ID

44295

Descripción

Study ID: 100601 Clinical Study ID: LPL100601 Study Title: LPL100601, A Clinical Outcomes Study of Darapladib versus Placebo in Subjects with Chronic Coronary Heart Disease to Compare the Incidence of Major Adverse Cardiovascular Events (MACE) Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00799903 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: phase 3 Study Recruitment Status: Completed Generic Name: darapladib Trade Name: darapladib Study Indication: Atherosclerosis Study part: Lifestyle Questionnaire.

Palabras clave

Versiones (4)
  1. 20/9/17 20/9/17 -
  2. 23/10/17 23/10/17 -
  3. 20/12/17 20/12/17 -
  4. 20/9/21 20/9/21 -
Titular de derechos de autor

GlaxoSmithKline

Subido en

20 de septiembre de 2021

DOI

Para solicitar uno, por favor iniciar sesión.

Licencia

Creative Commons BY-NC 3.0
Comentarios del modelo :

Puede comentar sobre el modelo de datos aquí. A través de las burbujas de diálogo en los grupos de elementos y elementos, puede agregar comentarios específicos.

Volver a los comentarios del modelo
Comentarios de grupo de elementos para :

Comentarios del elemento para :

Para descargar modelos de datos, debe haber iniciado sesión. Por favor iniciar sesión o Registrate gratis.

Lifestyle Questionnaire GSK study Chronic Coronary Heart Disease NCT00799903

Inglés

Lifestyle Questionnaire GSK study Chronic Coronary Heart Disease NCT00799903

1 formularios  
How much do you eat the following types of food?
Descripción

How much do you eat the following types of food?

1. Meat/poultry (e.g. beef, pork, lamb, chicken)
Descripción

Meat/poultry

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0025017
UMLS CUI [1,2]
C0013470
2. Fish (fresh-water and ocean fish, including dried and canned fish)
Descripción

Fish

Tipo de datos

text

Alias
UMLS CUI [1]
C0327606
3. Eggs
Descripción

Eggs

Tipo de datos

text

Alias
UMLS CUI [1]
C0013710
4. Dairy products (Milk, yogurt, cheese, etc.)
Descripción

Dairy products

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0009830
UMLS CUI [1,2]
C0010947
5. Whole grains (whole wheat flour, brown/white rice, corn, oats, etc.)
Descripción

Whole grains

Tipo de datos

text

Alias
UMLS CUI [1]
C4042940
6. Refined/milled grains (white flour, white rice, pasta, noodles, etc.)
Descripción

Refined/milled grains

Tipo de datos

text

Alias
UMLS CUI [1]
C0086369
7. Tofu/soybean curd (textured vegetable protein, soya milk, etc.)
Descripción

Tofu/soybean curd

Tipo de datos

text

Alias
UMLS CUI [1]
C0453233
8. Legumes (beans, lentils, peas, etc.)
Descripción

Legumes

Tipo de datos

text

Alias
UMLS CUI [1]
C4065479
9. Fruits
Descripción

Fruits

Tipo de datos

text

Alias
UMLS CUI [1]
C0016767
10. Vegetables (excluding potatoes)
Descripción

Vegetables

Tipo de datos

text

Alias
UMLS CUI [1]
C0042440
11. Deep fried food (e.g. French fries, potato chips, samosas, egg rolls, etc.)
Descripción

Deep fried food

Tipo de datos

text

Alias
UMLS CUI [1]
C0559579
12. Dessert/sweet snacks (cake, cookie, pie, chocolates, etc.)
Descripción

Dessert/sweet snacks

Tipo de datos

text

Alias
UMLS CUI [1]
C2008798
13. Sweetened drinks (excluding diet drinks)
Descripción

Sweetened drinks

Tipo de datos

text

Alias
UMLS CUI [1]
C3262404
During a typical week, how much of the following alcoholic drinks do you have?
Descripción

During a typical week, how much of the following alcoholic drinks do you have?

14. Beers
Descripción

standard drinks per week

Tipo de datos

integer

Alias
UMLS CUI [1]
C0559430
15. Red wine
Descripción

standard drinks per week

Tipo de datos

integer

Alias
UMLS CUI [1]
C0349371
16. White wine
Descripción

standard drinks per week

Tipo de datos

integer

Alias
UMLS CUI [1]
C0349372
17. Spirits or liquor (gin, rum, vodka, whisky, etc)
Descripción

standard drinks per week

Tipo de datos

integer

Alias
UMLS CUI [1]
C0301611
18. How often do you have six or more standard drinks on one occasion?
Descripción

number of standard drinks on one occasion

Tipo de datos

text

Alias
UMLS CUI [1]
C3698589
How many hours during a TYPICAL WEEK do you spend on the following activities?
Descripción

How many hours during a TYPICAL WEEK do you spend on the following activities?

19. Travelling by car, motorcycle, bus, train or other vehicle (including your routine commute)
Descripción

hours per week

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0040802
UMLS CUI [1,2]
C0449788
20. Relaxing while talking with friends or family
Descripción

hours per week

Tipo de datos

integer

Alias
UMLS CUI [1]
C0035028
21. In an environment where someone is smoking
Descripción

hours per week

Tipo de datos

integer

Alias
UMLS CUI [1]
C1948106
22. Watching TV
Descripción

hours per week

Tipo de datos

integer

Alias
UMLS CUI [1]
C0871498
23. On the computer (including time spent at work and during leisure time)
Descripción

hours per week

Tipo de datos

integer

Alias
UMLS CUI [1]
C3842632
How many hours during a TYPICAL WEEK do you spend doing the following physical activities for 10 minutes or more?
Descripción

How many hours during a TYPICAL WEEK do you spend doing the following physical activities for 10 minutes or more?

