ID

44295

Beschrijving

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.

Trefwoorden

  1. 20-09-17 20-09-17 -
  2. 23-10-17 23-10-17 -
  3. 20-12-17 20-12-17 -
  4. 20-09-21 20-09-21 -
Houder van rechten

GlaxoSmithKline

Geüploaded op

20 september 2021

DOI

Voor een aanvraag inloggen.

Licentie

Creative Commons BY-NC 3.0

Model Commentaren :

Hier kunt u commentaar leveren op het model. U kunt de tekstballonnen bij de itemgroepen en items gebruiken om er specifiek commentaar op te geven.

Itemgroep Commentaren voor :

Item Commentaren voor :

U moet ingelogd zijn om formulieren te downloaden. AUB inloggen of schrijf u gratis in.

Lifestyle Questionnaire GSK study Chronic Coronary Heart Disease NCT00799903

Lifestyle Questionnaire GSK study Chronic Coronary Heart Disease NCT00799903

How much do you eat the following types of food?
Beschrijving

How much do you eat the following types of food?

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

Meat/poultry

Datatype

text

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

Fish

Datatype

text

Alias
UMLS CUI [1]
C0327606
3. Eggs
Beschrijving

Eggs

Datatype

text

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

Dairy products

Datatype

text

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

Whole grains

Datatype

text

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

Refined/milled grains

Datatype

text

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

Tofu/soybean curd

Datatype

text

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

Legumes

Datatype

text

Alias
UMLS CUI [1]
C4065479
9. Fruits
Beschrijving

Fruits

Datatype

text

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

Vegetables

Datatype

text

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

Deep fried food

Datatype

text

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

Dessert/sweet snacks

Datatype

text

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

Sweetened drinks

Datatype

text

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

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

14. Beers
Beschrijving

standard drinks per week

Datatype

integer

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

standard drinks per week

Datatype

integer

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

standard drinks per week

Datatype

integer

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

standard drinks per week

Datatype

integer

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

number of standard drinks on one occasion

Datatype

text

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

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)
Beschrijving

hours per week

Datatype

integer

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

hours per week

Datatype

integer

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

hours per week

Datatype

integer

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

hours per week

Datatype

integer

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

hours per week

Datatype

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?
Beschrijving

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
Beschrijving

hours per week

Datatype

integer

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

hours per week

Datatype

integer

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

hours per week

Datatype

integer

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

physical activity at work

Datatype

text

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

physical activity during leisure time

Datatype

text

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

Does your health limit you in the following activities?

29. Walking 100 meters (or 100 yards)
Beschrijving

Walking short distance

Datatype

text

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

Climbing one flight of stairs

Datatype

text

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

Walking long distance

Datatype

text

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

Moderate physical activities

Datatype

text

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

Vigorous physical activities

Datatype

text

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

Are your activities limited by the following symptoms?

34. Shortness of breath
Beschrijving

Shortness of breath

Datatype

text

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

Chest discomfort or tightness

Datatype

text

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

Dizziness

Datatype

text

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

Fatigue or tiredness

Datatype

text

Alias
UMLS CUI [1]
C0848717
38. Arthritis
Beschrijving

Arthritis

Datatype

text

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

Muscle weakness

Datatype

text

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

Bleeding gums

Datatype

text

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

Number of teeth

Datatype

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
Beschrijving

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?
Beschrijving

Snoring

Datatype

text

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

Waking up at night

Datatype

text

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

Tiredness in the morning

Datatype

text

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

Sleepiness during the day

Datatype

text

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

gasping, choking, no breathing when asleep

Datatype

text

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

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

47. Have you felt stress at work?
Beschrijving

Stress at work

Datatype

text

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

Stress at home

Datatype

text

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

Financial stress

Datatype

text

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

Control at work

Datatype

text

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

Control at home

Datatype

text

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

Feeling depressed

Datatype

text

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

Loss of interest

Datatype

text

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

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

54. Exercise
Beschrijving

Exercise

Datatype

text

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

Stress level

Datatype

text

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

Eat meat/poultry

Datatype

text

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

Eat fish

Datatype

text

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

Eat fruit/vegetable

Datatype

text

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

Sugar intake

Datatype

text

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

Eat deep fried food

Datatype

text

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

Eat salty food

Datatype

text

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

Eat high fat food

Datatype

text

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

Eat dairy products

Datatype

text

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

Since your first heart problem

64. Have you
Beschrijving

Smoking

Datatype

text

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

Body weight

Datatype

text

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

Cardiac rehabilitation program

Datatype

boolean

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

General health

Datatype

text

Alias
UMLS CUI [1]
C0424575
Socio-economic
Beschrijving

Socio-economic

68. What is your current marital status?
Beschrijving

marital status

Datatype

text

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

living alone

Datatype

boolean

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

years of formal education

Datatype

text

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

internet access

Datatype

boolean

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

current employment

Datatype

text

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

Postal code / ZIP code

Datatype

integer

Alias
UMLS CUI [1]
C0421454

Similar models

Lifestyle Questionnaire GSK study Chronic Coronary Heart Disease NCT00799903

Name
Type
Description | Question | Decode (Coded Value)
Datatype
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])
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])

Gebruik dit formulier voor feedback, vragen en verbeteringsvoorstellen.

Velden gemarkeerd met een * zijn verplicht.

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