item05 List items involved. [SEPARATE BY A COMMA] String[20]
601 code05 Enter data code used. 1= Don't Know 2= Refusal 3= other
602 oth05 Enter other code used. String[20]
603 expl05 Explain what happened String[100]
604 reas06 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
605 test06 Enter test or procedure. String[15]
606 item06 List items involved. [SEPARATE BY A COMMA] String[20]
607 code06 Enter data code used. 1= Don't Know 2= Refusal 3= other
608 oth06 Enter other code used. String[20]
609 expl06 Explain what happened String[100]
610 reas07 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
611 test07 Enter test or procedure. String[15]
612 item07 List items involved. [SEPARATE BY A COMMA] String[20]
613 code07 Enter data code used. 1= Don't Know 2= Refusal 3= other
614 oth07 Enter other code used. String[20]
615 expl07 Explain what happened String[100]
616 reas08 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
617 test08 Enter test or procedure. String[15]
618 item08 List items involved. [SEPARATE BY A COMMA] String[20]
619 code08 Enter data code used. 1= Don't Know 2= Refusal 3= other
620 oth08 Enter other code used. String[20]
621 expl08 Explain what happened String[100]
622 reas09 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
623 test09 Enter test or procedure. String[15]
624 item09 List items involved. [SEPARATE BY A COMMA] String[20]
625 code09 Enter data code used. 1= Don't Know 2= Refusal 3= other
626 oth09 Enter other code used. String[20]
627 expl09 Explain what happened String[100]
628 reas10 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
629 test10 Enter test or procedure. String[15]
630 item10 List items involved. [SEPARATE BY A COMMA] String[20]
631 code10 Enter data code used. 1= Don't Know 2= Refusal 3= other
632 oth10 Enter other code used. String[20]
633 expl10 Explain what happened String[100]
634 reas11 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
635 test11 Enter test or procedure. String[15]
636 item11 List items involved. [SEPARATE BY A COMMA] String[20]
637 code11 Enter data code used. 1= Don't Know 2= Refusal 3= other
638 oth11 Enter other code used. String[20]
639 expl11 Explain what happened String[100]
640 reas12 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
641 test12 Enter test or procedure. String[15]
642 item12 List items involved. [SEPARATE BY A COMMA] String[20]
643 code12 Enter data code used. 1= Don't Know 2= Refusal 3= other
644 oth12 Enter other code used. String[20]
645 expl12 Explain what happened String[100]
646 reas13 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
647 test13 Enter test or procedure. String[15]
648 item13 List items involved. [SEPARATE BY A COMMA] String[20]
649 code13 Enter data code used. 1= Don't Know 2= Refusal 3= other
650 oth13 Enter other code used. String[20]
651 expl13 Explain what happened String[100]
652 reas14 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
653 test14 Enter test or procedure. String[15]
654 item14 List items involved. [SEPARATE BY A COMMA] String[20]
655 code14 Enter data code used. 1= Don't Know 2= Refusal 3= other
656 oth14 Enter other code used. String[20]
657 expl14 Explain what happened String[100]
658 reas15 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
659 test15 Enter test or procedure. String[15]
660 item15 List items involved. [SEPARATE BY A COMMA] String[20]
661 code15 Enter data code used. 1= Don't Know 2= Refusal 3= other
662 oth15 Enter other code used. String[20]
663 expl15 Explain what happened String[100]
664 reas16 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
665 test16 Enter test or procedure. String[15]
666 item16 List items involved. [SEPARATE BY A COMMA] String[20]
667 code16 Enter data code used. 1= Don't Know 2= Refusal 3= other
668 oth16 Enter other code used. String[20]
669 expl16 Explain what happened String[100]
670 reas17 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
671 test17 Enter test or procedure. String[15]
672 item17 List items involved. [SEPARATE BY A COMMA] String[20]
673 code17 Enter data code used. 1= Don't Know 2= Refusal 3= other
674 oth17 Enter other code used. String[20]
675 expl17 Explain what happened String[100]
676 reas18 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
677 test18 Enter test or procedure. String[15]
678 item18 List items involved. [SEPARATE BY A COMMA] String[20]
679 code18 Enter data code used. 1= Don't Know 2= Refusal 3= other
680 oth18 Enter other code used. String[20]
681 expl18 Explain what happened String[100]
682 reas19 Protocol Deviation or Missing Data? 1= Protocol Deviation 2= Missing Data
683 test19 Enter test or procedure. String[15]
684 item19 List items involved. [SEPARATE BY A COMMA] String[20]
685 code19 Enter data code used. 1= Don't Know 2= Refusal 3= other
686 oth19 Enter other code used. String[20]
687 expl19 Explain what happened String[100]

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