24. Doing MILD physical activity such as easy walking, yoga or Tai Chi
Descripción

hours per week

Tipo de datos

integer

Alias
UMLS CUI [1]
C0026606
Doing MODERATE physical activity such as fast walking, jogging, aerobics, gardening, bicycling, dancing, swimming or house cleaning
Descripción

hours per week

Tipo de datos

integer

Alias
UMLS CUI [1]
C1513375
26. Doing VIGOROUS physical activity such as running, lifting heavy objects, playing strenuous sports or strenuous work
Descripción

hours per week

Tipo de datos

integer

Alias
UMLS CUI [1]
C4060778
27. How active are you at work?
Descripción

physical activity at work

Tipo de datos

text

Alias
UMLS CUI [1]
C0026606
28. How active are you during leisure time?
Descripción

physical activity during leisure time

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0023292
UMLS CUI [1,2]
C0026606
Does your health limit you in the following activities?
Descripción

Does your health limit you in the following activities?

29. Walking 100 meters (or 100 yards)
Descripción

Walking short distance

Tipo de datos

text

Alias
UMLS CUI [1]
C0429886
30. Climbing one flight of stairs
Descripción

Climbing one flight of stairs

Tipo de datos

text

Alias
UMLS CUI [1]
C3831080
31. Walking more than one kilometer (or half a mile)
Descripción

Walking long distance

Tipo de datos

text

Alias
UMLS CUI [1]
C0429886
32. Moderate physical activities
Descripción

Moderate physical activities

Tipo de datos

text

Alias
UMLS CUI [1]
C3833417
33. Vigorous physical activities
Descripción

Vigorous physical activities

Tipo de datos

text

Alias
UMLS CUI [1]
C4060778
Are your activities limited by the following symptoms?
Descripción

Are your activities limited by the following symptoms?

34. Shortness of breath
Descripción

Shortness of breath

Tipo de datos

text

Alias
UMLS CUI [1]
C0013404
35. Chest discomfort or tightness (angina)
Descripción

Chest discomfort or tightness

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0232292
UMLS CUI [1,2]
C0013404
36. Dizziness
Descripción

Dizziness

Tipo de datos

text

Alias
UMLS CUI [1]
C0012833
37. Fatigue or tiredness
Descripción

Fatigue or tiredness

Tipo de datos

text

Alias
UMLS CUI [1]
C0848717
38. Arthritis
Descripción

Arthritis

Tipo de datos

text

Alias
UMLS CUI [1]
C0003864
39. Muscle weakness
Descripción

Muscle weakness

Tipo de datos

text

Alias
UMLS CUI [1]
C0151786
40. Do your gums bleed when brushing your teeth or at other times?
Descripción

Bleeding gums

Tipo de datos

text

Alias
UMLS CUI [1]
C0017565
41. How many teeth do you have in your mouth?
Descripción

Number of teeth

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0040426
UMLS CUI [1,2]
C0750480
Choose one answer for each question to describe your sleep pattern OVER THE LAST YEAR
Descripción

Choose one answer for each question to describe your sleep pattern OVER THE LAST YEAR

42. When sleeping, have you been told you snore loudly?
Descripción

Snoring

Tipo de datos

text

Alias
UMLS CUI [1]
C0037384
43. Do you wake up more than once a night?
Descripción

Waking up at night

Tipo de datos

text

Alias
UMLS CUI [1]
C1170730
44. Are you tired first thing in the morning?
Descripción

Tiredness in the morning

Tipo de datos

text

Alias
UMLS CUI [1]
C0541994
45. Are you sleepy during the day?
Descripción

Sleepiness during the day

Tipo de datos

text

Alias
UMLS CUI [1]
C0013144
46. Have you been told you gasp, choke or stop breathing when asleep?
Descripción

gasping, choking, no breathing when asleep

Tipo de datos

text

Alias
UMLS CUI [1]
C0008301
Choose one answer for each question to describe your condition over the last year
Descripción

Choose one answer for each question to describe your condition over the last year

47. Have you felt stress at work?
Descripción

Stress at work

Tipo de datos

text

Alias
UMLS CUI [1]
C0814090
48. Have you felt stress at home?
Descripción

Stress at home

Tipo de datos

text

Alias
UMLS CUI [1]
C0558919
49. Have you been under financial stress?
Descripción

Financial stress

Tipo de datos

text

Alias
UMLS CUI [1]
C0549106
50. When at work, have you felt control over what happens?
Descripción

Control at work

Tipo de datos

text

Alias
UMLS CUI [1]
C0425101
51. At home, have you felt control over what happens?
Descripción

Control at home

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0243148
UMLS CUI [1,2]
C0026606
52. Have you felt sad, low in your spirits or depressed?
Descripción

Feeling depressed

Tipo de datos

text

Alias
UMLS CUI [1]
C0497307
53. Have you lost interest in hobbies, work or activities that previously gave you pleasure?
Descripción

Loss of interest

Tipo de datos

text

Alias
UMLS CUI [1]
C0679474
Comparing your current lifestyle to your lifestyle before your first heart problem, DO YOU
Descripción

Comparing your current lifestyle to your lifestyle before your first heart problem, DO YOU

54. Exercise
Descripción

Exercise

Tipo de datos

text

Alias
UMLS CUI [1]
C0015259
55. Have stress
Descripción

Stress level

Tipo de datos

text

Alias
UMLS CUI [1]
C0038435
56. Eat meat/poultry
Descripción

Eat meat/poultry

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0025017
UMLS CUI [1,2]
C0012171
57. Eat fish
Descripción

