| ![]() |
![]() |
| Questions
|
Year(s) Asked on Long Forms (Click on year to view PDF of questionnaire.) |
|||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Questionnaires>>Home | 1986 | 1987 | 1988 | 1990 | 1992 | 1994 | 1996 | 1998 | 2000 | 2002 | 2004 | 2006 | 2008 | |||
| PAT | x | x | ||||||||||||||
| Appendectomy | x | |||||||||||||||
| Active liver disease or cirrhosis | x | |||||||||||||||
| Hayfever, other allergy | x | |||||||||||||||
| High blood pressure | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Diabetes mellitus | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Elevated cholesterol | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Elevated triglycerides | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Coronary artery bypass or coronary angioplasty | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Myocardial infarction (heart attack); Hospitalized for this MI? | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Angina pectoris; Confirmed by angiogram? | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Perpheral venous thrombosis | x | x | x | x | x | x | ||||||||||
| Deep vein thrombosis | x | x | x | x | x | x | x | |||||||||
| TIA | x | x | x | x | x | x | x | x | x | x | x | |||||
| Stroke | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Carotid artery surgery | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Intermittent claudication | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Surgery or angioplasty for arterial disease of the leg | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Pulmonary embolus | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Aortic aneurysm | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Heart-rhythm disturbance | x | x | x | x | x | x | x | x | x | x | ||||||
| Gout | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Rheumatoid arthritis | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Other arthritis | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Vasectomy | x | x | x | x | x | x | x | x | x | x | ||||||
| Diverticulitis or diverticulosis | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Prostatic enlargement, surgically treated (e.g. TURP) | x | x | x | x | x | x | x | x | x | x | ||||||
| Prostate cancer | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Colon or rectal polyp | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Cancer of colon or rectum | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Basal cell skin cancer | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Squamous cell skin cancer | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Melanoma | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Solar or actinic keratosis | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Lymphoma or leukemia | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Other cancer | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Glaucoma | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Cataract | x | x | x | x | x | x | x | x | ||||||||
| Cataract extraction | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Macular degeneration | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Osteoporosis | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Hip replacement | x | x | x | x | x | x | x | x | x | x | x | |||||
| Fractures - hip/wrist, forearm | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Peridontal disease with bone loss | x | x | x | x | x | x | x | x | x | x | x | |||||
| Leukoplakia or other oral precancerous lesion | x | x | x | x | x | x | x | |||||||||
| Gallstones | x | x | x | x | x | x | x | x | x | |||||||
| Gall bladder removal | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Kidney stones | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Gastric or duodenal ulcer | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Ulcerative colitis or Chron's disease | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Parkinson's disease | x | x | x | x | x | x | x | x | x | x | ||||||
| Multiple sclerosis | x | x | x | x | x | |||||||||||
| Chronic renal failure | x | x | x | x | x | x | x | x | x | x | ||||||
| Alcohol dependence problem | x | x | x | x | x | x | x | |||||||||
| Pneumonia (x-ray confirmed) | x | x | x | x | x | x | x | x | x | |||||||
| Asthma | x | x | x | x | x | x | x | x | ||||||||
| Emphysema or chronic bronchitis | x | x | x | x | x | x | x | |||||||||
| ALS | x | x | x | x | x | |||||||||||
| Active TB (x-ray confirmed) | x | x | ||||||||||||||
| Other major illness | x | x | x | x | x | x | x | x | x | x | x | x | ||||
| Head injury (loss of consciousness) | x | |||||||||||||||
| Erectile function questions | x | x | x | |||||||||||||
| Paraesthesias / unpleasant leg sensations | x | x | ||||||||||||||
| Pernicious anemia | x | x | x | x | ||||||||||||
| Congestive heart failure; time of diagnosis | x | x | x | x | ||||||||||||
| Shingles | x | x | x | |||||||||||||
| Seizure (1 or more) / epilepsy | x | x | x | |||||||||||||
| Hearing loss | x | x | ||||||||||||||
| Upper endoscopy (esophagus / stomach) | x | x | ||||||||||||||
| Helicobacter pylori infection | x | |||||||||||||||
| Barrett's esophagus | x | x | x | |||||||||||||
| MI (mark each hospitalization) | x | |||||||||||||||
| Heartburn / acid reflux | x | x | ||||||||||||||
| Knee pain | x | |||||||||||||||
| Atrial Fibrillation: 1hour or more | x | x | ||||||||||||||
| Bladder cancer | x | |||||||||||||||
| Psoriasis, increased intraocular pressure: year diagnosis/procedure | x | |||||||||||||||
| Gastrointestinal bleeding requiring hospitalization/transfusion; site of bleeding and year | x | x | ||||||||||||||
| Squamous/basal cell carcinoma lesions removed by surgery/cryotherapy/other | x | |||||||||||||||
| Questionnaires>>Home | 1986 | 1987 | 1988 | 1990 | 1992 | 1994 | 1996 | 1998 | 2000 | 2002 | 2004 | 2006 | 2008 | |||