Eat fish

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0566305
UMLS CUI [1,2]
C0016158
58. Eat fruit/vegetable
Descripción

Eat fruit/vegetable

Tipo de datos

text

Alias
UMLS CUI [1]
C0016767
59. Have desserts/sweet snacks/sugared drinks
Descripción

Sugar intake

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1512806
UMLS CUI [1,2]
C0242209
60. Eat deep fried food
Descripción

Eat deep fried food

Tipo de datos

text

Alias
UMLS CUI [1]
C0559579
61. Eat salty food
Descripción

Eat salty food

Tipo de datos

text

Alias
UMLS CUI [1]
C0453862
62. Eat high fat food
Descripción

Eat high fat food

Tipo de datos

text

Alias
UMLS CUI [1]
C0521974
63. Eat dairy products
Descripción

Eat dairy products

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0009830
UMLS CUI [1,2]
C0010947
Since your first heart problem
Descripción

Since your first heart problem

64. Have you
Descripción

Smoking

Tipo de datos

text

Alias
UMLS CUI [1]
C0543414
65. Has your body weight
Descripción

Body weight

Tipo de datos

text

Alias
UMLS CUI [1]
C0005910
66. Have you ever participated in a cardiac rehabilitation program?
Descripción

Cardiac rehabilitation program

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0700431
67. Overall, how do you feel your general health is now?
Descripción

General health

Tipo de datos

text

Alias
UMLS CUI [1]
C0424575
Socio-economic
Descripción

Socio-economic

68. What is your current marital status?
Descripción

marital status

Tipo de datos

text

Alias
UMLS CUI [1]
C0024819
69. Are you living alone?
Descripción

living alone

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0439044
70. How many years of formal education have you completed?
Descripción

years of formal education

Tipo de datos

text

Alias
UMLS CUI [1]
C0557280
71. Do you have access to the internet?
Descripción

internet access

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0282111
72. What is your current employment?
Descripción

current employment

Tipo de datos

text

Alias
UMLS CUI [1]
C0552390
73. Postal code / ZIP code
Descripción

Postal code / ZIP code

Tipo de datos

integer

Alias
UMLS CUI [1]
C0421454
Volver a la parte superior de la página

Similar models

Lifestyle Questionnaire GSK study Chronic Coronary Heart Disease NCT00799903

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
How much do you eat the following types of food?
Item
1. Meat/poultry (e.g. beef, pork, lamb, chicken)
text
C0025017 (UMLS CUI [1,1])
C0013470 (UMLS CUI [1,2])
Cognitive Function substudy entry criteria met
Code List
1. Meat/poultry (e.g. beef, pork, lamb, chicken)
CL Item
Never or rarely (<1/week) ([A00])
C0522498 (UMLS CUI-1)
(Comment:en)
CL Item
About 1 servings each week ([A01])
C0558293 (UMLS CUI-1)
(Comment:en)
CL Item
Several servings each week ([A02])
C3844034 (UMLS CUI-1)
(Comment:en)
CL Item
1-2 servings each day ([A03])
C1519269 (UMLS CUI-1)
(Comment:en)
CL Item
3 or more servings each day ([A04])
C1519269 (UMLS CUI-1)
(Comment:en)
Item
2. Fish (fresh-water and ocean fish, including dried and canned fish)
text
C0327606 (UMLS CUI [1])
Cognitive Function substudy entry criteria met
Code List
2. Fish (fresh-water and ocean fish, including dried and canned fish)
CL Item
Never or rarely (<1/week) ([A00])
C0522498 (UMLS CUI-1)
(Comment:en)
CL Item
About 1 servings each week ([A01])
C0558293 (UMLS CUI-1)
(Comment:en)
CL Item
Several servings each week ([A02])
C3844034 (UMLS CUI-1)
(Comment:en)
CL Item
1-2 servings each day ([A03])
C1519269 (UMLS CUI-1)
(Comment:en)
CL Item
3 or more servings each day ([A04])
C1519269 (UMLS CUI-1)
(Comment:en)
Item
3. Eggs
text
C0013710 (UMLS CUI [1])
Cognitive Function substudy entry criteria met
Code List
3. Eggs
CL Item
Never or rarely (<1/week) ([A00])
C0522498 (UMLS CUI-1)
(Comment:en)
CL Item
About 1 servings each week ([A01])
C0558293 (UMLS CUI-1)
(Comment:en)
CL Item
Several servings each week ([A02])
C3844034 (UMLS CUI-1)
(Comment:en)
CL Item
1-2 servings each day ([A03])
C1519269 (UMLS CUI-1)
(Comment:en)
CL Item
3 or more servings each day ([A04])
C1519269 (UMLS CUI-1)
(Comment:en)
Item
4. Dairy products (Milk, yogurt, cheese, etc.)
text
C0009830 (UMLS CUI [1,1])
C0010947 (UMLS CUI [1,2])
Cognitive Function substudy entry criteria met
Code List
4. Dairy products (Milk, yogurt, cheese, etc.)
CL Item
Never or rarely (<1/week) ([A00])
C0522498 (UMLS CUI-1)
(Comment:en)
CL Item
About 1 servings each week ([A01])
C0558293 (UMLS CUI-1)
(Comment:en)
CL Item
Several servings each week ([A02])
C3844034 (UMLS CUI-1)
(Comment:en)
CL Item
1-2 servings each day ([A03])
C1519269 (UMLS CUI-1)
(Comment:en)
CL Item
3 or more servings each day ([A04])
C1519269 (UMLS CUI-1)
(Comment:en)
Item
5. Whole grains (whole wheat flour, brown/white rice, corn, oats, etc.)
text
C4042940 (UMLS CUI [1])
Cognitive Function substudy entry criteria met
Code List
5. Whole grains (whole wheat flour, brown/white rice, corn, oats, etc.)
CL Item
Never or rarely (<1/week) ([A00])
C0522498 (UMLS CUI-1)
(Comment:en)
CL Item
About 1 servings each week ([A01])
C0558293 (UMLS CUI-1)
(Comment:en)
CL Item
Several servings each week ([A02])
C3844034 (UMLS CUI-1)
(Comment:en)
CL Item
1-2 servings each day ([A03])
C1519269 (UMLS CUI-1)
(Comment:en)
CL Item
3 or more servings each day ([A04])
C1519269 (UMLS CUI-1)
(Comment:en)
Item
6. Refined/milled grains (white flour, white rice, pasta, noodles, etc.)
text
C0086369 (UMLS CUI [1])
Cognitive Function substudy entry criteria met
Code List
6. Refined/milled grains (white flour, white rice, pasta, noodles, etc.)
CL Item
Never or rarely (<1/week) ([A00])
C0522498 (UMLS CUI-1)
(Comment:en)
CL Item
About 1 servings each week ([A01])
C0558293 (UMLS CUI-1)
(Comment:en)
CL Item
Several servings each week ([A02])
C3844034 (UMLS CUI-1)
(Comment:en)
CL Item
1-2 servings each day ([A03])
C1519269 (UMLS CUI-1)
(Comment:en)
CL Item
3 or more servings each day ([A04])
C1519269 (UMLS CUI-1)
(Comment:en)
Item
7. Tofu/soybean curd (textured vegetable protein, soya milk, etc.)
text
C0453233 (UMLS CUI [1])
Cognitive Function substudy entry criteria met
Code List
7. Tofu/soybean curd (textured vegetable protein, soya milk, etc.)
CL Item
Never or rarely (<1/week) ([A00])
C0522498 (UMLS CUI-1)
(Comment:en)
CL Item
About 1 servings each week ([A01])
C0558293 (UMLS CUI-1)
(Comment:en)
CL Item
Several servings each week ([A02])
C3844034 (UMLS CUI-1)
(Comment:en)
CL Item
1-2 servings each day ([A03])
C1519269 (UMLS CUI-1)
(Comment:en)
CL Item
3 or more servings each day ([A04])
C1519269 (UMLS CUI-1)
(Comment:en)
Item
8. Legumes (beans, lentils, peas, etc.)
text
C4065479 (UMLS CUI [1])
Cognitive Function substudy entry criteria met
Code List
8. Legumes (beans, lentils, peas, etc.)
CL Item
Never or rarely (<1/week) ([A00])
C0522498 (UMLS CUI-1)
(Comment:en)
CL Item
About 1 servings each week ([A01])
C0558293 (UMLS CUI-1)
(Comment:en)
CL Item
Several servings each week ([A02])
C3844034 (UMLS CUI-1)
(Comment:en)
CL Item
1-2 servings each day ([A03])
C1519269 (UMLS CUI-1)
(Comment:en)
CL Item
3 or more servings each day ([A04])
C1519269 (UMLS CUI-1)
(Comment:en)
Item
9. Fruits
text
C0016767 (UMLS CUI [1])
Cognitive Function substudy entry criteria met
Code List
9. Fruits
CL Item
Never or rarely (<1/week) ([A00])
C0522498 (UMLS CUI-1)
(Comment:en)
CL Item
About 1 servings each week ([A01])
C0558293 (UMLS CUI-1)
(Comment:en)
CL Item
Several servings each week ([A02])
C3844034 (UMLS CUI-1)
(Comment:en)
CL Item
1-2 servings each day ([A03])
C1519269 (UMLS CUI-1)
(Comment:en)
CL Item
3 or more servings each day ([A04])
C1519269 (UMLS CUI-1)
(Comment:en)
Item
10. Vegetables (excluding potatoes)
text
C0042440 (UMLS CUI [1])
Cognitive Function substudy entry criteria met
Code List
10. Vegetables (excluding potatoes)
CL Item
Never or rarely (<1/week) ([A00])
C0522498 (UMLS CUI-1)
(Comment:en)
CL Item
About 1 servings each week ([A01])
C0558293 (UMLS CUI-1)
(Comment:en)
CL Item
Several servings each week ([A02])
C3844034 (UMLS CUI-1)
(Comment:en)
CL Item
1-2 servings each day ([A03])
C1519269 (UMLS CUI-1)
(Comment:en)
CL Item
3 or more servings each day ([A04])
C1519269 (UMLS CUI-1)
(Comment:en)
Item
11. Deep fried food (e.g. French fries, potato chips, samosas, egg rolls, etc.)
text
C0559579 (UMLS CUI [1])
Cognitive Function substudy entry criteria met
Code List
11. Deep fried food (e.g. French fries, potato chips, samosas, egg rolls, etc.)
CL Item
Never or rarely (<1/week) ([A00])
C0522498 (UMLS CUI-1)
(Comment:en)
CL Item
About 1 servings each week ([A01])
C0558293 (UMLS CUI-1)
(Comment:en)
CL Item
Several servings each week ([A02])
C3844034 (UMLS CUI-1)
(Comment:en)
CL Item
1-2 servings each day ([A03])
C1519269 (UMLS CUI-1)
(Comment:en)
CL Item
3 or more servings each day ([A04])
C1519269 (UMLS CUI-1)
(Comment:en)
Item
12. Dessert/sweet snacks (cake, cookie, pie, chocolates, etc.)
text
C2008798 (UMLS CUI [1])
Cognitive Function substudy entry criteria met
Code List
12. Dessert/sweet snacks (cake, cookie, pie, chocolates, etc.)
CL Item
Never or rarely (<1/week) ([A00])
C0522498 (UMLS CUI-1)
(Comment:en)
CL Item
About 1 servings each week ([A01])
C0558293 (UMLS CUI-1)
(Comment:en)
CL Item
Several servings each week ([A02])
C3844034 (UMLS CUI-1)
(Comment:en)
CL Item
1-2 servings each day ([A03])
C1519269 (UMLS CUI-1)
(Comment:en)
CL Item
3 or more servings each day ([A04])
C1519269 (UMLS CUI-1)
(Comment:en)
Item
13. Sweetened drinks (excluding diet drinks)
text
C3262404 (UMLS CUI [1])
Cognitive Function substudy entry criteria met
Code List
13. Sweetened drinks (excluding diet drinks)
CL Item
Never or rarely (<1/week) ([A00])
C0522498 (UMLS CUI-1)
(Comment:en)
CL Item
About 1 servings each week ([A01])
C0558293 (UMLS CUI-1)
(Comment:en)
CL Item
Several servings each week ([A02])
C3844034 (UMLS CUI-1)
(Comment:en)
CL Item
1-2 servings each day ([A03])
C1519269 (UMLS CUI-1)
(Comment:en)
CL Item
3 or more servings each day ([A04])
C1519269 (UMLS CUI-1)
(Comment:en)
Item Group
During a typical week, how much of the following alcoholic drinks do you have?
Beers
Item
14. Beers
integer
C0559430 (UMLS CUI [1])
Red wine
Item
15. Red wine
integer
C0349371 (UMLS CUI [1])
White wine
Item
16. White wine
integer
C0349372 (UMLS CUI [1])
Spirits or liquor
Item
17. Spirits or liquor (gin, rum, vodka, whisky, etc)
integer
C0301611 (UMLS CUI [1])
Item
18. How often do you have six or more standard drinks on one occasion?
text
C3698589 (UMLS CUI [1])
number of standard drinks on one occasion
Code List
18. How often do you have six or more standard drinks on one occasion?
CL Item
Never ([B00])
C2003901 (UMLS CUI-1)
(Comment:en)
CL Item
Less than monthly ([B01])
C0332177 (UMLS CUI-1)
C0439092 (UMLS CUI-2)
(Comment:en)
CL Item
Monthly ([B02])
C0332177 (UMLS CUI-1)
(Comment:en)
CL Item
Weekly ([B03])
C0332174 (UMLS CUI-1)
(Comment:en)
CL Item
Daily or almost daily ([B04])
C0332173 (UMLS CUI-1)
(Comment:en)
Item Group
How many hours during a TYPICAL WEEK do you spend on the following activities?
travelling time
Item
19. Travelling by car, motorcycle, bus, train or other vehicle (including your routine commute)
integer
C0040802 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
Relaxation
Item
20. Relaxing while talking with friends or family
integer
C0035028 (UMLS CUI [1])
exposure to cigarette smoke
Item
21. In an environment where someone is smoking
integer
C1948106 (UMLS CUI [1])
Watching TV
Item
22. Watching TV
integer
C0871498 (UMLS CUI [1])
time spent on computer
Item
23. On the computer (including time spent at work and during leisure time)
integer
C3842632 (UMLS CUI [1])
Item Group
How many hours during a TYPICAL WEEK do you spend doing the following physical activities for 10 minutes or more?
mild physical activity
Item
24. Doing MILD physical activity such as easy walking, yoga or Tai Chi
integer
C0026606 (UMLS CUI [1])
moderate physical activity
Item
Doing MODERATE physical activity such as fast walking, jogging, aerobics, gardening, bicycling, dancing, swimming or house cleaning
integer
C1513375 (UMLS CUI [1])
vigorous physical activity
Item
26. Doing VIGOROUS physical activity such as running, lifting heavy objects, playing strenuous sports or strenuous work
integer
C4060778 (UMLS CUI [1])
Item
27. How active are you at work?
text
C0026606 (UMLS CUI [1])
physical activity at work
Code List
27. How active are you at work?
CL Item
Mainly sedentary ([C00])
CL Item
Predominantly walking on one level, no heavy lifting ([C01])
CL Item
Mainly walking, including climbing stairs, or walking uphill or lifting heavy objects ([C02])
CL Item
Heavy physical activity ([C03])
CL Item
I do not work ([C04])
Item
28. How active are you during leisure time?
text
C0023292 (UMLS CUI [1,1])
C0026606 (UMLS CUI [1,2])
physical activity during leisure time
Code List
28. How active are you during leisure time?
CL Item
Mainly sedentary ([C00])
CL Item
Mild exercise ([C05])
CL Item
Moderate exercise ([C06])
CL Item
Strenuous physical exercise ([C07])
Item Group
Does your health limit you in the following activities?
Item
29. Walking 100 meters (or 100 yards)
text
C0429886 (UMLS CUI [1])
Walking
Code List
29. Walking 100 meters (or 100 yards)
CL Item
Not limited ([C08])
C3845941 (UMLS CUI-1)
(Comment:en)
CL Item
Limited a little ([C09])
C3829283 (UMLS CUI-1)
(Comment:en)
CL Item
Limited a lot ([C10])
C3829282 (UMLS CUI-1)
(Comment:en)
CL Item
Do not do for non-health reasons ([C20])
C3840932 (UMLS CUI-1)
(Comment:en)
Item
30. Climbing one flight of stairs
text
C3831080 (UMLS CUI [1])
Walking
Code List
30. Climbing one flight of stairs
CL Item
Not limited ([C08])
C3845941 (UMLS CUI-1)
(Comment:en)
CL Item
Limited a little ([C09])
C3829283 (UMLS CUI-1)
(Comment:en)
CL Item
Limited a lot ([C10])
C3829282 (UMLS CUI-1)
(Comment:en)
CL Item
Do not do for non-health reasons ([C20])
C3840932 (UMLS CUI-1)
(Comment:en)
Item
31. Walking more than one kilometer (or half a mile)
text
C0429886 (UMLS CUI [1])
Walking
Code List
31. Walking more than one kilometer (or half a mile)
CL Item
Not limited ([C08])
C3845941 (UMLS CUI-1)
(Comment:en)
CL Item
Limited a little ([C09])
C3829283 (UMLS CUI-1)
(Comment:en)
CL Item
Limited a lot ([C10])
C3829282 (UMLS CUI-1)
(Comment:en)
CL Item
Do not do for non-health reasons ([C20])
C3840932 (UMLS CUI-1)
(Comment:en)
Item
32. Moderate physical activities
text
C3833417 (UMLS CUI [1])
Walking
Code List
32. Moderate physical activities
CL Item
Not limited ([C08])
C3845941 (UMLS CUI-1)
(Comment:en)
CL Item
Limited a little ([C09])
C3829283 (UMLS CUI-1)
(Comment:en)
CL Item
Limited a lot ([C10])
C3829282 (UMLS CUI-1)
(Comment:en)
CL Item
Do not do for non-health reasons ([C20])
C3840932 (UMLS CUI-1)
(Comment:en)
Item
33. Vigorous physical activities
text
C4060778 (UMLS CUI [1])
Walking
Code List
33. Vigorous physical activities
CL Item
Not limited ([C08])
C3845941 (UMLS CUI-1)
(Comment:en)
CL Item
Limited a little ([C09])
C3829283 (UMLS CUI-1)
(Comment:en)
CL Item
Limited a lot ([C10])
C3829282 (UMLS CUI-1)
(Comment:en)
CL Item
Do not do for non-health reasons ([C20])
C3840932 (UMLS CUI-1)
(Comment:en)
Item Group
Are your activities limited by the following symptoms?
Item
34. Shortness of breath
text
C0013404 (UMLS CUI [1])
Shortness of breath
Code List
34. Shortness of breath
CL Item
Not limited ([C08])
CL Item
Limited a little ([C09])
CL Item
Limited a lot ([C10])
Item
35. Chest discomfort or tightness (angina)
text
C0232292 (UMLS CUI [1,1])
C0013404 (UMLS CUI [1,2])
Shortness of breath
Code List
35. Chest discomfort or tightness (angina)
CL Item
Not limited ([C08])
CL Item
Limited a little ([C09])
CL Item
Limited a lot ([C10])
Item
36. Dizziness
text
C0012833 (UMLS CUI [1])
Shortness of breath
Code List
36. Dizziness
CL Item
Not limited ([C08])
CL Item
Limited a little ([C09])
CL Item
Limited a lot ([C10])
Item
37. Fatigue or tiredness
text
C0848717 (UMLS CUI [1])
Shortness of breath
Code List
37. Fatigue or tiredness
CL Item
Not limited ([C08])
CL Item
Limited a little ([C09])
CL Item
Limited a lot ([C10])
Item
38. Arthritis
text
C0003864 (UMLS CUI [1])
Shortness of breath
Code List
38. Arthritis
CL Item
Not limited ([C08])
CL Item
Limited a little ([C09])
CL Item
Limited a lot ([C10])
Item
39. Muscle weakness
text
C0151786 (UMLS CUI [1])
Shortness of breath
Code List
39. Muscle weakness
CL Item
Not limited ([C08])
CL Item
Limited a little ([C09])
CL Item
Limited a lot ([C10])
Item
40. Do your gums bleed when brushing your teeth or at other times?
text
C0017565 (UMLS CUI [1])
Bleeding gums
Code List
40. Do your gums bleed when brushing your teeth or at other times?
CL Item
Never/rarely ([C11])
CL Item
Sometimes ([C12])
CL Item
Often ([C13])
CL Item
Always ([C14])
Item
41. How many teeth do you have in your mouth?
text
C0040426 (UMLS CUI [1,1])
C0750480 (UMLS CUI [1,2])
Number of teeth
Code List
41. How many teeth do you have in your mouth?
CL Item
26-32 (all) ([C15])
CL Item
20 to 25 ([C16])
CL Item
15 to 19 ([C17])
CL Item
Less than 15 ([C18])
CL Item
No teeth ([C19])
Item Group
Choose one answer for each question to describe your sleep pattern OVER THE LAST YEAR
Item
42. When sleeping, have you been told you snore loudly?
text
C0037384 (UMLS CUI [1])
Snoring
Code List
42. When sleeping, have you been told you snore loudly?
CL Item
Never/rarely ([D01])
C0522498 (UMLS CUI-1)
(Comment:en)
CL Item
Sometimes ([D02])
C1998882 (UMLS CUI-1)
(Comment:en)
CL Item
Often ([D03])
C0332183 (UMLS CUI-1)
(Comment:en)
CL Item
Always ([D04])
C2003902 (UMLS CUI-1)
(Comment:en)
Item
43. Do you wake up more than once a night?
text
C1170730 (UMLS CUI [1])
Snoring
Code List
43. Do you wake up more than once a night?
CL Item
Never/rarely ([D01])
C0522498 (UMLS CUI-1)
(Comment:en)
CL Item
Sometimes ([D02])
C1998882 (UMLS CUI-1)
(Comment:en)
CL Item
Often ([D03])
C0332183 (UMLS CUI-1)
(Comment:en)
CL Item
Always ([D04])
C2003902 (UMLS CUI-1)
(Comment:en)
Item
44. Are you tired first thing in the morning?
text
C0541994 (UMLS CUI [1])
Snoring
Code List
44. Are you tired first thing in the morning?
CL Item
Never/rarely ([D01])
C0522498 (UMLS CUI-1)
(Comment:en)
CL Item
Sometimes ([D02])
C1998882 (UMLS CUI-1)
(Comment:en)
CL Item
Often ([D03])
C0332183 (UMLS CUI-1)
(Comment:en)
CL Item
Always ([D04])
C2003902 (UMLS CUI-1)
(Comment:en)
Item
45. Are you sleepy during the day?
text
C0013144 (UMLS CUI [1])
Snoring
Code List
45. Are you sleepy during the day?
CL Item
Never/rarely ([D01])
C0522498 (UMLS CUI-1)
(Comment:en)
CL Item
Sometimes ([D02])
C1998882 (UMLS CUI-1)
(Comment:en)
CL Item
Often ([D03])
C0332183 (UMLS CUI-1)
(Comment:en)
CL Item
Always ([D04])
C2003902 (UMLS CUI-1)
(Comment:en)
Item
46. Have you been told you gasp, choke or stop breathing when asleep?
text
C0008301 (UMLS CUI [1])
Snoring
Code List
46. Have you been told you gasp, choke or stop breathing when asleep?
CL Item
Never/rarely ([D01])
C0522498 (UMLS CUI-1)
(Comment:en)
CL Item
Sometimes ([D02])
C1998882 (UMLS CUI-1)
(Comment:en)
CL Item
Often ([D03])
C0332183 (UMLS CUI-1)
(Comment:en)
CL Item
Always ([D04])
C2003902 (UMLS CUI-1)
(Comment:en)
Item Group
Choose one answer for each question to describe your condition over the last year
Item
47. Have you felt stress at work?
text
C0814090 (UMLS CUI [1])
Stress at work
Code List
47. Have you felt stress at work?
CL Item
Never/rarely ([E01])
CL Item
Sometimes ([E02])
CL Item
Often ([E03])
CL Item
Always ([E04])
CL Item
Don't work ([E05])
Item
48. Have you felt stress at home?
text
C0558919 (UMLS CUI [1])
Stress at home
Code List
48. Have you felt stress at home?
CL Item
Never/rarely ([E01])
CL Item
Sometimes ([E02])
CL Item
Often ([E03])
CL Item
Always ([E04])
Item
49. Have you been under financial stress?
text
C0549106 (UMLS CUI [1])
Stress at home
Code List
49. Have you been under financial stress?
CL Item
Never/rarely ([E01])
CL Item
Sometimes ([E02])
CL Item
Often ([E03])
CL Item
Always ([E04])
Item
50. When at work, have you felt control over what happens?
text
C0425101 (UMLS CUI [1])
Stress at work
Code List
50. When at work, have you felt control over what happens?
CL Item
Never/rarely ([E01])
CL Item
Sometimes ([E02])
CL Item
Often ([E03])
CL Item
Always ([E04])
CL Item
Don't work ([E05])
Item
51. At home, have you felt control over what happens?
text
C0243148 (UMLS CUI [1,1])
C0026606 (UMLS CUI [1,2])
Stress at home
Code List
51. At home, have you felt control over what happens?
CL Item
Never/rarely ([E01])
CL Item
Sometimes ([E02])
CL Item
Often ([E03])
CL Item
Always ([E04])
Item
52. Have you felt sad, low in your spirits or depressed?
text
C0497307 (UMLS CUI [1])
Stress at home
Code List
52. Have you felt sad, low in your spirits or depressed?
CL Item
Never/rarely ([E01])
CL Item
Sometimes ([E02])
CL Item
Often ([E03])
CL Item
Always ([E04])
Item
53. Have you lost interest in hobbies, work or activities that previously gave you pleasure?
text
C0679474 (UMLS CUI [1])
Stress at home
Code List
53. Have you lost interest in hobbies, work or activities that previously gave you pleasure?
CL Item
Never/rarely ([E01])
CL Item
Sometimes ([E02])
CL Item
Often ([E03])
CL Item
Always ([E04])
Item Group
Comparing your current lifestyle to your lifestyle before your first heart problem, DO YOU
Item
54. Exercise
text
C0015259 (UMLS CUI [1])
Exercise
Code List
54. Exercise
CL Item
Less now ([E06])
CL Item
About same ([E07])
CL Item
More now ([E08])
Item
55. Have stress
text
C0038435 (UMLS CUI [1])
Exercise
Code List
55. Have stress
CL Item
Less now ([E06])
CL Item
About same ([E07])
CL Item
More now ([E08])
Item
56. Eat meat/poultry
text
C0025017 (UMLS CUI [1,1])
C0012171 (UMLS CUI [1,2])
Exercise
Code List
56. Eat meat/poultry
CL Item
Less now ([E06])
CL Item
About same ([E07])
CL Item
More now ([E08])
Item
57. Eat fish
text
C0566305 (UMLS CUI [1,1])
C0016158 (UMLS CUI [1,2])
Exercise
Code List
57. Eat fish
CL Item
Less now ([E06])
CL Item
About same ([E07])
CL Item
More now ([E08])
Item
58. Eat fruit/vegetable
text
C0016767 (UMLS CUI [1])
Exercise
Code List
58. Eat fruit/vegetable
CL Item
Less now ([E06])
CL Item
About same ([E07])
CL Item
More now ([E08])
Item
59. Have desserts/sweet snacks/sugared drinks
text
C1512806 (UMLS CUI [1,1])
C0242209 (UMLS CUI [1,2])
Exercise
Code List
59. Have desserts/sweet snacks/sugared drinks
CL Item
Less now ([E06])
CL Item
About same ([E07])
CL Item
More now ([E08])
Item
60. Eat deep fried food
text
C0559579 (UMLS CUI [1])
Exercise
Code List
60. Eat deep fried food
CL Item
Less now ([E06])
CL Item
About same ([E07])
CL Item
More now ([E08])
Item
61. Eat salty food
text
C0453862 (UMLS CUI [1])
Exercise
Code List
61. Eat salty food
CL Item
Less now ([E06])
CL Item
About same ([E07])
CL Item
More now ([E08])
Item
62. Eat high fat food
text
C0521974 (UMLS CUI [1])
Exercise
Code List
62. Eat high fat food
CL Item
Less now ([E06])
CL Item
About same ([E07])
CL Item
More now ([E08])
Item
63. Eat dairy products
text
C0009830 (UMLS CUI [1,1])
C0010947 (UMLS CUI [1,2])
Exercise
Code List
63. Eat dairy products
CL Item
Less now ([E06])
CL Item
About same ([E07])
CL Item
More now ([E08])
Item Group
Since your first heart problem
Item
64. Have you
text
C0543414 (UMLS CUI [1])
Smoking
Code List
64. Have you
CL Item
Stopped smoking completely ([E09])
C0425310 (UMLS CUI-1)
(Comment:en)
CL Item
Smoked intermittently ([E10])
C1608325 (UMLS CUI-1)
(Comment:en)
CL Item
Continued to smoke ([E11])
C0439994 (UMLS CUI-1)
C0549178 (UMLS CUI-2)
(Comment:en)
CL Item
Did not smoke at the time ([E12])
C0337672 (UMLS CUI-1)
(Comment:en)
Item
65. Has your body weight
text
C0005910 (UMLS CUI [1])
Body weight
Code List
65. Has your body weight
CL Item
Decreased ([E13])
C1262477 (UMLS CUI-1)
(Comment:en)
CL Item
Fluctuated/varied ([E14])
C0005910 (UMLS CUI-1)
C0231239 (UMLS CUI-2)
(Comment:en)
CL Item
Stayed about the same ([E15])
C0442739 (UMLS CUI-1)
C0005910 (UMLS CUI-2)
(Comment:en)
CL Item
Increased ([E16])
C0005911 (UMLS CUI-1)
C0442805 (UMLS CUI-2)
(Comment:en)
Cardiac rehabilitation program
Item
66. Have you ever participated in a cardiac rehabilitation program?
boolean
C0700431 (UMLS CUI [1])
Item
67. Overall, how do you feel your general health is now?
text
C0424575 (UMLS CUI [1])
General health
Code List
67. Overall, how do you feel your general health is now?
CL Item
Excellent ([E17])
C1961136 (UMLS CUI-1)
(Comment:en)
CL Item
Very good ([E18])
C3641222 (UMLS CUI-1)
(Comment:en)
CL Item
Good ([E19])
C0205170 (UMLS CUI-1)
(Comment:en)
CL Item
Fair ([E20])
C2911689 (UMLS CUI-1)
(Comment:en)
CL Item
Poor ([E21])
C2700379 (UMLS CUI-1)
(Comment:en)
Item Group
Socio-economic
Item
68. What is your current marital status?
text
C0024819 (UMLS CUI [1])
marital status
Code List
68. What is your current marital status?
CL Item
Single ([F01])
C0037179 (UMLS CUI-1)
(Comment:en)
CL Item
Married or living with a partner ([F02])
C0555047 (UMLS CUI-1)
(Comment:en)
CL Item
Divorced or separated ([F03])
C0682073 (UMLS CUI-1)
(Comment:en)
CL Item
Widowed ([F04])
C0206275 (UMLS CUI-1)
(Comment:en)
living alone
Item
69. Are you living alone?
boolean
C0439044 (UMLS CUI [1])
Item
70. How many years of formal education have you completed?
text
C0557280 (UMLS CUI [1])
years of formal education
Code List
70. How many years of formal education have you completed?
CL Item
None ([F05])
C0549184 (UMLS CUI-1)
(Comment:en)
CL Item
1-8 years ([F06])
(Comment:en)
CL Item
9-12 years ([F07])
(Comment:en)
CL Item
Trade school ([F08])
C0036375 (UMLS CUI-1)
(Comment:en)
CL Item
College/university ([F09])
C0041740 (UMLS CUI-1)
(Comment:en)
internet access
Item
71. Do you have access to the internet?
boolean
C0282111 (UMLS CUI [1])
Item
72. What is your current employment?
text
C0552390 (UMLS CUI [1])
undefined item
Code List
72. What is your current employment?
CL Item
[F10] I am in paid employment - full time. ([F10] I am in paid employment - full time.)
CL Item
I am in paid employment - part time. ([F11])
CL Item
I am self employed. ([F12])
CL Item
I am unemployed. ([F13])
CL Item
I am not working because of my health. ([F14])
CL Item
I choose not to work. ([F15])
CL Item
I am retired. ([F16])
Postal code / ZIP code
Item
73. Postal code / ZIP code
integer
C0421454 (UMLS CUI [1])
Volver a la parte superior de la página 

Contacto

Utilice este formulario para comentarios, preguntas y sugerencias.

Los campos marcados con * son obligatorios.

Ayuda

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial