 |
 |
 |
|
   |
||||||||
|
|
|||||||
|
Scientific Data Documentation
Physician's Exam, Ages 6 months - 74 years (1982-1984)
DSN: CC37.HSPHANES.MEDEXAM2 ABSTRACT Hispanic Health and Nutrition Examination Survey Mexican Americans Cuban Americans Puerto Ricans The Hispanic Health and Nutrition Examination Survey (HHANES) was conducted from July 1982 through December 1984. The data on the tape documented here are from all three portions of the survey: Mexican Americans Residing in selected counties of Texas, Colorado, New Mexico, Arizona, and California Surveyed from July 1982 through November 1983 9,894 persons sampled; 8,554 interviewed; 7,462 examined Cuban Americans Residing in Dade County (Miami), Florida Surveyed from January 1984 through April 1984 2,244 persons sampled; 1,766 interviewed; 1,357 examined Puerto Ricans Residing in New York City area, including parts of New Jersey and Connecticut Surveyed from May 1984 through December 1984 3,786 persons sampled; 3,369 interviewed; 2,834 examinedCaution Notice C A U T I O N BEFORE USING THIS DATA TAPE, PLEASE READ THIS PAGE. * Read the accompanying description of the survey, "The Plan and Operation of the Hispanic Health and Nutrition Examination Survey", DHHS Publication No. (PHS) 85-1321 before conducting analyses of the data on this tape. * Two aspects of HHANES, especially, should be taken into account when conducting any analyses: the sample weights and the complex survey design. * Analyses should not be conducted on data combined from the three portions of the survey (Mexican-American, Cuban-American, Puerto Rican). * HHANES is a survey of Hispanic households and some of the sample persons included on this tape are not of Hispanic origin. A detailed description of the data codes dealing with national origin or ancestry appears in the NOTES section of this document. * Examine the range and frequency of values of a variable before conducting an analyses of data. The range may include unusual or unexpected values. The frequency counts may be useful to determine which analyses may be worthwhile. * Language of interview, which may appear several places on this tape, can vary depending on the questionnaire (several used in the survey) and on whether the response was provided by the sample person or by a proxy. * For some data items, reference is made to a note. The notes (in a separate section of this document) may be very important in data analyses. Attention to them is strongly urged. This Public Use Data Tape has been edited very carefully. Numerous consistency and other checks were also performed. Nevertheless, due especially to the large number of data items, some errors may have gone undetected. Please bring to the attention of NCHS any errors in the data tape or the documentation. Errata sheets will be sent to people who have purchased the data tapes and corrections will be made to subsequently released data tapes. In publications, please acknowledge NCHS as the original data source. The acknowledgment should include a disclaimer crediting the authors for analyses, interpretations, and conclusions; NCHS should be cited as being responsible for only the collection and processing of the data. In addition, NCHS requests that the acronym HHANES be placed in the abstracts of journal articles and other publications based on data from this survey in order to facilitate the retrieval of such materials through automated bibliographic searches. Please send reprints of journal articles and other publications that include data from this tape to NCHS. Division of Health Examination Statistics National Center for Health Statistics Center Building, Room 2-58 3700 East-West Highway Hyattsville, MD 20782 Public Use Data Tapes for the Hispanic Health and Nutrition Examination Survey will be released through the National Technical Information Service (NTIS) as soon as the data have been edited, validated, and documented. A list of NCHS Public Use Data Tapes that can be purchased from NTIS may be obtained by writing the Scientific and Technical Information Branch, NCHS. Scientific and Technical Information Branch National Center for Health Statistics Center Building, Room 1-57 3700 East-West Highway Hyattsville, MD 20782 301-436-8500BACKGROUND Introduction The National Center for Health Statistics (NCHS) collects, analyzes, and disseminates data on the health status of Americans. The results of surveys, analyses, and studies are made known primarily through publications and the release of computer data tapes. This document contains details required to guide programmers, statistical analysts, and research scientists in the use of a Public Use Data Tape. From 1960 through 1980 NCHS conducted five population-based, national health examination surveys. Each survey involved collecting data by direct physical examination, the taking of a medical history, and laboratory and clinical tests and measurements. Questionnaires and examination components have been designed to obtain and support analyses of data on certain targeted conditions such as diabetes, hypertension, and anemia. Beginning with the first National Health and Nutrition Examination Survey (NHANES I) a nutrition component was added to obtain information on nutritional status and dietary practices. The numbers of Hispanics in these samples were, however, insufficient to enable adequate estimation of their health conditions. From 1982 through 1984 a Hispanic Health and Nutrition Examination Survey (HHANES) was conducted to obtain data on the health and nutritional status of three Hispanic groups: Mexican Americans from Texas, Colorado, New Mexico, Arizona, and California; Cuban Americans from Dade County, Florida; and Puerto Ricans from the New York City area, including parts of New Jersey and Connecticut. The general structure of the HHANES sample design was similar to that of the previous National Health and Nutrition Examination Surveys. All of these studies have used complex, multistage, stratified, clustered samples of defined populations. The major difference between HHANES and the previous surveys is that HHANES was a survey of three special subgroups of the population in selected areas of the United States rather than a national probability sample. A detailed presentation of the design specifications is found in Chapter 5 of "Plan and Operation of the Hispanic Health and Nutrition Examination Survey, 1982-84" (Ref. No. 1). Data collection began with a household interview. Several questionnaires were administered: * A Household Screener Questionnaire (HSQ), administered at each selected address, for determining household eligibility and for selecting sample persons. * A Family Questionnaire (FQ), administered once for each family containing sample persons, which included sections on family relationships, basic demographic information for sample persons and head of family, Medicare and health insurance coverage, participation in income assistance programs, and housing characteristics. * An Adult Sample Person Questionnaire (ASPQ), for persons 12 through 74 years which, depending on age, included sections on health status measures, health services utilization, smoking (20 through 74 years), meal program participation, and acculturation. Information on the use of medicines and vitamins in the past two weeks was also obtained. * A Child Sample Person Questionnaire (CSPQ), for sample persons 6 months through 11 years which included sections on a number of health status issues, health care utilization, infant feeding practices, participation in meal programs, school attendance, and language use. Information on the use of medicines and vitamins in the past two weeks was also obtained. At the Mobile Examination Center two questionnaires were administered and an examination performed: * An Adult Sample Person Supplement (ASPS), for sample persons 12 through 74 years, which included sections on alcohol consumption, drug abuse, depression, smoking (12 through 19 years), pesticide exposure, and reproductive history. * A Dietary Questionnaire (DQ), for persons 6 months through 74 years, by which trained dietary interviewers collected information about "usual" consumption habits and dietary practices, and recorded foods consumed 24-hours prior to midnight of the interview. * An examination which included a variety of tests and procedures. Age at interview and other factors determined which procedures were administered to which examinees. A dentist performed a dental examination and a vision test. Technicians took blood and urine specimens and administered a glucose tolerance test, X-rays, electrocardiograms, and ultrasonographs of the gallbladder. Technicians also performed hearing tests and took a variety of body measurements. A physician performed a medical examination focusing especially on the cardiovascular, gastrointestinal, neurological, and musculoskeletal systems. The physician's impression of overall health, nutritional and weight status, and health care needs were also recorded. Some blood and urine specimen analyses were performed by technicians in the examination center; others were conducted under contract at various laboratories. Because the HHANES sample is not a simple random one, it is necessary to incorporate sample weights for proper analysis of the data. These sample weights are a composite of individual selection probabilities, adjustments for noncoverage and nonresponse, and poststratification adjustments. The HHANES sample weights, which are necessary for the calculation of point estimates, are located on all data tapes in positions 184-213. Because of the complex sample design and the ratio adjustments used to produce the sample weights, commonly used methods of point and variance estimation and hypothesis testing which assume simple random sampling may give misleading results. In order to provide users with the capability of estimating the complex sample variances in the HHANES data, Strata and Pseudo Primary Sampling Unit (PSU) codes have been provided on all data tapes in positions 214-217. These codes and the sample weights are necessary for the calculation of variances. There are computer programs available designed for variance estimation for complex sample designs. The balanced repeated replication approach (Ref. No. 2) is used in &REPERR and a linearization approach is used in &PSALMS to calculate variance-covariance matrixes. Both routines are available within the OSIRIS IV library (Ref. No. 3). SURREGR (Ref. No. 4) and SUPERCARP (Ref. No. 5) are programs that calculate variance-covariance matrixes using a linearization approach (Ref. No. 6) (Taylor series expansion). Another program, SESUDAAN (Ref. No. 7) calculates standard errors, variances, and design effects. (Note: This version of SESUDAAN should not be used to obtain variances for totals.) SURREGR and SESUDAAN are special procedures which run data under the SAS system (Ref. No. 8). Even though the total number of examined persons in this survey is quite large, subclass analyses can lead to estimates that are unstable, particularly estimates of variances. Consequently, analysis of subclasses require that the user pay particular attention to the number of sample persons in the subclass and the number of PSU's that contain at least one sample person in the subclass. Small sample sizes, or a small number of PSU's used in the variance calculations, may produce unstable estimates of the variances. A more complete discussion of these issues and possible analytic strategies for examining various hypotheses is presented in Chapter 11 of "Plan and Operation of the Hispanic Health and Nutrition Examination Survey, 1982-84" (Ref. No. 1) and in an earlier NCHS methodology (Series 2) publication (Ref. No. 9). Some users, however, may not have access to the computer programs for estimating complex sample variances or may want to do their preliminary analyses without using them. In addition, variance estimates calculated from HHANES data through use of the programs described previously are likely to be unstable because there were so few sample areas for each portion of HHANES. This instability is not due to there being too few people in the sample but may be due to the fact that the sample was selected from relatively few areas. Therefore, the following discussion is designed to provide an alternative approach to deal with the unavailability of software and the small number of PSU's. The approach is based on using average design effects (Ref. No. 10). The design effect, defined as the ratio of the variance of a statistic from a complex sample to the variance of the same statistic from a simple random sample of the same size, that is, DESIGN EFFECT (DEFF) = COMPLEX SAMPLE VARIANCE ----------------------------- SIMPLE RANDOM SAMPLE VARIANCE is often used to show the impact of the complex sample design on variances. If the design effect is near 1, the complex sample design has little effect on the variances and the user could consider assuming simple random sampling for the analysis. Some illustrative design effects for HHANES data on this tape are given in the following tables. The design effects in the tables are the average for the age groups usually presented in NCHS Series 11 publications. If the average design effect for a subgroup was less than 1.0 (implying an improvement over simple random sampling), it was coded as 1.0. The following guidelines were used in the calculation of the average design effects: 1. Exclude all persons of non-Hispanic origin, 2. Exclude all estimates for large age ranges, such as all ages combined or 'all adults', and 3. Exclude all estimates where the proportion of the subpopulation with the specific characteristic or condition was zero percent or one hundred percent. Design effects tend to be larger when age groups are combined, just as they are when the sexes are combined, as shown in the tables. The data in the tables give the user an idea of the range in design effects for selected response variables from this data tape. If a response variable is not one shown in the tables take the range into account; it is possible that a user could have one of the higher, rather than one of the lower, design effects.Table 1 PHYSICIAN'S EXAMINATION Average Design Effects, by Sex, for Selected Variables -- Mexican-American Portion Mean or Tape Both Physician's Examination Proportion Positions Sexes Male Female Left Tympanic Membrane Scar(s) p 444 3.4 2.1 2.2 Strabismus p 465 5.3 3.1 3.4 Surgical Scars on Abdomen p 599 1.1 1.0 1.1 Right Hip Limitation of Motion (10+ years) p 675 2.2 1.6 1.3 Pulse (all ages) p 778-780 3.8 2.5 2.5 Systolic Blood Pressure (6+ years) x 783-785 2.9 2.3 1.8 Diastolic Blood Pressure (6+ years) x 786-788 2.3 2.0 1.6 Scoliosis (5+ years) p 790 5.2 3.3 3.2 Right Dosalis Pedis Pulse (Presence/Absence) p 657 1.7 1.3 1.3 Source: NCHS, HHANES, 1982-84, Tape Number 6509, Version 2.Table 2 Average Design Effects, by Sex, for Selected Variables -- Cuban-American Portion Mean or Tape Both Physician's Examination Proportion Positions Sexes Male Female Left Tympanic Membrane Scar(s) p 444 1.0 1.0 1.0 Strabismus p 465 1.0 1.0 1.0 Surgical Scars on Abdomen p 599 1.4 1.0 1.5 Right Hip Limitation of Motion (10+ years) p 675 1.1 1.0 1.0 Pulse (all ages) p 778-780 1.4 1.3 1.1 Systolic Blood Pressure (6+ years) x 783-785 1.5 1.1 1.2 Diastolic Blood Pressure (6+ years) x 786-788 1.0 1.0 1.1 Scoliosis (5+ years) p 790 1.1 1.0 1.3 Right Dosalis Pedis Pulse (Presence/Absence) p 657 1.0 1.0 1.2 Source: NCHS, HHANES, 1982-84, Tape Number 6509, Version 2.Table 3 Average Design Effects, by Sex, for Selected Variables Puerto Rican Portion Mean or Tape Both Physician's Examination Proportion Positions Sexes Male Female Left Tympanic Membrane Scar(s) p 444 1.3 1.2 1.1 Strabismus p 465 1.3 1.1 1.2 Surgical Scars on Abdomen p 599 1.0 1.0 1.1 Right Hip Limitation of Motion (10+ years) p 675 1.2 1.2 1.0 Pulse (all ages) p 778-780 1.1 1.0 1.0 Systolic Blood Pressure (6+ years) x 783-785 1.1 1.8 1.2 Diastolic Blood Pressure (6+ years) x 786-788 1.1 1.5 1.3 Scoliosis (5+ years) p 790 1.6 1.0 1.5 Right Dosalis Pedis Pulse (Presence/Absence) p 657 1.4 1.3 1.1 Source: NCHS, HHANES, 1982-84, Tape Number 6509, Version 2. A hypothetical example will be given for illustrative purposes only. Suppose there are 850 Mexican-American females in the sample 30-64 years old, of whom 8.4 percent had scoliosis and their mean systolic blood pressure was 124. Assuming simple random sampling, the variance for the percent is calculated by converting the percent to a proportion and using the standard formula for the variance of a proportion, V = pq -- n This variance (V) multiplied by the design effect (DEFF) provides an estimate of the variance from a complex sample of the same sample size (n). In the example above, V = (.084) (.916) 850 = .00009 = variance for a simple random sample Then, multiplying by the design effect, = (.00009) (3.2) = .00029 = estimated variance for the complex sample In a similar way, the complex sample variance of the mean systolic blood pressure for this age-sex is determined by multiplying the simple random sample variance of the mean by the appropriate design effect -- in this example, 1.8. The user can then proceed with estimating confidence intervals and testing hypotheses in the usual manner. The user should recognize that this approach does not incorporate the variance-covariance matrix. In most cases, this leads to a slight overestimate of the variance because the covariance terms, which are subtracted in the variance of a ratio, in general, are positive. Thus, in a borderline case, the null hypothesis would be less likely to be rejected (Ref. No. 11). Alternative or better approaches may exist or be developed. Users who want to suggest such approaches, or who want the latest information should contact the Scientific and Technical Information Branch (address given in the beginning of this documentation).METHODS DATA COLLECTION AND PROCESSING PROCEDURES Data presented in Sections E through H and the family relationships data in Section J were collected on the Household Screener and Family Questionnaires. These interview schedules were administered in sample persons' households. Data presented in Section K were collected on the Adult Sample Person Questionnaire. Completed interview and examination forms were reviewed in the Survey's field offices and again at the data processing center of NCHS by clerical editors. The editors checked the forms for completeness, clarity, and compliance with skip patterns, and they coded items such as industry and occupation. At the data processing center the questionnaires were keyed and verified on key-to-disk data entry equipment under the control of programs that checked for valid codes and ranges, compliance with skip patterns, and consistency. After being keyed, data were reedited by analysts for reasonableness and consistency and for compliance with instructions for sampling and questionnaire administration. The general tape description format is Tape Position X Item X Counts. The item (field) may be a tape descriptor (e.g., Version Number), a sample person descriptor (e.g., Age at Interview), or a question (e.g., Is sample person covered by Medicare?). Where appropriate, data entries are presented by codes. Frequency counts are given for each code. The counts are included to help the user in planning analyses and in verifying that programs account for all data. The data source is given also (e.g., from Family Questionnaire). In some cases, a note is referenced. The notes contain explanations of the item (e.g., how Poverty Index is calculated). The questionnaire data have undergone many quality control and editing procedures. The responses of sample persons to some questions may appear extreme or illogical. Self-reported data, especially, are subject to a number of sources of variability, including recall and other reporting errors. In the data clean-up process, responses that varied considerably from expected were verified through direct review of the collection form or a copy of it. Such responses may not represent fact, but they are included as recorded in the field. The user must determine if these responses should be included in analyses. Responses to "other" and "specify" were recoded to existing categories, if possible. For responses that could not be recoded, new code categories were created if the information was deemed analytically useful. Caution should be used in interpreting the data from these new categories because there is no way of knowing which other respondents would have selected one of the new categories if given the option. For the physician's examination tape there are three codes for missing information: 7's, 8's, and blanks. In a few questions, 7's were used when the question was not applicable. A code "8", which is labeled as "blank but applicable", is used to indicate that a sample person should have a data value for a particular item but for varying reasons that value is unavailable. Blanks were used to follow skip patterns, i.e., when a question was not supposed to be asked or was not applicable. The physician's examination data give an objective measure of the health and well-being of individuals examined in HHANES. The physicians underwent extensive training to standardize the techniques and definitions used in the physician's examination. Periodic monitoring ensured that the established procedures were followed throughout the survey. The Appendix contains a description of the techniques and definitions used in the physician's examination. It is taken from the Physician's Examination Manual for the Hispanic Health and Nutrition Examination Survey, 1982-1984 (Ref. No. 12). However, examiner differences are likely to remain. The user should identify relevant examiner differences before beginning their analyses. At the completion of the physical examination, the physician recorded a subset of the medical conditions diagnosed based on data collected in the physical examination and the Sample Person Questionnaire. The physician listed all medical conditions which fulfilled any one of the three following conditions: * Potentially or presently life threatening, * Causing loss of functioning and/or limitation of activity for at least the previous three months, or * On a potentially downward course. The conditions listed were coded using the Ninth Revision of the International Classification of Diseases. The physician also decided on a level of referral for the sample person. The levels of referral were: * Level I - emergency * Level II - needs major medical care within one month * Level III - no major medical findings. Copies of the questionnaires and examination forms, both in English and Spanish, can be found in the plan and operation report for HHANES (Ref. No. 1). Detailed information on interviewing and examination procedures is contained in the household interviewer's manual (Ref. No. 13) and the mobile examination center interviewer's manual (Ref. No. 14), and the physician's examination manual (Ref. No. 12). These manuals are available upon request from: Division of Health Examination Statistics National Center for Health Statistics Center Building, Room 2-58 3700 East-West Highway Hyattsville, MD 20782 301-436-7080 TAPE DESCRIPTION SUMMARY TAPE POSITIONS 1-400 contain data categories common to all data tapes: sociodemographic data, family composition, family income, residence and household. Sample weights are also in this set of data. TAPE POSITIONS 401+ contain data categories unique to this data tape. SOCIODEMOGRAPHIC DATA - SAMPLE PERSON (E) 1-5 Sample Person Sequence Number 6-15 Survey and Tape Identifiers 16 Examination Status 17 Language of Interview 18-21 Date of Interview 22-25 Date of Examination 26-29 Date of Birth 30-32 Age at Interview 33-38 Age at Examination 39-43 Family Number 44-45 Relationship to Head of Family 46 Sex 47 Race 48-49 National Origin or Ancestry 50-52 Birth Place 53 National Origin Recode 54-56 Education 57 Marital Status 58 Service in Armed Forces 59-69 Work/Occupation/Employment 70-95 Health Insurance/Health Care Support 96-99 Income Assistance/Public Compensation or Support SOCIODEMOGRAPHIC DATA - HEAD OF FAMILY (F) 100 Interview and Examination Status 102-105 Date of Birth 106-108 Age at Interview 109 Sex 110 Race 111-112 National Origin or Ancestry 113-115 Birth Place 116-118 Education 119 Marital Status 120 Service in Armed Forces 121-131 Work/Occupation/Employment FAMILY COMPOSITION AND INCOME DATA (G) 132-133 Number of People in Family 134-135 Number of Sample People in Family 136-138 Combined Family Income 139-143 Per Capita Income 144-146 Poverty Index 147-162 Income, Food Stamps RESIDENCE AND HOUSEHOLD DATA (H) 163 Size of Place 164 Standard Metropolitan Statistical Area 165-166 Number of People in Household 167-168 Number of Sample People in Household 169-170 Number of Rooms 171 Kitchen Facilities Access 172-183 Heating/Cooling Equipment SAMPLE WEIGHTS (I) 184-189 Examination Final Weight 190-195 Interview Final Weight 196-201 GTT/Ultrasound Weight 202-207 Audiometry/Vision Weight 208-213 Pesticide Weight 214-215 Strata Code 216-217 Pseudo PSU Code FAMILY RELATIONSHIPS (J) 218-400 Data not yet available PHYSICIAN EXAMINATION DATA (K) 401-404 Tape Number 406 Physician's Examination Form Blank 410-412 Examiner Number 420-448 Skull and Ears 450-459 Nares 461-463 Lips and Pharynx 465-498 Eyes 500-504 Neck 506-516 Pulse and Blood Pressure 518-565 Chest Findings and CVA Tenderness 568-569 Breast Mass(es) 571-597 Heart 599-642 Abdomen 644-647 Gallbladder Questions 648-650 Tanner Staging 652-666 Extremities 669-741 Joints 743-756 Neurological Evaluation 759-776 Skin Evaluation 778-788 Pulse and Blood Pressure 790-805 Back 806-808 Gait 809-810 Varicose Veins 812-814 Health Status 815-855 ICD Codes 856 Level of ReferralRECORD LAYOUT Sociodemographic Data - Sample Person General Tape Counts Source Location Item Description and Code M C P and Notes E. SOCIODEMOGRAPHIC DATA - SAMPLE PERSON (POS 1-99) Source: Family Questionnaire (FQ) Household Screener Questionnaire (HSQ) 1-5 Sample person sequence number7462 00001-09894 Mexican Americans 7462 - - 10002-12238 Cuban Americans - 1357 - 13001-16785 Puerto Ricans - - 2834 6-12 Blank 13 Portion of survey 1 Mexican-American (M) 7462 - - 2 Cuban-American (C) - 1357 - 3 Puerto Rican (P) - - 2834 14 Family Questionnaire missing 1 Yes 21 6 10 See Note 1 2 No 7441 1351 2824 15 Version number 7462 1357 2834 2 16 Examination status 1 Examined 7462 1357 2834 See Note 2 2 Not examined 0 0 0 17 Language of interview (Pos. 1-400) FQ 1 English 4513 244 1229 2 Spanish 2929 1107 1595 Blank 20 6 10 Date of interview HSQ 4 18-19 01-12 Month 7462 1357 2834 20-21 82-84 Year 7462 1357 2834 Date of examination From survey control record 22-23 01-12 Month 7462 1357 2834 24-25 82-84 Year 7462 1357 2834 Date of birth HSQ 2e 26-27 01-12 Month 7462 1357 2834 88 Blank but applicable 0 0 0 28-29 08-84 Year 7462 1357 2834 88 Blank but applicable 0 0 0 30-31 Age at interview (computed) 01-74 (See next column for units) 7462 1357 2834 32 Age at interview units HSQ 2f 1 Years 7342 1349 2796 2 Months 120 8 38 Age at examination (computed) Positions 33-38 are all 0 for non- examined persons. 33-34 00-75 Years 7462 1357 2834 35-36 00-11 Months 7462 1357 2834 37-38 00-30 Days 7462 1357 2834 39-43 Family number See Note 3 00002-03529 7462 - - 04005-04922 - 1357 - 07001-08584 - - 2834 44-45 What is sample person's relationship HSQ 2b to head of family? Sample person is: See Note 4 01 Head of family living alone (1 145 56 113 family with only 1 member) 02 Head of family, with no related 76 23 24 persons in household (2+ persons in household) 03 Head of family, with related 1582 369 678 persons in household 04 Wife of head (husband living at 1299 300 296 home and not in Armed Forces) 05 Wife of head (husband living at 5 0 0 home and is in Armed Forces) 06 Husband of head (wife living at 35 12 37 home and not in Armed Forces) 07 Husband of head (wife living at 0 0 0 home and is in Armed Forces) 08 Child of head or head's spouse 3769 484 1437 09 Grandchild of head or head's 217 32 115 spouse 10 Parent of head or head's spouse 57 35 33 11 Other relative (includes ex- 273 46 101 spouse, daughter-in-law, etc.) 12 Foster child 4 0 0 46 Sex FQ B-4 1 Male 3516 636 1237 2 Female 3946 721 1597 47 Observed race FQ B-5 1 White 7213 1300 2462 See Note 5 2 Black 76 15 152 3 Other 8 3 73 8 Blank but applicable 72 15 59 9 Not observed 72 18 78 Blank 21 6 10 48-49 Sample person's national origin or HSQ 2c ancestry. See Note 6 01 Mexican/Mexicano 1641 1 1 02 Mexican-American 5202 0 0 03 Chicano 102 0 0 04 Puerto Rican 7 3 2596 05 Boricuan 0 0 36 06 Cuban 4 1069 20 07 Cuban-American 0 222 0 08 Hispano - specify 150 14 26 09 Other Latin-American or other 37 18 41 Spanish - specify 00 Other - specify 276 30 114 10 Spanish-American 22 0 0 11 Spanish (Spain) 21 0 0 50-52 In what state or foreign country FQ B-6 was sample person born? See Note 7 001-118 State/country code 7403 1345 2771 888 Blank but applicable 38 6 53 Blank 21 6 10 53 National origin recode See Note 8 "Hispanic" = Mexican-American in Southwest, Cuban-American in Florida and Puerto Rican in New York City area. 1 "Hispanic" 7197 1291 2645 2 Not "Hispanic" 265 66 189 54-55 What is the highest grade or year of FQ B-7 regular school sample person has ever attended? 00 Never attended or kinder- 1476 116 446 garten only 01-08 Elementary grade 3118 556 1090 09-12 High school grade 2119 400 1011 13-16 College 581 243 225 17 Graduate school 70 30 14 88 Blank but applicable 77 6 38 Blank 21 6 10 56 Did sample person finish that FQ B-8 grade/year? 1 Yes 3938 853 1436 2 No 1934 368 861 8 Blank but applicable 93 14 81 Blank 1497 122 456 57 Is sample person now married, FQ B-9 widowed, divorced, separated, or has he or she never been married? 0 Under 14 years of age 2953 297 1000 1 Married - spouse in household 2600 632 660 2 Married - spouse not in household 70 17 54 3 Widowed 161 50 66 4 Divorced 214 92 155 5 Separated 159 21 149 6 Never married 1265 241 730 8 Blank but applicable 19 1 10 Blank 21 6 10 58 Did sample person ever serve in the FQ B-11 Armed Forces of the United States? 1 Yes 416 27 145 2 No 3557 952 1409 8 Blank but applicable 7 3 14 Blank 3482 375 1266 59 During the past 2 weeks, did sample FQ B-12 person work at any time at a job or business, not counting work around the house? 1 Yes 2210 622 613 2 No 1751 349 930 8 Blank but applicable 19 11 25 Blank 3482 375 1266 60 Even though sample person did not FQ B-13 work during those 2 weeks, did he or she have a job or business? 1 Yes 46 13 23 2 No 1704 334 902 8 Blank but applicable 20 13 30 Blank 5692 997 1879 61 Was sample person looking for work FQ B-14 or on layoff from a job? 1 Yes 217 43 60 2 No 1533 304 865 8 Blank but applicable 20 13 30 Blank 5692 997 1879 62 Which, looking for work or on layoff FQ B-15 from a job or both? 1 Looking 146 34 44 2 Layoff 46 6 8 3 Both 23 2 7 8 Blank but applicable 22 14 31 Blank 7225 1301 2744 63-65 What kind of business or industry FQ B-19 does sample person work for? See Note 9 010-932 Industry code 2429 665 681 990 Blank but applicable 49 18 37 Blank 4984 674 2116 66-68 What kind of work was sample FQ B-20 person doing? See Note 9 003-889 Occupation code 2432 666 681 999 Blank but applicable 46 17 37 Blank 4984 674 2116 69 Class of worker FQ B-22 1 An employee of a private company, 1912 543 551 business or individual for wages, salary, or commission 2 A Federal government employee 74 6 21 3 A State government employee 124 19 17 4 A Local government employee 169 17 56 5 Self-employed in own incorporated 17 12 7 business or professional practice 6 Self-employed in own unincorpora- 131 67 27 ted business, professional practice, or farm 7 Working without pay in family 3 0 0 business or farm 8 Blank but applicable 46 18 38 0 Never worked or never worked at a 2 1 1 full-time civilian job lasting 2 weeks or more Blank 4984 674 2116 70 Is sample person now covered by FQ C-2 Medicare? 1 Covered 303 107 139 2 Not covered 7129 1237 2674 8 Blank but applicable 6 6 11 9 Don't know 3 1 0 Blank 21 6 10 71 Is sample person now covered by the FQ C-3 part of Social Security Medicare which pays for hospital bills? 1 Yes 270 100 124 2 No 18 4 5 8 Blank but applicable 15 6 20 9 Don't know 6 3 1 Blank 7153 1244 2684 72 Is sample person now covered by that FQ C-4 part of Medicare which pays for doctor's bills? This is the Medi- care plan for which he or she or some agency must pay a certain amount each month. 1 Yes 269 100 111 2 No 17 5 17 8 Blank but applicable 15 6 20 9 Don't know 8 2 2 Blank 7153 1244 2684 73 Type of Medicare coverage FQ C-5 As shown on Medicare card 1 Hospital 0 0 0 2 Medical 2 0 0 3 Card not available 3 0 2 4 Hospital and medical 5 3 0 8 Blank but applicable 15 6 20 Blank 7437 1348 2812 See Note 10 Health Insurance 74 Is sample person covered by any FQ C-11 health insurance plan which pays any part of a hospital, doctor's, or surgeon's bill? 1 Yes 4094 818 1011 2 No 3326 526 1796 8 Blank but applicable 13 7 16 9 Don't know 8 0 1 Blank 21 6 10 75 Is sample person covered by a plan FQ C-9 that pays any part of hospital expenses? 1 Yes 4039 806 955 2 No 6 7 9 8 Blank but applicable 54 12 55 9 Don't know 8 0 8 Blank 3355 532 1807 76 Is sample person covered by a plan FQ C-10 that pays any part of a doctor's or surgeon's bills for operations? 1 Yes 4034 804 945 2 No 22 11 28 8 Blank but applicable 36 10 35 9 Don't know 15 0 19 Blank 3355 532 1807 Many people do not carry health FQ C-13/15 insurance for various reasons. Which of these statements describes why sample person is not covered by any health insurance (or Medicare)? (Positions 77-80) 77-78 Main Reason 01 Care received through Medicaid 267 31 854 or Welfare 02 Unemployed, or reasons related 350 40 114 to unemployment 03 Can't obtain insurance because 24 2 15 of poor health, illness or age 04 Too expensive, can't afford 1767 280 506 health insurance 05 Dissatisfied with previous 50 3 3 isurance 06 Don't believe in insurance 31 4 8 07 Have been healthy, not much sick- 206 23 31 ness in the family, haven't needed health insurance 08 Military dependent, (CHAMPUS), 45 1 15 Veteran's benefits 09 Some other reason - not specified 2 0 7 10 Some other reason - specified 255 35 58 88 Blank but applicable 118 34 77 Blank 4347 904 1146 79-80 Second Reason 00 No second reason reported 2573 339 1374 01 Care received through Medicaid 70 17 58 or Welfare 02 Unemployed or reasons related to 109 30 30 unemployment 03 Can't obtain insurance because of 4 2 3 poor health, illness or age 04 Too expensive, can't afford 168 20 132 health insurance 05 Dissatisfied with previous 15 1 2 insurance 06 Don't believe in insurance 18 3 3 07 Have been health, not much sick- 47 4 8 ness in the family, haven't needed health insurance 08 Military dependent, (CHAMPUS), 0 0 2 Veteran's benefits 09 Some other reason - not specified 0 0 0 10 Some other reason - specified 25 8 7 88 Blank but applicable 86 29 69 Blank 4347 904 1146 81-87 Blank 88 During the last 12 months, has sample FQ D-6 person received health care which has been or will be paid for by Medicaid? 1 Yes 537 101 1076 2 No 6859 1242 1708 8 Blank but applicable 45 7 40 9 Don't know 0 1 0 Blank 21 6 10 89 Does sample person have a Medicaid FQ D-8 card? 1 Yes 530 104 1144 2 No 6872 1232 1647 8 Blank but applicable 39 15 33 9 Don't know 0 0 0 Blank 21 6 10 90 Status of sample person's Medicaid FQ D-9 card? 1 Medicaid card seen - current 382 84 832 2 Medicaid card seen - expired 7 0 12 3 No card seen 128 17 274 4 Other card seen 0 0 0 5 Other card seen (specify) 5 0 2 8 Blank but applicable 47 18 57 Blank 6893 1238 1657 91 Is sample person now covered by any FQ D-11 other public assistance program that pays for health care? 1 Yes 54 2 28 2 No 7376 1348 2780 8 Blank but applicable 11 1 15 9 Don't know 0 0 0 Blank 21 6 10 92 Does sample person now receive FQ D-13 military retirement payments from any branch of the Armed Forced or a pension from the Veteran's Admini- stration? Do not include VA disa- bility compensation. 1 Yes 56 4 9 2 No 7373 1346 2806 8 Blank but applicable 12 1 9 9 Don't know 0 0 0 Blank 21 6 10 93 Which does sample person receive: FQ D-14 the Armed Forces retirement; the VA pension; or both? 1 Armed Forces 16 0 2 2 Veteran's Administration 30 0 5 3 Both 4 4 1 8 Blank but applicable 18 1 10 Blank 7394 1352 2816 94 Is sample person now covered by FQ D-16 CHAMP-VA, which is medical insurance for dependents or survivors of dis- abled veterans? 1 Yes 45 4 10 2 No 7388 1346 2806 8 Blank but applicable 8 1 6 9 Don't know 0 0 0 Blank 21 6 10 95 Is sample person now covered by any FQ D-18 other program that provides health care for military dependents or sur- vivors of military persons? 1 Yes 41 4 8 2 No 7387 1346 2804 8 Blank but applicable 13 1 12 9 Don't know 0 0 0 Blank 21 6 10 96 Is sample person included in the FQ D-2 AFDC, "Aid to Families With Dependent Children", assistance payment? 1 Yes 394 39 650 2 No 7020 1304 2134 8 Blank but applicable 27 6 39 9 Don't know 0 2 1 Blank 21 6 10 97 Does sample person now receive the FQ D-4 "Supplemental Security Income" or "SSI" gold-colored check? 1 Yes 131 44 135 2 No 7285 1295 2659 8 Blank but applicable 25 12 30 9 Don't know 0 0 0 Blank 21 6 10 98 Does sample person have a disability FQ D-20 related to his or her service in the Armed Forces of the United States? 1 Yes 48 2 14 2 No 346 20 108 8 Blank but applicable 29 8 37 Blank 7039 1327 2675 99 Does sample person now receive com- FQ D-21 pensation for this disability from the Veteran's Administration? 1 Yes 31 1 9 2 No 17 1 4 8 Blank but applicable 29 8 38 Blank 7385 1347 2783 Sociodemographic Data - Head of Family Tape Counts Source Location Item Description and Code M C P and Notes F. SOCIODEMOGRAPHIC DATA - HEAD OF FAMILY (POS 100-131) Source: Family Questionnaire (FQ) Household Screener Questionnaire (HSQ) 100 Interview and examination status of See Note 4 head of family 1 Selected as sample person, 5523 1076 2098 interviewed on Adult Sample Person Questionnaire, and examined 2 Selected as sample person, 338 62 79 interviewed on Adult Sample Person Questionnaire, but not examined 3 Selected as sample person, not 218 34 23 interviewed, and not examined 4 Not selected as sample person 1362 179 624 Blank 21 6 10 101 Blank Date of birth HSQ 2e 102-103 01-12 Month 7413 1348 2830 88 Blank but applicable 49 9 4 104-105 08-86, 89-88 Year 7440 1353 2832 88 Blank but applicable 22 4 2 106-107 Age at interview 17-95 Years 7462 1357 2834 108 Blank 109 Sex FQ B-4 1 Male 5982 1069 1331 2 Female 1460 282 1493 Blank 20 6 10 110 Observed race FQ B-5 1 White 7138 1282 2511 See Note 5 2 Black 75 27 165 3 Other 6 3 58 8 Blank but applicable 106 31 59 9 Not observed 117 8 31 Blank 20 6 10 111-112 Head of family's national origin HSQ 2c or ancestry. See Note 6 01 Mexican/Mexicano 2068 0 3 02 Mexican-American 4523 0 0 03 Chicano 97 0 0 04 Puerto Rican 19 7 2503 05 Boricuan 0 0 29 06 Cuban 6 1197 46 07 Cuban-American 0 85 2 08 Hispano - specify 147 20 37 09 Other Latin-American or other 54 17 39 Spanish - specify 00 Other - specify 513 31 175 10 Spanish-American 17 0 0 11 Spanish (Spain) 18 0 0 113-115 In what state or foreign country FQ B-6 was head of family born? See Note 7 001-118 State/country code 7362 1331 2762 888 Blank but applicable 80 20 62 Blank 20 6 10 116-117 What is the highest grade or year FQ B-7 of regular school head of family has ever attended? 00 Never attended or kinder- 250 7 35 garten only 01-08 Elementary grade 2959 511 889 09-12 High school grade 2896 411 1445 13-16 College 1002 336 363 17 Graduate school 170 57 41 88 Blank but applicable 165 29 51 Blank 20 6 10 118 Did head of family finish that FQ B-8 grade/year? 1 Yes 5710 1171 2210 2 No 1316 137 492 8 Blank but applicable 166 36 87 Blank 270 13 45 119 Is head of family now married, FQ B-9 widowed, divorced, separated, or has he or she never been married? 0 Under 14 0 0 0 1 Married - spouse in household 5706 1059 1295 2 Married - spouse not in household 129 9 129 3 Widowed 333 48 133 4 Divorced 492 136 376 5 Separated 388 28 452 6 Never married 320 56 418 8 Blank but applicable 74 15 21 Blank 20 6 10 120 Did head of family ever serve in FQ B-11 the Armed Forces of the United States? 1 Yes 1478 64 383 2 No 5883 1265 2400 8 Blank but applicable 81 22 41 Blank 20 6 10 121 During the past 2 weeks, did head FQ B-12 of family work at any time at a job or business, not counting work around the house? 1 Yes 5443 1019 1283 2 No 1923 305 1504 8 Blank but applicable 76 27 37 Blank 20 6 10 122 Even though head of family did not FQ B-13 work during those 2 weeks, did he or she have a job or business? 1 Yes 101 19 28 2 No 1822 286 1476 8 Blank but applicable 76 27 37 Blank 5463 1025 1293 123 Was head of family looking for work FQ B-14 or on layoff from a job? 1 Yes 510 61 118 2 No 1413 244 1384 8 Blank but applicable 76 27 39 Blank 5463 1025 1293 124 Which, looking for work or on FQ B-15 layoff from a job or both? 1 Looking 270 43 69 2 Layoff 151 12 26 3 Both 85 3 17 8 Blank but applicable 80 30 45 Blank 6876 1269 2677 125-127 What kind of business or industry FQ B-19 does head of family work for? See Note 9 010-932 Industry code 5980 1080 1395 990 Blank but applicable 118 28 62 Blank 1364 249 1377 128-130 What kind of work was head of FQ B-20 family doing? See Note 9 003-889 Occupation code 5988 1080 1391 999 Blank but applicable 110 28 66 Blank 1364 249 1377 131 Class of worker FQ B-22 1 Employee of a private company, 4702 842 1058 business or individual for wages, salary, or commission 2 A Federal government employee 219 4 45 3 A State government employee 246 12 54 4 A Local government employee 359 22 169 5 Self-employed in own incorpora- 49 25 14 ted business or professional practice 6 Self-employed in own unincor- 420 171 56 porated business, profes- sional practice, or farm 7 Working without pay in family 0 0 0 business or farm 8 Blank but applicable 99 32 60 0 Never worked or never worked at 4 0 1 a full-ime civilian job lasting 2 weeks or more Blank 1364 249 1377 Family Composition and Income Data Tape Counts Source Location Item Description and Code M C P and Notes G. FAMILY COMPOSITION AND INCOME DATA (POS 132-162) Source: Family Questionnaire (FQ) 132-133 Number of persons in family (computed) 01-18 Persons 7462 1357 2834 134-135 Number of sample persons in family (computed) 01-13 Persons 7462 1357 2834 136 Was the total combined family FQ E-10 income during the past 12 months more or less than $20,000? Include money from jobs, Social Security, retirement income, unemployment pay- ments, public assistance, and so forth. Also include income net from interest, dividends, income from business, farm or rent, and any other money income received. 1 $20,000 or more 2353 536 578 2 Less than $20,000 4856 795 2193 7 Refused information 31 1 7 8 Blank but applicable 202 19 46 Blank 20 6 10 137-138 Of those income groups, which best FQ E-11 represents the total combined family income during the past 12 months? Include wages, salaries, and other items we just talked about. (in dollars) 01 Less than 1,000 40 8 7 02 1,000 - 1,999 107 10 33 03 2,000 - 2,999 143 25 68 04 3,000 - 3,999 182 28 132 05 4,000 - 4,999 184 34 250 06 5,000 - 5,999 234 45 202 07 6,000 - 6,999 312 35 213 08 7,000 - 7,999 314 46 169 09 8,000 - 8,999 284 42 106 10 9,000 - 9,999 263 52 125 11 10,000 - 10,999 282 72 139 12 11,000 - 11,999 250 47 75 13 12,000 - 12,999 296 54 100 14 13,000 - 13,999 186 32 64 15 14,000 - 14,999 254 25 66 16 15,000 - 15,999 208 36 77 17 16,000 - 16,999 209 34 51 18 17,000 - 17,999 231 37 66 19 18,000 - 18,999 333 28 82 20 19,000 - 19,999 240 55 79 21 20,000 - 24,999 694 148 152 22 25,000 - 29,999 585 83 124 23 30,000 - 34,999 358 78 92 24 35,000 - 39,999 257 64 43 25 40,000 - 44,999 192 48 36 26 45,000 - 49,999 84 43 30 27 50,000 and over 107 55 54 77 Refused information 76 10 43 88 Blank but applicable 537 77 146 Blank 20 6 10 139-143 Per capita income (computed) See Note 11 00083-50000 Dollars 6829 1264 2636 88888 Blank but applicable 613 87 189 Blank 20 6 9 144-146 Poverty index (computed) See Note 12 Decimal not shown on tape 0.04-9.78 6829 1264 2636 999 Blank but applicable 613 87 189 Blank 20 6 9 147 Did any member of this family FQ E-12 receive any Government food stamps in any of the past 12 months? 1 Yes 1651 234 1344 2 No 5783 1115 1474 8 Blank but applicable 8 2 6 Blank 20 6 10 148-149 In how many months of the past 12 FQ E-13 months did any member of this family receive food stamps? 01-12 Months 1631 234 1335 88 Blank but applicable 28 2 15 Blank 5803 1121 1484 150 Did this family receive any FQ E-14 government food stamps last month? 1 Yes 1345 187 1290 2 No 303 47 50 8 Blank but applicable 11 2 10 Blank 5803 1121 1484 151-152 In which month did any member of FQ E-15 this family last receive food stamps? 01-12 Months 298 47 50 88 Blank but applicable 16 2 10 Blank 7148 1308 2774 153-154 For how many persons were those FQ E-16 food stamps authorized? 01-13 Persons 1641 234 1337 88 Blank but applicable 18 2 13 Blank 5803 1121 1484 155-157 What was the total face value of FQ E-17 those food stamps received by this family in that month? 010-520 Dollars 1567 230 1325 888 Blank but applicable 92 6 25 Blank 5803 1121 1484 158 Did this family spend more for food FQ E-18 in that month than the value of your food stamps? 1 Yes 1405 194 1279 2 No 231 40 64 8 Blank but applicable 23 2 7 Blank 5803 1121 1484 159-161 How much more? FQ E-19 003-880 Dollars 1314 182 1258 888 Blank but applicable 114 14 28 Blank 6034 1161 1548 162 Is your family receiving food FQ E-20 stamps at the present time? 1 Yes 1273 175 1269 2 No 6153 1171 1542 8 Blank but applicable 16 5 13 Blank 20 6 10 Residence and Household Data Tape Counts Source Location Item Description and Code M C P and Notes H. RESIDENCE AND HOUSEHOLD DATA (POS 163-183) Source: Family Questionnaire (FQ) Household Screener Questionnaire (HSQ) 163 Size of place See Note 13 1 1 million or more 1049 0 2070 2 500,000 - 999,999 844 0 0 3 250,000 - 499,999 884 467 0 4 100,000 - 249,999 203 364 368 5 50,000 - 99,999 1277 70 76 6 25,000 - 49,999 785 205 216 7 10,000 - 24,999 746 120 79 8 200 - 9,999 1003 88 24 9 Not in a place 671 43 1 164 Standard Metropolitan Statistical See Note 13 Area 1 In SMSA, in central city 3707 467 2465 2 In SMSA, not in central city 2854 890 369 4 Not in SMSA 901 0 0 165-166 Number of persons in household HSQ 1a 01-18 Persons 7462 1357 2834 167-168 Number of sample persons in household (computed) 01-13 Persons 7462 1357 2834 169-170 How many rooms are in this home? FQ E-1 Count the kitchen, but not the bathroom. 01-14 Rooms 7433 1350 2816 88 Blank but applicable 9 1 8 Blank 20 6 10 171 Do you have access to complete FQ E-2 kitchen facilities in this home; that is, a kitchen sink with piped water, a refrigerator and a range or cookstove? 1 Yes 7136 1315 2548 2 No 83 10 18 8 Blank but applicable 223 26 258 Blank 20 6 10 172-173 What is the main fuel used for FQ E-3 heating this home? See Note 14 00 No fuel used 538 231 16 01 Oil 4 0 1988 02 Natural gas 5955 78 718 03 Electricity 604 1027 37 04 Bottled gas (propane) 174 2 0 05 Kerosene 13 3 0 06 Wood 98 3 0 07 Coal 0 0 14 08 Other, not specified 0 0 2 09 Other, specified 11 0 8 88 Blank but applicable 45 7 41 Blank 20 6 10 174-175 What is the main heating equipment FQ E-4 for this home? See Note 14 00 No heating equipment used 538 231 20 01 Steam or hot water with 44 5 1450 radiators or convectors 02 Central warm air furnace with 2677 542 180 ducts to individual rooms, or central heat pump 03 Built-in electric units (per- 474 323 63 manently installed in wall, ceiling or baseboard) 04 Floor, wall or pipeless furnace 1598 46 21 05 Room heaters with flue or vent, 805 17 596 burning oil, gas, or kerosene 06 Room heaters without flue or 847 6 425 vent, burning oil, gas, or kerosene 07 Heating stove burning wood, 88 0 9 coal or coke 08 Fireplace(s) 91 4 0 09 Portable electric heater(s) 139 137 4 10 Other, not specified 0 0 0 11 Other, specified 114 35 16 88 Blank but applicable 1 5 23 99 Don't know 26 0 17 Blank 20 6 10 176-177 Are any other types of equipment FQ E-5 used for heating this home? See Note 14 00 No other heating equipment used 6057 1073 2350 01 Steam or hot water with 0 0 13 radiators or convectors 02 Central warm air furnace with 11 15 7 ducts to individual rooms, or central heat pump 03 Built-in electric units (per- 24 0 2 manently installed in wall, ceiling or baseboard) 04 Floor, wall or pipeless furnace 11 0 0 05 Room heaters with flue or vent, 22 0 3 burning oil, gas, or kerosene 06 Room heaters without flue or 22 1 29 vent, burning oil, gas, or kerosene 07 Heating stove burning wood, 70 0 8 coal or coke 08 Fireplace(s) 449 8 9 09 Portable electric heater(s) 186 18 351 10 Other, not specified 4 2 3 11 Other, specified 18 2 4 88 Blank but applicable 30 1 25 Blank 558 237 30 178-179 What is the main fuel used by this FQ E-6 additional equipment? See Note 14 00 No fuel used 2 0 2 01 Oil 0 0 20 02 Natural gas 96 2 27 03 Electricity 214 35 345 04 Bottled gas (propane) 9 0 1 05 Kerosene 2 0 25 06 Wood 471 8 11 07 Coal 2 0 0 08 Other, not specified 0 0 0 09 Other, specified 7 0 0 88 Blank but applicable 44 2 3 Blank 6615 1310 2380 180-181 What is the main fuel used for FQ E-7 cooking in this home? 00 No fuel used 21 4 4 01 Oil 14 0 31 02 Natural gas 5899 253 2603 03 Electricity 1295 1083 148 04 Bottled gas (propane) 182 8 12 05 Kerosene 0 0 3 06 Wood 0 0 0 07 Coal 0 0 0 08 Other, not specified 0 0 0 09 Other, specified 14 1 0 88 Blank but applicable 17 2 23 Blank 20 6 10 182 Do you have air-conditioning - FQ E-8 either individual room units, a central system or evaporative cooling? 1 Yes 3583 1254 653 2 No 3845 96 2153 8 Blank but applicable 14 1 18 Blank 20 6 10 183 Which do you have? FQ E-9 1 Individual room unit 1625 583 613 2 Central air-conditioning 1233 660 22 3 Evaporative cooling 719 6 10 8 Blank but applicable 20 6 26 Blank 3865 102 2163 Sample Weights Tape Counts Source Location Item Description and Code M C P and Notes I. SAMPLE WEIGHTS (POS 184-217) 184-189 Examined final weight 000439-002711 7462 - - 000223-000891 - 1357 - 000177-002000 - - 2834 190-195 Interview final weight 000447-002096 7462 - - 000176-000604 - 1357 - 000175-001220 - - 2834 GTT/ULTRASOUND, AUDIOMETRY/VISION, PESTICIDE WEIGHTS By design, only some of the persons in the sample were included in the GTT/ultrasound, audiometry/vision, and pesticide components of the survey. Tape positions for those persons not part of these subsamples are BLANK. 196-201 GTT/ultrasound weight 000843-005302 1777 - - 000469-001685 - 449 - 000349-003110 5685 908 2167 Blank - - 667 202-207 Audiometry/vision weight 000507-006283 4431 - - 000223-001600 - 804 - 000264-003123 - - 1759 Blank 3031 553 1075 208-213 Pesticide weight 000872-005584 2465 - - 000441-001600 - 568 - 000343-003117 - - 1012 Blank 4997 789 1822 214-215 Strata code 01-08 7462 1357 2834 216-217 Pseudo PSU code 01-02 7462 1357 2834 Family Relationships Tape Counts Source Location Item Description and Code M C P and Notes J. FAMILY RELATIONSHIPS (POS 218-400) Source: Adult Sample Person Questionnaire Family Questionnaire 218-400 Blank Data not yet available Physical Examination Data General Position Item description Counts Source and code M C P and notes K. PHYSICAL EXAMINATION DATA (POS 401-860) Source: Physician's Examination 401-404 Tape number 6509 7462 1357 2834 405 Blank 406 Physician's examination form blank See Note 15 1 No physician's examination data were taken. Positions 407-860 are blank. 135 12 70 2 Physician's examination data are present. 7327 1345 2764 407-409 Blank 410-412 Examiner number 500 175 0 0 501 3811 0 0 502 3334 647 1039 504 0 698 621 505 0 0 1057 510 7 0 47 Blank 135 12 70 413-419 Blank Skull and Ears (Positions 420-448) Position Item description Counts Source and code M C P and notes 420 Bossing of skull 1 Yes 4 0 0 4 No 7311 1343 2758 8 Blank but applicable 12 2 6 Blank 135 12 70 421 Right auditory canal-otitis externa 1 Yes 14 2 5 4 No 7302 1339 2750 8 Blank but applicable 11 4 9 Blank 135 12 70 422 Left auditory canal-otitis externa 1 Yes 8 3 3 4 No 7308 1338 2752 8 Blank but applicable 11 4 9 Blank 135 12 70 423 Right auditory canal-purulent discharge 1 Yes 6 0 0 4 No 7309 1339 2755 8 Blank but applicable 12 6 9 Blank 135 12 70 424 Left auditory canal-purulent discharge 1 Yes 3 1 3 4 No 7313 1338 2753 8 Blank but applicable 11 6 8 Blank 135 12 70 425 Right ear drum See Note 16 Blank Visualized or exam not given 6782 1055 2413 1 Not visualized, other 378 43 67 2 Not visualized, canal completely occluded 301 254 346 8 Blank but applicable 1 5 8 426 Left ear drum See Note 16 Blank Visualized or exam not given 6851 1060 2408 1 Not visualized, other 319 44 76 2 Not visualized, canal completely occluded 291 248 342 8 Blank but applicable 1 5 8 427 Right ear drum-dull (opaque) 1 Yes 84 9 34 4 No 6560 1034 2309 8 Blank but applicable 4 5 8 Blank 814 309 483 428 Left ear drum-dull (opaque) 1 Yes 79 9 46 4 No 6634 1039 2291 8 Blank but applicable 4 5 9 Blank 745 304 488 429 Right ear drum-transparent 1 Yes 74 3 15 4 No 6570 1040 2328 8 Blank but applicable 4 5 8 Blank 814 309 483 430 Left ear drum-transparent 1 Yes 89 4 21 4 No 6624 1044 2317 8 Blank but applicable 4 5 8 Blank 745 304 488 431 Right ear drum-bulging 1 Yes 2 0 6 4 No 6642 1043 2337 8 Blank but applicable 4 5 8 Blank 814 309 483 432 Left ear drum-bulging 1 Yes 1 0 11 4 No 6712 1048 2327 8 Blank but applicable 4 5 8 Blank 745 304 488 433 Right ear drum-retracted 1 Yes 114 4 16 4 No 6529 1039 2327 8 Blank but applicable 5 5 8 Blank 814 309 483 434 Left ear drum-retracted 1 Yes 143 15 33 4 No 6569 1033 2305 8 Blank but applicable 5 5 8 Blank 745 304 488 435 Right ear drum-calcium plaques 1 Yes 78 2 24 4 No 6566 1041 2318 8 Blank but applicable 4 5 9 Blank 814 309 483 436 Left ear drum-calcium plaques 1 Yes 85 4 20 4 No 6628 1044 2317 8 Blank but applicable 4 5 9 Blank 745 304 488 437 Right ear drum-reddened 1 Yes 95 17 30 4 No 6549 1026 2312 8 Blank but applicable 4 5 9 Blank 814 309 483 438 Left ear drum-reddened 1 Yes 107 21 30 4 No 6607 1027 2307 8 Blank but applicable 3 5 9 Blank 745 304 488 439 Right ear drum-other discoloration 1 Yes 8 0 15 4 No 6635 1043 2328 8 Blank but applicable 5 5 8 Blank 814 309 483 440 Left ear drum-other discoloration 1 Yes 11 0 24 4 No 6701 1048 2314 8 Blank but applicable 5 5 8 Blank 745 304 488 441 Right ear drum-fluid 1 Yes 20 0 2 4 No 6622 1043 2340 8 Blank but applicable 6 5 9 Blank 814 309 483 442 Left ear drum-fluid 1 Yes 30 0 7 4 No 6681 1048 2330 8 Blank but applicable 6 5 9 Blank 745 304 488 443 Right ear drum-scars 1 Yes 551 12 36 4 No 6091 1031 2307 8 Blank but applicable 6 5 8 Blank 814 309 483 444 Left ear drum-scars 1 Yes 608 18 65 4 No 6101 1030 2273 8 Blank but applicable 8 5 8 Blank 745 304 488 445 Right ear drum-perforation with discharge 1 Yes 5 0 3 4 No 6638 1043 2340 8 Blank but applicable 5 5 8 Blank 814 309 483 446 Left ear drum-perforation with discharge 1 Yes 9 0 0 4 No 6703 1048 2338 8 Blank but applicable 5 5 8 Blank 745 304 488 447 Right ear drum-perforation without discharge 1 Yes 39 0 9 4 No 6604 1043 2334 8 Blank but applicable 5 5 8 Blank 814 309 483 448 Left ear drum-perforation without discharge 1 Yes 28 0 11 4 No 6684 1048 2327 8 Blank but applicable 5 5 8 Blank 745 304 488 449 Blank Nares (Positions 450-459) Position Item description Counts Source and code M C P and notes 450 Right nares-obstruction 1 Yes 18 3 3 4 No 7281 1339 2749 8 Blank but applicable 28 3 12 Blank 135 12 70 451 Left nares-obstruction 1 Yes 17 5 5 4 No 7282 1337 2747 8 Blank but applicable 28 3 12 Blank 135 12 70 452 Right nares-deviated septum 1 Yes 140 19 11 4 No 7171 1323 2732 8 Blank but applicable 16 3 21 Blank 135 12 70 453 Left nares-deviated septum 1 Yes 87 14 10 4 No 7223 1328 2733 8 Blank but applicable 17 3 21 Blank 135 12 70 454 Right nares-swollen turbinates 1 Yes 224 5 22 4 No 7086 1337 2684 8 Blank but applicable 17 3 58 Blank 135 12 70 455 Left nares-swollen turbinates 1 Yes 234 4 25 4 No 7075 1338 2681 8 Blank but applicable 18 3 58 Blank 135 12 70 456 Right nares-inflammation 1 Yes 114 4 5 4 No 7197 1338 2701 8 Blank but applicable 16 3 58 Blank 135 12 70 457 Left nares-inflammation 1 Yes 121 8 10 4 No 7189 1334 2696 8 Blank but applicable 17 3 58 Blank 135 12 70 458 Right nares-polyps 1 Yes 5 1 3 4 No 7303 1341 2703 8 Blank but applicable 19 3 58 Blank 135 12 70 459 Left nares-polyps 1 Yes 4 0 4 4 No 7304 1342 2702 8 Blank but applicable 19 3 58 Blank 135 12 70 460 Blank Lips and Pharynx (Positions 461-463) Position Item description Counts Source and code M C P and notes 461 Lips-cheilosis 1 Yes 4 5 1 4 No 7320 1338 2760 8 Blank but applicable 3 2 3 Blank 135 12 70 462 Lips-cyanosis 1 Yes 0 1 0 4 No 7322 1342 2758 8 Blank but applicable 5 2 6 Blank 135 12 70 463 Pharynx-enlarged tonsils 1 Yes 501 22 88 4 No 6809 1321 2642 8 Blank but applicable 17 2 34 Blank 135 12 70 464 Blank Eyes (Positions 465-498) Position Item description Counts Source and code M C P and notes 465 Eyes-strabismus 1 Yes 733 14 42 4 No 6587 1327 2718 8 Blank but applicable 7 4 4 Blank 135 12 70 466 Eyes-conjunctival injection 1 Yes 84 9 9 4 No 7240 1332 2753 8 Blank but applicable 3 4 2 Blank 135 12 70 467 Eyes-pale conjunctiva 1 Yes 14 0 4 4 No 7309 1341 2758 8 Blank but applicable 4 4 2 Blank 135 12 70 468 Eyes-xerophthalmia 1 Yes 0 0 0 4 No 7323 1341 2762 8 Blank but applicable 4 4 2 Blank 135 12 70 469 Eyes-keratomalacia 1 Yes 0 0 0 4 No 7323 1341 2762 8 Blank but applicable 4 4 2 Blank 135 12 70 470 Eyes-pterygium 1 Yes 267 32 48 4 No 7056 1309 2714 8 Blank but applicable 4 4 2 Blank 135 12 70 471 Right eye-corneal lesion(s) 1 Yes 23 5 1 4 No 7243 1337 2756 8 Blank but applicable 56 3 7 Blank 140 12 70 472 Left eye-corneal lesion(s) 1 Yes 23 3 4 4 No 7243 1338 2751 8 Blank but applicable 56 3 7 Blank 140 13 72 473 Eyes-pupils 1 Right larger 18 4 12 2 Left larger 13 6 3 4 Equal 7281 1331 2738 8 Blank but applicable 5 3 9 Blank 145 13 72 474 Eyes-pupillary light reflex 1 Abnormal 32 13 20 4 Normal 7293 1328 2734 8 Blank but applicable 2 4 10 Blank 135 12 70 475 Right eye-globe absent See Note 16 1 Absent 5 0 0 Blank-present or exam not given 7457 1357 2834 476 Left eye-globe absent See Note 16 1 Absent 5 1 2 Blank-present or exam not given 7457 1356 2832 477 Right eye-ocular fundus-red reflex 1 Abnormal 15 3 8 4 Normal 7261 1314 2734 8 Blank but applicable 46 28 22 Blank 140 12 70 478 Left eye-ocular fundus-red reflex 1 Abnormal 12 0 8 4 Normal 7266 1317 2732 8 Blank but applicable 44 27 22 Blank 140 13 72 479 Right eye-lens opacities 1 Yes 58 16 18 4 No 7203 1301 2724 8 Blank but applicable 61 28 22 Blank 140 12 70 480 Left eye-lens opacities 1 Yes 58 19 23 4 No 7207 1299 2717 8 Blank but applicable 57 26 22 Blank 140 13 72 481 Right eye-fundus visualization See Note 17 1 Not visualized 254 66 219 Blank Visualized 7165 1277 2596 8 Blank but applicable 43 14 19 482 Left eye-fundus visualization See Note 17 1 Not visualized 276 69 231 Blank Visualized 7144 1276 2584 8 Blank but applicable 42 12 19 483 Right eye-ocular fundus- narrow arterioles 1 Yes 110 2 6 4 No 6892 1263 2512 8 Blank but applicable 66 14 27 Blank 394 78 289 484 Left eye-ocular fundus- narrow arterioles 1 Yes 149 11 32 4 No 6834 1252 2471 8 Blank but applicable 63 12 28 Blank 416 82 303 485 Right eye-ocular fundus- tortuous arterioles 1 Yes 42 2 5 4 No 6952 1263 2513 8 Blank but applicable 74 14 27 Blank 394 78 289 486 Left eye-ocular fundus- tortuous arterioles 1 Yes 41 1 5 4 No 6934 1262 2499 8 Blank but applicable 71 12 27 Blank 416 82 303 487 Right eye-ocular fundus-AV compression 1 Yes 25 0 11 4 No 6964 1265 2507 8 Blank but applicable 79 14 27 Blank 394 78 289 488 Left eye-ocular fundus-AV compression 1 Yes 27 0 15 4 No 6943 1263 2489 8 Blank but applicable 76 12 27 Blank 416 82 303 489 Right eye-ocular fundus-hemorrhage 1 Yes 4 0 0 4 No 6986 1265 2518 8 Blank but applicable 78 14 27 Blank 394 78 289 490 Left eye-ocular fundus-hemorrhage 1 Yes 4 0 0 4 No 6967 1263 2504 8 Blank but applicable 75 12 27 Blank 416 82 303 491 Right eye-ocular fundus-exudate 1 Yes 5 0 4 4 No 6983 1265 2515 8 Blank but applicable 80 14 26 Blank 394 78 289 492 Left eye-ocular fundus-exudate 1 Yes 3 0 6 4 No 6966 1263 2499 8 Blank but applicable 77 12 26 Blank 416 82 303 493 Right eye-ocular fundus- venous engorgement 1 Yes 1 0 0 4 No 6987 1264 2519 8 Blank but applicable 80 15 26 Blank 394 78 289 494 Left eye-ocular fundus- venous engorgement 1 Yes 2 0 0 4 No 6967 1262 2505 8 Blank but applicable 77 13 26 Blank 416 82 303 495 Right eye-ocular fundus-papilledema 1 Yes 0 0 1 4 No 6988 1265 2523 8 Blank but applicable 80 14 21 Blank 394 78 289 496 Left eye-ocular fundus-papilledema 1 Yes 0 0 1 4 No 6969 1263 2509 8 Blank but applicable 77 12 21 Blank 416 82 303 497 Right eye-ocular fundus-disc abnormal 1 Yes 3 1 10 4 No 6985 1264 2514 8 Blank but applicable 80 14 21 Blank 394 78 289 498 Left eye-ocular fundus-disc abnormal 1 Yes 3 2 7 4 No 6966 1261 2503 8 Blank but applicable 77 12 21 Blank 416 82 303 499 Blank Neck (Positions 500-504) Position Item description Counts Source and code M C P and notes 500 Neck-enlarged lymph nodes 1 Yes 449 22 198 4 No 6877 1322 2543 8 Blank but applicable 1 1 23 Blank 135 12 70 501 Neck-tender lymph nodes 1 Yes 14 0 11 4 No 7310 1344 2729 8 Blank but applicable 3 1 24 Blank 135 12 70 502 Neck-thyroid evaluation- WHO classification See Appendix Grade 0 7300 1339 2714 1.9.2 Grade 1 24 5 12 Grade 2 1 0 3 Grade 3 0 0 1 8 Blank but applicable 2 1 34 Blank 135 12 70 503 Neck-tenderness 1 Yes 1 0 2 4 No 7326 1344 2727 8 Blank but applicable 0 1 35 Blank 135 12 70 504 Neck-nodule 1 Yes 3 2 4 4 No 7324 1342 2725 8 Blank but applicable 0 1 35 Blank 135 12 70 505 Blank Pulse (Positions 506-509; Ages 6 Years and Over) Position Item description Counts Source and code M C P and notes 506-508 Pulse-rate (beats per minutes) 040-176 6088 1244 2386 888 Blank but applicable 14 2 5 Blank 1360 111 443 509 Pulse-regularity 1 Irregular 26 9 16 2 Regular 6047 1234 2365 8 Blank but applicable 29 3 10 Blank 1360 111 443 Blood Pressure (Positions 510-516; Ages 6 Years and Over) Position Item description Counts Source and code M C P and notes 510 Blood pressure-cuff width 1 Infant 24 5 7 2 Child 1676 170 506 3 Adult 3839 934 1591 4 Large arm 534 133 272 5 Thigh 8 2 6 8 Blank but applicable 21 2 9 Blank 1360 111 443 511-513 Blood pressure-systolic See Note 18 070-240 6090 1243 2385 888 Blank but applicable 12 3 6 Blank 1360 111 443 514-516 Blood pressure-diastolic See Note 18 000-138 6090 1243 2384 888 Blank but applicable 12 3 7 Blank 1360 111 443 517 Blank Chest Findings and CVA Tenderness (Positions 518-565) Position Item description Counts Source and code M C P and notes 518 Chest-beading of ribs 1 Yes 1 0 1 4 No 7315 1343 2756 8 Blank but applicable 11 2 7 Blank 135 12 70 519 Chest-asymmetry 1 Yes 32 4 9 4 No 7285 1339 2748 8 Blank but applicable 10 2 7 Blank 135 12 70 520 Chest-funnel breast 1 Yes 27 0 7 4 No 7289 1343 2750 8 Blank but applicable 11 2 7 Blank 135 12 70 521 Chest-pigeon breast 1 Yes 13 0 3 4 No 7303 1343 2754 8 Blank but applicable 11 2 7 Blank 135 12 70 522 Chest-increased A.P. diameter 1 Yes 48 0 14 4 No 7267 1343 2743 8 Blank but applicable 12 2 7 Blank 135 12 70 523 CVA tenderness 1 Yes 97 14 50 4 No 7052 1308 2667 8 Blank but applicable 178 23 47 Blank 135 12 70 524 Chest-diminished breath sounds-area 1 See Note 19 1 Yes 12 4 6 8 Blank but applicable 5 2 7 Blank 7445 1351 2821 525 Chest-diminished breath sounds-area 2 2 Yes 12 4 5 8 Blank but applicable 5 2 7 Blank 7445 1351 2822 526 Chest-diminished breath sounds-area 3 3 Yes 13 4 6 8 Blank but applicable 5 2 7 Blank 7444 1351 2821 527 Chest-diminished breath sounds-area 4 4 Yes 15 4 4 8 Blank but applicable 5 2 7 Blank 7442 1351 2823 528 Chest-diminished breath sounds-area 5 5 Yes 15 4 7 8 Blank but applicable 5 2 7 Blank 7442 1351 2820 529 Chest-diminished breath sounds-area 6 6 Yes 17 6 5 8 Blank but applicable 5 2 7 Blank 7440 1349 2822 530 Chest-diminished breath sounds in any area 4 No diminished breath sounds 7302 1337 2746 8 Blank but applicable 5 2 7 Blank 155 18 81 531 Chest-absent breath sounds-area 1 See Note 19 1 Yes 0 0 0 8 Blank but applicable 5 2 7 Blank 7457 1355 2827 532 Chest-absent breath sounds-area 2 2 Yes 0 1 0 8 Blank but applicable 5 2 7 Blank 7457 1354 2827 533 Chest-absent breath sounds-area 3 3 Yes 0 0 0 8 Blank but applicable 5 2 7 Blank 7457 1355 2827 534 Chest-absent breath sounds-area 4 4 Yes 0 1 0 8 Blank but applicable 5 2 7 Blank 7457 1354 2827 535 Chest-absent breath sounds-area 5 5 Yes 0 0 0 8 Blank but applicable 5 2 7 Blank 7457 1355 2827 536 Chest-absent breath sounds-area 6 6 Yes 0 0 0 8 Blank but applicable 5 2 7 Blank 7457 1355 2827 537 Breath sounds heard in all areas 4 Yes 7322 1342 2757 8 Blank but applicable 5 2 7 Blank 135 13 70 538 Chest-bronchial breath sounds-area 1 See Note 19 1 Yes 7 0 4 8 Blank but applicable 5 2 7 Blank 7450 1355 2823 539 Chest-bronchial breath sounds-area 2 2 Yes 7 0 5 8 Blank but applicable 5 2 7 Blank 7450 1355 2822 540 Chest-bronchial breath sounds-area 3 3 Yes 13 0 7 8 Blank but applicable 5 2 7 Blank 7444 1355 2820 541 Chest-bronchial breath sounds-area 4 4 Yes 13 0 7 8 Blank but applicable 5 2 7 Blank 7444 1355 2820 542 Chest-bronchial breath sounds-area 5 5 Yes 11 0 4 8 Blank but applicable 5 2 7 Blank 7446 1355 2823 543 Chest-bronchial breath sounds-area 6 6 Yes 11 0 5 8 Blank but applicable 5 2 7 Blank 7446 1355 2822 544 Chest-bronchial breath sounds in any area 4 No bronchial breath sounds 7304 1343 2747 8 Blank but applicable 5 2 7 Blank 153 12 80 545 Chest-rales-area 1 See Note 19 1 Yes 0 0 0 8 Blank but applicable 5 2 7 Blank 7457 1355 2827 546 Chest-rales-area 2 2 Yes 0 0 1 8 Blank but applicable 5 2 7 Blank 7457 1355 2826 547 Chest-rales-area 3 3 Yes 3 2 1 8 Blank but applicable 5 2 7 Blank 7454 1353 2826 548 Chest-rales-area 4 4 Yes 3 1 1 8 Blank but applicable 5 2 7 Blank 7454 1354 2826 549 Chest-rales-area 5 5 Yes 3 1 1 8 Blank but applicable 5 2 7 Blank 7454 1354 2826 550 Chest-rales-area 6 6 Yes 7 0 4 8 Blank but applicable 5 2 7 Blank 7450 1355 2823 551 Chest-rales in any area 4 No rales 7313 1341 2752 8 Blank but applicable 5 2 7 Blank 144 14 75 552 Chest-rhonchi-area 1 See Note 19 1 Yes 14 2 3 8 Blank but applicable 4 2 7 Blank 7444 1353 2824 553 Chest-rhonchi-area 2 2 Yes 15 2 5 8 Blank but applicable 4 2 7 Blank 7443 1353 2822 554 Chest-rhonchi-area 3 3 Yes 22 5 5 8 Blank but applicable 4 2 7 Blank 7436 1350 2822 555 Chest-rhonchi-area 4 4 Yes 24 3 6 8 Blank but applicable 4 2 7 Blank 7434 1352 2821 556 Chest-rhonchi-area 5 5 Yes 20 1 4 8 Blank but applicable 4 2 7 Blank 7438 1354 2823 557 Chest-rhonchi-area 6 6 Yes 18 0 5 8 Blank but applicable 4 2 7 Blank 7440 1355 2822 558 Chest-rhonchi in any area 4 No rhonchi 7293 1338 2750 8 Blank but applicable 4 2 7 Blank 165 17 77 559 Chest-wheeze-area 1 See Note 19 1 Yes 23 9 46 8 Blank but applicable 7 2 7 Blank 7432 1346 2781 560 Chest-wheeze-area 2 2 Yes 27 10 41 8 Blank but applicable 7 2 7 Blank 7428 1345 2786 561 Chest-wheeze-area 3 3 Yes 22 8 39 8 Blank but applicable 7 2 7 Blank 7433 1347 2788 562 Chest-wheeze-area 4 4 Yes 28 9 46 8 Blank but applicable 7 2 7 Blank 7427 1346 2781 563 Chest-wheeze-area 5 5 Yes 18 6 35 8 Blank but applicable 7 2 7 Blank 7437 1349 2792 564 Chest-wheeze-area 6 6 Yes 20 6 40 8 Blank but applicable 7 2 7 Blank 7435 1349 2787 565 Chest-wheezes in any area 4 No wheezes 7274 1328 2683 8 Blank but applicable 7 2 7 Blank 181 27 144 566-567 Blank Breast Mass(es) (Positions 565-569; Ages 10 Years and Over) Position Item description Counts Source and code M C P and notes 568 Right breast mass(es) See Note 20 1 Yes 18 3 30 4 No 5151 1115 2023 8 Blank but applicable 59 41 43 Blank 2234 198 738 569 Left breast mass(es) See Note 20 1 Yes 15 3 37 4 No 5150 1116 2017 8 Blank but applicable 63 40 42 Blank 2234 198 738 570 Blank Heart (Positions 571-597) Position Item description Counts Source and code M C P and notes 571 Heart-right carotid pulsations 1 Absent 0 0 5 2 Diminished 24 2 25 4 Normal 7285 1336 2678 8 Blank but applicable 18 7 56 Blank 135 12 70 572 Heart-right carotid bruit 1 Yes 55 1 27 4 No 7224 1335 2680 8 Blank but applicable 48 9 57 Blank 135 12 70 573 Heart-left carotid pulsations 1 Absent 0 0 4 2 Diminished 34 6 24 4 Normal 7273 1332 2680 8 Blank but applicable 20 7 56 Blank 135 12 70 574 Heart-left carotid bruit 1 Yes 53 0 21 4 No 7221 1336 2686 8 Blank but applicable 53 9 57 Blank 135 12 70 575 Heart-P.M.I. (ages 18 years and over) 1 Felt 3139 717 781 2 Not felt 591 220 672 8 Blank but applicable 37 11 17 Blank 3695 409 1364 576 Heart-P.M.I. location-interspace 4 4th interspace 1044 107 83 5 5th interspace 2062 574 650 6 6th interspace 24 36 46 7 7th interspace 7 0 2 8 Blank but applicable 39 11 17 Blank 4286 629 2036 577 Heart-P.M.I. location-midclavicular line 1 At 3010 659 743 2 Inside 53 37 27 3 Outside 72 20 11 8 Blank but applicable 41 12 17 Blank 4286 629 2036 578 Heart-thrills 1 Yes 0 0 1 4 No 7287 1334 2741 8 Blank but applicable 40 11 22 Blank 135 12 70 579 Heart-thrills-location 1 Base 0 0 0 2 Apex 0 0 1 8 Blank but applicable 40 11 22 Blank 7422 1346 2811 580 Heart-first sound 1 Accentuated 3 0 4 2 Diminished 14 0 9 4 Normal 7298 1342 2744 8 Blank but applicable 12 3 7 Blank 135 12 70 581 Heart-second sound-aortic 1 Accentuated 11 0 2 2 Diminished 14 0 9 4 Normal 7290 1342 2746 8 Blank but applicable 12 3 7 Blank 135 12 70 582 Heart-second sound-pulmonic 1 Accentuated 12 0 7 2 Diminished 12 0 9 4 Normal 7291 1342 2741 8 Blank but applicable 12 3 7 Blank 135 12 70 583 Heart-third sound 1 Yes 12 0 0 2 Maybe 7 0 1 4 No 7294 1342 2754 8 Blank but applicable 14 3 9 Blank 135 12 70 584 Heart-systolic click 1 Yes 8 2 1 4 No 7304 1340 2754 8 Blank but applicable 15 3 9 Blank 135 12 70 585 Heart murmur(s)-present 1 Yes 380 13 133 4 No 6930 1327 2623 8 Blank but applicable 17 5 8 Blank 135 12 70 586 Heart murmur-first systolic murmur-location 1 Mitral 66 3 28 2 Aortic 215 9 62 3 Tricuspid 0 0 28 4 Pulmonic 93 1 15 8 Blank but applicable 21 5 8 Blank 7067 1339 2693 587 Heart murmur-second systolic murmur-location 1 Mitral 4 0 0 2 Aortic 2 0 0 3 Tricuspid 0 0 2 4 Pulmonic 2 0 1 8 Blank but applicable 18 5 8 Blank 7436 1352 2823 588 Heart murmur-first diastolic murmur-location 1 Mitral 2 0 1 2 Aortic 9 0 0 3 Tricuspid 0 0 0 4 Pulmonic 2 0 0 8 Blank but applicable 18 5 8 Blank 7431 1352 2825 589 Heart murmur-second diastolic murmur-location 1 Mitral 1 0 0 2 Aortic 1 0 0 3 Tricuspid 0 0 0 4 Pulmonic 0 0 1 8 Blank but applicable 18 5 8 Blank 7442 1352 2825 590 Heart murmur-first systolic murmur-type 1 Functional 294 8 76 2 Organic 46 5 18 3 Don't know 37 0 39 8 Blank but applicable 18 5 8 Blank 7067 1339 2693 591 Heart murmur-second systolic murmur-type 1 Functional 1 0 1 2 Organic 7 0 1 3 Don't know 0 0 1 8 Blank but applicable 18 5 8 Blank 7436 1352 2823 592 Heart murmur-first diastolic murmur-type 1 Functional 0 0 0 2 Organic 9 0 1 3 Don't know 2 0 0 8 Blank but applicable 20 5 8 Blank 7431 1352 2825 593 Heart murmur-second diastolic murmur-type 1 Functional 0 0 0 2 Organic 1 0 0 3 Don't know 0 0 0 8 Blank but applicable 19 5 9 Blank 7442 1352 2825 594 Heart murmur-first systolic murmur-grade 1 Grade 1 111 4 40 2 Grade 2 215 6 74 3 Grade 3 44 1 16 4 Grade 4 6 2 2 5 Grade 5 1 0 0 6 Grade 6 0 0 0 8 Blank but applicable 18 5 9 Blank 7067 1339 2693 595 Heart murmur-second systolic murmur-grade 1 Grade 1 0 0 0 2 Grade 2 3 0 2 3 Grade 3 4 0 1 4 Grade 4 1 0 0 5 Grade 5 0 0 0 6 Grade 6 0 0 0 8 Blank but applicable 18 5 8 Blank 7436 1352 2823 596 Heart murmur-first diastolic murmur-grade 1 Grade 1 4 0 0 2 Grade 2 4 0 0 3 Grade 3 4 0 0 4 Grade 4 1 0 1 5 Grade 5 0 0 0 6 Grade 6 0 0 0 8 Blank but applicable 18 5 8 Blank 7431 1352 2825 597 Heart murmur-second diastolic murmur-grade 1 Grade 1 1 0 0 2 Grade 2 1 0 0 3 Grade 3 0 0 1 4 Grade 4 0 0 0 5 Grade 5 0 0 0 6 Grade 6 0 0 0 8 Blank but applicable 18 5 8 Blank 7442 1352 2825 598 Blank Abdomen (Positions 599-642) Position Item description Counts Source and code M C P and notes 599 Abdomen-surgical scar(s) 1 Yes 1201 356 499 4 No 6115 985 2254 8 Blank but applicable 11 4 11 Blank 135 12 70 600 Abdomen-scar(s)-area 1 See Note 21 1 Yes 219 15 44 0 Blank but applicable 13 4 11 Blank 7230 1338 2779 601 Abdomen-scar(s)-area 2 2 Yes 99 49 43 0 Blank but applicable 13 4 11 Blank 7350 1304 2780 602 Abdomen-scar(s)-area 3 3 Yes 12 1 5 0 Blank but applicable 13 4 11 Blank 7437 1352 2818 603 Abdomen-scar(s)-area 4 4 Yes 67 32 64 0 Blank but applicable 13 4 11 Blank 7382 1321 2759 604 Abdomen-scar(s)-area 5 5 Yes 245 109 148 0 Blank but applicable 13 4 11 Blank 7204 1244 2675 605 Abdomen-scar(s)-area 6 6 Yes 19 5 6 0 Blank but applicable 13 4 11 Blank 7430 1348 2817 606 Abdomen-scar(s)-area 7 7 Yes 391 213 135 0 Blank but applicable 13 4 11 Blank 7058 1140 2688 607 Abdomen-scar(s)-area 8 8 Yes 596 175 309 0 Blank but applicable 13 4 11 Blank 6853 1178 2514 608 Abdomen-scar(s)-area 9 9 Yes 50 41 47 0 Blank but applicable 13 4 11 Blank 7399 1312 2776 609 Abdomen-ascites 1 Yes 2 0 0 4 No 7308 1341 2745 8 Blank but applicable 17 4 19 Blank 135 12 70 610 Abdomen bruit 1 Yes 0 1 1 4 No 7309 1340 2731 8 Blank but applicable 18 4 32 Blank 135 12 70 611 Abdomen-bruit-area 1 See Note 21 1 Yes 0 0 0 0 Blank but applicable 18 4 32 Blank 7444 1353 2802 612 Abdomen-bruit-area 2 2 Yes 0 0 1 0 Blank but applicable 18 4 32 Blank 7444 1353 2801 613 Abdomen-bruit-area 3 3 Yes 0 0 0 0 Blank but applicable 18 4 32 Blank 7444 1353 2802 614 Abdomen-bruit-area 4 4 Yes 0 0 0 0 Blank but applicable 18 4 32 Blank 7444 1353 2802 615 Abdomen-bruit-area 5 5 Yes 0 1 0 0 Blank but applicable 18 4 32 Blank 7444 1352 2802 616 Abdomen-bruit-area 6 6 Yes 0 0 0 0 Blank but applicable 18 4 32 Blank 7444 1353 2802 617 Abdomen-bruit-area 7 7 Yes 0 0 0 0 Blank but applicable 18 4 32 Blank 7444 1353 2802 618 Abdomen-bruit-area 8 8 Yes 0 1 0 0 Blank but applicable 18 4 32 Blank 7444 1352 2802 619 Abdomen-bruit-area 9 9 Yes 0 0 0 0 Blank but applicable 18 4 32 Blank 7444 1353 2802 620 Abdomen-hepatomegaly 1 Yes 13 4 4 4 No 7294 1337 2743 8 Blank but applicable 20 4 17 Blank 135 12 70 621 Abdomen-splenomegaly 1 Yes 1 0 0 4 No 7306 1341 2747 8 Blank but applicable 20 4 17 Blank 135 12 70 622 Abdomen-uterine enlargement See Note 22 1 Yes 72 5 19 4 No 3774 708 1531 8 Blank but applicable 21 1 16 Blank 3595 643 1268 623 Abdomen-tenderness on palpation 1 Yes 108 20 130 4 No 7202 1321 2612 8 Blank but applicable 17 4 22 Blank 135 12 70 624 Abdomen-tenderness on palpation-area 1 See Note 21 1 Yes 19 4 11 0 Blank but applicable 17 4 22 Blank 7426 1349 2801 625 Abdomen-tenderness on palpation-area 2 2 Yes 15 1 17 0 Blank but applicable 17 4 22 Blank 7430 1352 2795 626 Abdomen-tenderness on palpation-area 3 3 Yes 18 2 13 0 Blank but applicable 17 4 22 Blank 7427 1351 2799 627 Abdomen-tenderness on palpation-area 4 4 Yes 12 2 19 0 Blank but applicable 17 4 22 Blank 7433 1351 2793 628 Abdomen-tenderness on palpation-area 5 5 Yes 23 11 34 0 Blank but applicable 17 4 22 Blank 7422 1342 2778 629 Abdomen-tenderness on palpation-area 6 6 Yes 21 3 32 0 Blank but applicable 17 4 22 Blank 7424 1350 2780 630 Abdomen-tenderness on palpation-area 7 7 Yes 33 3 23 0 Blank but applicable 17 4 22 Blank 7412 1350 2789 631 Abdomen-tenderness on palpation-area 8 8 Yes 46 4 29 0 Blank but applicable 17 4 22 Blank 7399 1349 2783 632 Abdomen-tenderness on palpation-area 9 9 Yes 44 2 35 0 Blank but applicable 17 4 22 Blank 7401 1351 2777 633 Abdomen-mass(es) 1 Yes 51 1 3 4 No 7256 1341 2733 8 Blank but applicable 20 3 28 Blank 135 12 70 634 Abdomen-mass(es)-area 1 See Note 21 1 Yes 1 0 0 0 Blank but applicable 20 3 28 Blank 7441 1354 2806 635 Abdomen-mass(es)-area 2 2 Yes 2 0 0 0 Blank but applicable 20 3 28 Blank 7440 1354 2806 636 Abdomen-mass(es)-area 3 3 Yes 1 0 0 0 Blank but applicable 20 3 28 Blank 7441 1354 2806 637 Abdomen-mass(es)-area 4 4 Yes 2 0 0 0 Blank but applicable 20 3 28 Blank 7440 1354 2806 638 Abdomen-mass(es)-area 5 5 Yes 18 1 1 0 Blank but applicable 20 3 28 Blank 7424 1353 2805 639 Abdomen-mass(es)-area 6 6 Yes 2 0 0 0 Blank but applicable 20 3 28 Blank 7440 1354 2806 640 Abdomen-mass(es)-area 7 7 Yes 6 0 0 0 Blank but applicable 20 3 28 Blank 7436 1354 2806 641 Abdomen-mass(es)-area 8 8 Yes 34 0 1 0 Blank but applicable 20 3 28 Blank 7408 1354 2805 642 Abdomen-mass(es)-area 9 9 Yes 3 0 2 0 Blank but applicable 20 3 28 Blank 7439 1354 2804 643 Blank Gallbladder Questions (Positions 644-647) Position Item description Counts Source and code M C P and notes ATTENTION: ONLY THE FASTING GROUP (AGES 20-74 YEARS) WERE ASKED THE QUESTIONS IN POSITIONS 644-647 . 644 During the past year has this examinee had any attacks of nausea and/or vomiting lasting more than 2 hours? 1 Yes 36 29 52 2 No 1349 414 582 8 Blank but applicable 349 3 22 9 Do not know 0 0 5 Blank 5728 911 2173 645 During the past 5 years has this examinee had pain in the gallbladder area which lasted a half hour or more? 1 Yes 77 51 92 2 No 1310 392 541 8 Blank but applicable 347 2 22 9 Do not know 0 1 6 Blank 5728 911 2173 646 Does this examinee usually feel sick to his/her stomach either before or after getting this pain? 1 Yes 34 11 45 2 No 35 30 44 8 Blank but applicable 355 10 25 9 Do not know 0 2 0 Blank 7038 1304 2720 647 What is your opinion of the likelihood See Notes of this examinee having gallstones? 23 1 Definitely, has gallstones 2 1 0 2 Probably has gallstones 11 12 12 3 Probably does not have gallstones 196 227 347 4 Definitely does not have gallstones 710 193 252 5 Unable to form opinion 6 3 19 8 Blank but applicable 76 10 31 Blank 6461 911 2173 Tanner Staging (Positions 648-650; Ages 10-17 Years) Position Item description Counts Source and code M C P and notes 648 Tanner staging-hair 1 Stage 1 355 29 69 2 Stage 2 205 32 83 3 Stage 3 243 18 66 4 Stage 4 229 29 108 5 Stage 5 395 102 275 8 Blank but applicable 34 1 25 Blank 6001 1146 2208 649 Tanner staging-genitalia-males only 1 Stage 1 218 21 42 2 Stage 2 113 20 43 3 Stage 3 105 12 39 4 Stage 4 129 13 49 5 Stage 5 149 50 128 8 Blank but applicable 15 0 12 Blank 6733 1241 2521 650 Tanner staging breasts-females only 1 Stage 1 88 9 19 2 Stage 2 107 11 34 3 Stage 3 149 9 37 4 Stage 4 104 14 59 5 Stage 5 261 50 151 8 Blank but applicable 23 2 13 Blank 6730 1262 2521 651 Blank Extremities (Positions 652-666) Position Item description Counts Source and code M C P and notes 652 Extremities-legs-abduction of hips (Ortolani's maneuver)-ages 6 months- 2 years 1 Abnormal 3 0 0 4 Normal 541 47 131 8 Blank but applicable 21 3 30 Blank 6897 1307 2673 653 Extremities-right leg-femoral pulsations 1 Absent 5 1 30 2 Diminished 58 11 36 4 Normal 7251 1328 2624 8 Blank but applicable 13 5 74 Blank 135 12 70 654 Extremities-right leg-femoral bruit 1 Yes 8 0 2 4 No 7278 1336 2685 8 Blank but applicable 41 9 77 Blank 135 12 70 655 Extremities-left leg-femoral pulsations 1 Absent 6 0 29 2 Diminished 58 11 39 4 Normal 7250 1329 2622 8 Blank but applicable 13 5 74 Blank 135 12 70 656 Extremities-left leg-femoral bruit 1 Yes 9 0 2 4 No 7276 1336 2684 8 Blank but applicable 42 9 78 Blank 135 12 70 657 Extremities-right leg-dorsalis pedis pulsations See Note 24ote 24 1 Absent 179 59 87 2 Diminished 146 18 55 4 Normal 6971 1263 2579 7 Extremity missing or immobilized 7 0 0 8 Blank but applicable 24 5 43 Blank 135 12 70 658 Extremities-left leg-dorsalis pedis pulsation See Note 24 1 Absent 195 56 93 2 Diminished 137 16 50 4 Normal 6956 1267 2574 7 Extremity missing or immobilized 11 0 2 8 Blank but applicable 28 6 45 Blank 135 12 70 659 Extremities-right leg-ulceration 1 Yes 8 1 6 4 No 7283 1335 2718 8 Blank but applicable 36 9 40 Blank 135 12 70 660 Extremities-left leg-ulceration 1 Yes 6 0 2 4 No 7285 1337 2721 8 Blank but applicable 36 8 41 Blank 135 12 70 661 Extremities-right leg-edema 1 Severe 0 0 0 2 Moderate 5 5 6 3 Mild 37 20 30 4 None 7268 1317 2701 8 Blank but applicable 17 3 27 Blank 135 12 70 662 Extremities-left leg-edema 1 Severe 1 0 1 2 Moderate 8 5 8 3 Mild 42 21 32 4 None 7253 1316 2694 8 Blank but applicable 23 3 29 Blank 135 12 70 ATTENTION: THE STRAIGHT LEG-RAISING TEST (POSITIONS 663-666) WAS PERFORMED ON SAMPLE PERSONS AGES 18 YEARS AND OVER. 663 Extremities-right leg-straight leg raising test 1 Abnormal 47 11 53 4 Normal 3694 934 1405 8 Blank but applicable 26 3 12 Blank 3695 409 1364 664 Extremities-left leg-straight leg raising test 1 Abnormal 41 12 53 4 Normal 3698 934 1403 8 Blank but applicable 28 2 14 Blank 3695 409 1364 665 Extremities-right leg-straight leg raising test-pain with ankle dorsiflexion See Note 24 1 Yes 21 5 7 4 No 3671 929 1398 7 Extremity missing or immobilized 7 0 0 8 Blank but applicable 21 3 12 Blank 3742 420 1417 666 Extremities-right leg-straight leg raising test-pain with ankle dorsiflexion See Note 24 1 Yes 20 6 8 4 No 3672 928 1395 7 Extremity missing or immobilized 10 0 2 8 Blank but applicable 24 2 12 Blank 3736 421 1417 667-668 Blank Joints (Positions 669-741; Ages 10 Years And Over) Position Item description Counts Source and code M C P and notes 669 Joints-right hip-tender 1 Yes 14 3 13 8 Blank but applicable 9 1 9 Blank 7439 1353 2812 670 Joints-left hip-tender 1 Yes 16 3 20 8 Blank but applicable 9 1 9 Blank 7437 1353 2805 671 Joints-right hip-swelling 1 Yes 0 0 0 8 Blank but applicable 9 1 9 Blank 7453 1356 2825 672 Joints-left hip-swelling 1 Yes 1 0 1 8 Blank but applicable 9 1 9 Blank 7452 1356 2824 673 Joints-right hip-deformity 1 Yes 0 0 0 8 Blank but applicable 9 1 9 Blank 7453 1356 2825 674 Joints-left hip-deformity 1 Yes 0 2 0 8 Blank but applicable 9 1 9 Blank 7453 1354 2825 675 Joints-right hip-limitation of motion 1 Yes 62 48 56 8 Blank but applicable 9 1 9 Blank 7391 1308 2769 676 Joints-left hip-limitation of motion 1 Yes 65 40 57 8 Blank but applicable 9 1 9 Blank 7388 1316 2768 677 Joints-both hips normal See Note 25 1 Yes 5136 1105 2007 8 Blank but applicable 9 1 9 Blank 2317 251 818 678 Joints-right knee-tender See Note 24 1 Yes 20 4 11 7 Extremity missing or immobilized 5 0 0 8 Blank but applicable 8 1 9 Blank 7429 1352 2814 679 Joints-left knee-tender See Note 24 1 Yes 28 4 14 7 Extremity missing or immobilized 5 0 0 8 Blank but applicable 8 1 9 Blank 7421 1352 2811 680 Joints-right knee-swelling See Note 24 1 Yes 7 1 2 7 Extremity missing or immobilized 5 0 0 8 Blank but applicable 8 1 9 Blank 7442 1355 2823 681 Joints-left knee-swelling See Note 24 1 Yes 10 4 2 7 Extremity missing or immobilized 5 0 0 8 Blank but applicable 8 1 9 Blank 7439 1352 2823 682 Joints-right knee-deformity See Note 24 1 Yes 9 1 2 7 Extremity missing or immobilized 5 0 0 8 Blank but applicable 8 1 9 Blank 7440 1355 2823 683 Joints-left knee-deformity See Note 24 1 Yes 8 1 2 7 Extremity missing or immobilized 5 0 0 8 Blank but applicable 8 1 9 Blank 7441 1355 2823 684 Joints-right knee-limitation of motion See Note 24 1 Yes 21 10 31 7 Extremity missing 5 0 0 8 Blank but applicable 8 1 9 Blank 7428 1346 2794 685 Joints-left knee-limitation of motion See Note 24 1 Yes 31 13 36 7 Extremity missing or immobilized 5 0 0 8 Blank but applicable 8 1 9 Blank 7418 1343 2789 686 Joints-both knees normal See Notes 1 Yes 5160 1136 2038 24,25 7 Both extremities missing or immobilized 1 0 0 8 Blank but applicable 8 1 9 Blank 2293 220 787 687 Joints-right ankle-tender See Note 24 1 Yes 8 2 6 7 Extremity missing or immobilized 7 0 0 8 But applicable 6 1 9 Blank 7441 1354 2819 688 Joints-left ankle-tender See Note 24 1 Yes 11 2 3 7 Extremity missing or immobilized 11 0 2 8 But applicable 6 1 9 Blank 7434 1354 2820 689 Joints-right ankle-swelling See Note 24 1 Yes 9 0 3 7 Extremity missing or immobilized 7 0 0 8 But applicable 6 1 9 Blank 7440 1356 2822 690 Joints-left ankle-swelling See Note 24 1 Yes 12 1 1 7 Extremity missing or immobilized 11 0 2 8 But applicable 6 1 9 Blank 7433 1355 2822 691 Joints-right ankle-deformity See Note 24 1 Yes 12 1 0 7 Extremity missing or immobilized 7 0 0 8 Blank but applicable 6 1 9 Blank 7437 1355 2825 692 Joints-left ankle-deformity See Note 24 1 Yes 12 0 0 7 Extremity missing or immobilized 11 0 2 8 Blank but applicable 6 1 9 Blank 7433 1356 2823 693 Joints-right ankle-limitation of motion See Note 24 1 Yes 12 9 21 7 Extremity missing or immobilized 7 0 0 8 Blank but applicable 6 1 9 Blank 7437 1347 2804 694 Joints-left ankle-limitation of motion See Note 24 1 Yes 20 8 21 7 Extremity missing or immobilized 11 0 2 8 Blank but applicable 6 1 9 Blank 7425 1348 2802 695 Joints-both ankles normal See Notes 1 Yes 5182 1147 2058 24,25 7 Both extremities missing or immobilized 4 0 0 8 Blank but applicable 6 1 9 Blank 2270 209 767 696 Joints-right foot-tender See Note 24 1 Yes 6 0 4 7 Extremity missing or immobilized 7 0 0 8 Blank but applicable 6 1 9 Blank 7443 1356 2821 697 Joints-left foot-tender See Note 24 1 Yes 6 1 3 7 Extremity missing or immobilized 11 0 2 8 Blank but applicable 6 1 9 Blank 7439 1355 2820 698 Joints-right foot-swelling See Note 24 1 Yes 2 0 1 7 Extremity missing or immobilized 7 0 0 8 Blank but applicable 6 1 9 Blank 7447 1356 2824 699 Joints-left foot-swelling See Note 24 1 Yes 5 1 0 7 Extremity missing or immobilized 11 0 2 8 Blank but applicable 6 1 9 Blank 7440 1355 2823 700 Joints-right foot-deformity See Note 24 1 Yes 8 1 1 7 Extremity missing or immobilized 7 0 0 8 Blank but applicable 6 1 9 Blank 7441 1355 2824 701 Joints-left foot-deformity See Note 24 1 Yes 10 1 1 7 Extremity missing or immobilized 11 0 2 8 Blank but applicable 6 1 9 Blank 7435 1355 2822 702 Joints-right foot-limitation of motion See Note 24 1 Yes 8 9 20 7 Extremity missing or immobilized 7 0 0 8 Blank but applicable 6 1 9 Blank 7441 1347 2805 703 Joints-left foot-limitation of motion See Note 24 1 Yes 13 8 21 7 Extremity missing or immobilized 11 0 2 8 Blank but applicable 6 1 9 Blank 7432 1348 2802 704 Joints-both feet normal See Notes 1 Yes 5197 1145 2059 24,25 7 Both extremities missing or immobilized 4 0 0 8 Blank but applicable 6 1 9 Blank 2255 211 766 705 Joints-right shoulder-tender See Note 24 1 Yes 34 5 7 7 Extremity missing or immobilized 0 0 1 8 Blank but applicable 5 1 8 Blank 7423 1351 2818 706 Joints-left shoulder-tender 1 Yes 22 3 5 8 Blank but applicable 5 1 8 Blank 7435 1353 2821 707 Joints-right shoulder-swelling See Note 24 1 Yes 1 1 1 7 Extremity missing or immobilized 0 0 1 8 Blank but applicable 5 1 8 Blank 7456 1355 2824 708 Joints-left shoulder-swelling 1 Yes 1 0 0 8 Blank but applicable 5 1 8 Blank 7456 1356 2826 709 Joints-right shoulder-deformity See Note 24 1 Yes 3 0 1 7 Extremity missing or immobilized 0 0 1 8 Blank but applicable 5 1 8 Blank 7454 1356 2824 710 Joints-left shoulder-deformity 1 Yes 2 1 0 8 Blank but applicable 5 1 8 Blank 7455 1355 2826 711 Joints-right shoulder-limitation of motion See Note 24 1 Yes 33 19 34 7 Extremity missing or immobilized 0 0 1 8 Blank but applicable 5 1 8 Blank 7424 1337 2791 712 Joints-left shoulder-limitation of motion 1 Yes 23 17 36 8 Blank but applicable 5 1 8 Blank 7434 1339 2790 713 Joints-both shoulders normal See Note 25 1 Yes 5161 1133 2037 8 Blank but applicable 5 1 8 Blank 2296 223 789 714 Joint-right elbow-tender See Note 24 1 Yes 5 2 3 7 Extremity missing or immobilized 2 0 1 8 Blank but applicable 5 1 7 Blank 7450 1354 2823 715 Joint-left elbow-tender See Note 24 1 Yes 4 3 2 7 Extremity missing or immobilized 1 0 0 8 Blank but applicable 5 1 7 Blank 7452 1353 2825 716 Joint-right elbow-swelling See Note 24 1 Yes 4 0 1 7 Extremity missing or immobilized 2 0 1 8 Blank but applicable 5 1 7 Blank 7451 1356 2825 717 Joint-left elbow-swelling See Note 24 1 Yes 3 0 2 7 Extremity missing or immobilized 1 0 0 8 Blank but applicable 5 1 7 Blank 7453 1356 2825 718 Joint-right elbow-deformity See Note 24 1 Yes 7 0 4 7 Extremity missing or immobilized 2 0 1 8 Blank but applicable 5 1 7 Blank 7448 1356 2822 719 Joint-left elbow-deformity See Note 24 1 Yes 10 0 5 7 Extremity missing or immobilized 1 0 0 8 Blank but applicable 5 1 7 Blank 7446 1356 2822 720 Joints-right elbow-limitation of motion See Note 24 1 Yes 12 10 27 7 Extremity missing or immobilized 2 0 1 8 Blank but applicable 5 1 7 Blank 7443 1346 2799 721 Joints-left elbow-limitation of motion See Note 24 1 Yes 12 8 24 7 Extremity missing or immobilized 1 0 0 8 Blank but applicable 5 1 7 Blank 7444 1348 2803 722 Joints-both elbows normal See Notes 25 1 Yes 5194 1144 2052 8 Blank but applicable 5 1 7 Blank 2263 212 775 723 Joints-right wrist-tender See Note 24 1 Yes 7 1 3 7 Extremity missing or immobilized 2 0 1 8 Blank but applicable 5 1 8 Blank 7448 1355 2822 724 Joints-left wrist-tender See Note 24 1 Yes 5 1 3 7 Extremity missing or immobilized 1 0 0 8 Blank but applicable 5 1 8 Blank 7451 1355 2823 725 Joints-right wrist-swelling See Note 24 1 Yes 3 0 2 7 Extremity missing or immobilized 2 0 1 8 Blank but applicable 5 1 8 Blank 7452 1356 2823 726 Joints-left wrist-swelling See Note 24 1 Yes 4 0 2 7 Extremity missing or immobilized 1 0 0 8 Blank but applicable 5 1 8 Blank 7452 1356 2824 727 Joints-right wrist-deformity See Note 24 1 Yes 11 0 1 7 Extremity missing or immobilized 2 0 1 8 Blank but applicable 5 1 8 Blank 7444 1356 2824 728 Joints-left wrist-deformity See Note 24 1 Yes 13 1 1 7 Extremity missing or immobilized 1 0 0 8 Blank but applicable 5 1 8 Blank 7443 1355 2825 729 Joints-right wrist-limitation of motion See Note 24 1 Yes 11 2 14 7 Extremity missing or immobilized 2 0 1 8 Blank but applicable 5 1 8 Blank 7444 1354 2811 730 Joints-left wrist-limitation of motion See Note 24 1 Yes 14 2 13 7 Extremity missing or immobilized 1 0 0 8 Blank but applicable 5 1 8 Blank 7442 1354 2813 731 Joints-both wrists normal See Notes 1 Yes 5196 1154 2067 24,25 7 Both extremities missing or immobilized 0 0 8 8 Blank but applicable 5 1 0 Blank 2261 202 759 732 Joints-right hand-tender See Note 24 1 Yes 8 2 4 7 Extremity missing or immobilized 2 0 1 8 Blank but applicable 6 1 7 Blank 7446 1354 2822 733 Joints-left hand-tender See Note 24 1 Yes 9 3 4 7 Extremity missing or immobilized 1 0 0 8 Blank but applicable 6 1 7 Blank 7446 1353 2823 734 Joints-right hand-swelling See Note 24 1 Yes 6 6 2 7 Extremity missing or immobilized 2 0 1 8 Blank but applicable 6 1 7 Blank 7448 1350 2824 735 Joints-left hand-swelling See Note 24 1 Yes 8 7 2 7 Extremity missing or immobilized 1 0 0 8 Blank but applicable 6 1 7 Blank 7447 1349 2825 736 Joints-right hand-deformity See Note 24 1 Yes 25 5 14 7 Extremity missing or immobilized 2 0 1 8 Blank but applicable 6 1 7 Blank 7429 1351 2812 737 Joints-left hand-deformity See Note 24 1 Yes 27 6 14 7 Extremity missing or immobilized 1 0 0 8 Blank but applicable 6 1 7 Blank 7428 1350 2813 738 Joints-right hand-limitation of motion See Note 24 1 Yes 13 2 11 7 Extremity missing or immobilized 2 0 1 8 Blank but applicable 6 1 7 Blank 7441 1354 2815 739 Joints-left hand-limitation of motion See Note 24 1 Yes 18 2 12 7 Extremity missing or immobilized 1 0 0 8 Blank but applicable 6 1 7 Blank 7437 1354 2815 740 Joints-both hands normal See Note 25 1 Yes 5175 1143 2058 8 Blank but applicable 6 1 7 Blank 2281 213 769 741 Joints-epiphysial enlargement (ages 6 months-17 years) 1 Yes 467 0 1 4 No 3031 350 1219 8 Blank but applicable 62 47 74 Blank 3902 960 1540 742 Blank Neurological Evaluation (Positions 743-756) Position Item description Counts Source and code M C P and notes ATTENTION: THE COORDINATION AND SENSORY EXAMS (POSITIONS 743-748) WERE PERFORMED ON SAMPLE PERSONS AGES 5 YEARS AND OVER. 743 Neurologic-coordination-pronation/supination of right hand See Note 24 1 Abnormal 2 4 6 4 Normal 6295 1252 2436 7 Extremity missing or immobilized 2 0 1 8 Blank but applicable 14 1 6 Blank 1139 100 385 744 Neurologic-coordination-pronation/supination of left hand See Note 24 1 Abnormal 12 2 8 4 Normal 6295 1254 2434 7 Extremity missing or immobilized 1 0 0 8 Blank but applicable 15 1 7 Blank 1139 100 385 745 Neurologic-vibratory sensation-right arm 1 Abnormal 15 3 3 4 Normal 6286 1254 2438 8 Blank but applicable 22 0 8 Blank 1139 100 385 746 Neurologic-vibratory sensation-left arm 1 Abnormal 9 2 3 4 Normal 6292 1255 2438 8 Blank but applicable 22 0 8 Blank 1139 100 385 747 Neurologic-vibratory sensation-right leg 1 Abnormal 26 5 10 4 Normal 6275 1252 2431 8 Blank but applicable 22 0 8 Blank 1139 100 385 748 Neurologic-vibratory sensation-left leg 1 Abnormal 26 12 12 4 Normal 6273 1245 2427 8 Blank but applicable 24 0 10 Blank 1139 100 385 749 Neurologic-muscle weakness 1 Yes 39 9 22 4 No 7269 1320 2729 8 Blank but applicable 19 16 13 Blank 135 12 70 750 Neurologic-muscles-right arm paralysis 1 Yes 6 0 0 4 No 7307 1329 2751 8 Blank but applicable 14 16 13 Blank 135 12 70 751 Neurologic-muscles-left arm paralysis 1 Yes 6 0 0 4 No 7307 1329 2751 8 Blank but applicable 14 16 13 Blank 135 12 70 752 Neurologic-muscles-right leg paralysis 1 Yes 7 1 3 4 No 7297 1328 2749 8 Blank but applicable 23 16 12 Blank 135 12 70 753 Neurologic-muscles-left leg paralysis 1 Yes 10 1 3 4 No 7293 1328 2747 8 Blank but applicable 24 16 14 Blank 135 12 70 754 Neurologic-speech-stuttering (ages 5 years and over) 1 Yes 11 0 2 4 No 6290 1257 2440 8 Blank but applicable 22 0 7 Blank 1139 100 385 755 Blank 7462 1357 2834 756 Neurologic-knee jerk See Note 24 1 Absent 192 27 88 4 Present 7091 1298 2656 7 Both extremities missing or immobilized 1 0 0 8 Blank but applicable 43 20 20 Blank 135 12 70 757-758 Blank Skin Evaluation (Positions 759-776) Position Item description Counts Source and code M C P and notes 759 Skin-follicular hyperkeratosis-arms 1 Yes 3 4 1 4 No 7319 1339 2754 8 Blank but applicable 5 2 9 Blank 135 12 70 760 Skin-follicular hyperkeratosis-back 1 Yes 3 6 1 4 No 7319 1337 2754 8 Blank but applicable 5 2 9 Blank 135 12 70 761 Skin-hyperpigmentation, hands and face 1 Yes 14 8 5 4 No 7308 1335 2750 8 Blank but applicable 5 2 9 Blank 135 12 70 762 Skin-dry or scaling 1 Yes 75 16 7 4 No 7248 1327 2748 8 Blank but applicable 4 2 9 Blank 135 12 70 763 Skin-perifolliculitis 1 Yes 8 1 1 4 No 7315 1342 2754 8 Blank but applicable 4 2 9 Blank 135 12 70 764 Skin-petechiae 1 Yes 9 3 9 4 No 7314 1340 2745 8 Blank but applicable 4 2 10 Blank 135 12 70 765 Blank 766 Skin-mosaic 1 Yes 3 6 5 4 No 7320 1337 2750 8 Blank but applicable 4 2 9 Blank 135 12 70 767 Skin-pellagrous dermatitis 1 Yes 0 0 1 4 No 7323 1343 2754 8 Blank but applicable 4 2 9 Blank 135 12 70 768 Skin-ecchymoses 1 Yes 6 7 11 4 No 7317 1336 2744 8 Blank but applicable 4 2 9 Blank 135 12 70 769 Blank 770 Skin-spider angioma 1 Yes 12 5 7 4 No 7311 1338 2748 8 Blank but applicable 4 2 9 Blank 135 12 70 771 Skin-eczema 1 Yes 60 8 24 4 No 7263 1335 2731 8 Blank but applicable 4 2 9 Blank 135 12 70 772 Skin-inflammation 1 Yes 14 1 12 4 No 7309 1342 2743 8 Blank but applicable 4 2 9 Blank 135 12 70 773 Skin-impetigo 1 Yes 3 1 2 4 No 7320 1342 2753 8 Blank but applicable 4 2 9 Blank 135 12 70 774 Skin-scars 1 Yes 28 12 32 4 No 7295 1331 2723 8 Blank but applicable 4 2 9 Blank 135 12 70 775 Skin-urticaria 1 Yes 7 2 1 4 No 7315 1341 2753 8 Blank but applicable 5 2 10 Blank 135 12 70 776 Skin-infestation 1 Yes 7 1 16 4 No 7312 1342 2739 8 Blank but applicable 8 2 9 Blank 135 12 70 777 Blank Pulse (Positions 778-781; All Ages) Position Item description Counts Source and code M C P and notes 778-780 Pulse-rate (beats per minute) 040-192 7262 1329 2729 888 Blank but applicable 65 16 35 Blank 135 12 70 781 Pulse-regularity 1 Irregular 29 9 16 2 Regular 7171 1280 2672 8 Blank but applicable 127 56 76 Blank 135 12 70 Blood Pressure Reading (Positions 782-788; Ages 6 Years And Over Position Item description Counts Source and code M C P and notes 782 Blood pressure-cuff width 1 Infant 25 5 5 2 Child 1651 167 510 3 Adult 3859 936 1587 4 Large arm 539 134 271 5 Thigh 7 2 6 8 Blank but applicable 21 2 12 Blank 1360 111 443 783-785 Blood pressure-systolic See Note 18 070-246 6084 1240 2382 888 Blank but applicable 18 6 9 Blank 1360 111 443 786-788 Blood pressure-diastolic See Note 18 000-138 6084 1240 2380 888 Blank but applicable 18 6 11 Blank 1360 111 443 789 Blank Back (Positions 790-805; Ages 5 Years And Over) Position Item description Counts Source and code M C P and notes 790 Back-scoliosis 1 Yes 301 85 170 4 No 6012 1172 2269 8 Blank but applicable 10 0 10 Blank 1139 100 385 791 Back-kyphosis 1 Yes 201 22 21 4 No 6113 1234 2417 8 Blank but applicable 9 1 11 Blank 1139 100 385 792 Back-lordosis 1 Yes 166 3 12 4 No 6142 1252 2425 8 Blank but applicable 15 2 12 Blank 1139 100 385 793 Back-right sciatic notch tenderness 1 Yes 32 8 59 4 No 6274 1248 2377 8 Blank but applicable 17 1 13 Blank 1139 100 385 794 Back-left sciatic notch tenderness 1 Yes 28 8 55 4 No 6278 1248 2381 8 Blank but applicable 17 1 13 Blank 1139 100 385 795 Back-right sacroiliac tenderness 1 Yes 72 10 75 4 No 6235 1246 2364 8 Blank but applicable 16 1 10 Blank 1139 100 385 796 Back-left sacroiliac tenderness 1 Yes 64 10 68 4 No 6243 1246 2371 8 Blank but applicable 16 1 10 Blank 1139 100 385 797 Blank 798 Back-lumbar spine limitation of motion-flexion 1 Yes 92 31 88 4 No 6206 1224 2341 8 Blank but applicable 25 2 20 Blank 1139 100 385 799 Back-lumbar spine limitation of motion-extension 1 Yes 94 39 111 4 No 6204 1215 2319 8 Blank but applicable 25 3 19 Blank 1139 100 385 800 Back-lumbar spine limitation of motion-right lateral bending 1 Yes 79 26 79 4 No 6217 1229 2353 8 Blank but applicable 27 2 17 Blank 1139 100 385 801 Back-lumbar spine limitation of motion-left lateral bending 1 Yes 74 26 80 4 No 6222 1229 2352 8 Blank but applicable 27 2 17 Blank 1139 100 385 802 Back-lumbar spine limitation of motion-right rotation 1 Yes 130 29 69 4 No 6166 1226 2363 8 Blank but applicable 27 2 17 Blank 1139 100 385 803 Back-lumbar spine limitation of motion-left rotation 1 Yes 127 28 69 4 No 6169 1227 2363 8 Blank but applicable 27 2 17 Blank 1139 100 385 804 Back-cervical spine limitation-flexion 1 Yes 8 8 6 4 No 6303 1249 2432 8 Blank but applicable 12 0 11 Blank 1139 100 385 805 Back-cervical spine limitation-extension 1 Yes 14 10 12 4 No 6296 1247 2426 8 Blank but applicable 13 0 11 Blank 1139 100 385 Gait (Positions 806-808) Position Item description Counts Source and code M C P and notes 806 Gait-simple walking (ages 3 years and over) 1 Abnormal 194 21 27 4 Normal 6555 1273 2565 8 Blank but applicable 13 1 11 Blank 700 62 231 807 Gait-bowed legs 1 Yes 47 13 11 4 No 7252 1325 2737 7 Extremity missing or immobilized 10 0 0 8 Blank but applicable 18 7 16 Blank 135 12 70 808 Gait-knock knees 1 Yes 44 0 5 4 No 7251 1338 2741 7 Extremity missing or immobilized 10 0 0 8 Blank but applicable 22 7 18 Blank 135 12 70 Varicose Veins (Positions 809-810) Position Item description Counts Source and code M C P and notes 809 Varicose veins-right leg 1 Severe 24 2 2 2 Moderate 107 13 24 3 Mild 464 77 104 4 Normal 6711 1247 2619 8 Blank but applicable 21 6 15 Blank 135 12 70 810 Varicose veins-left leg 1 Severe 36 1 2 2 Moderate 115 13 32 3 Mild 454 79 88 4 Normal 6700 1246 2625 8 Blank but applicable 22 6 17 Blank 135 12 70 811 Blank Health Status (Positions 812-814) Position Item description Counts Source and code M C P and notes 812 Health status-physician's assessment of sample person's health 1 Excellent 4916 648 809 2 Very good 1687 379 1205 3 Good 538 270 579 4 Fair 158 45 145 5 Poor 21 1 15 8 Blank but applicable 7 2 11 Blank 135 12 70 813 Health status-nutritional status See Note 23 1 Normal 4136 1328 2737 2 Abnormal 23 14 12 8 Blank but applicable 7 3 15 Blank 3296 12 70 814 Health status-weight status See Note 23 1 Obesity 866 270 649 2 Normal weight 3204 1046 2051 3 Underweight 92 25 49 8 Blank but applicable 4 4 15 Blank 3296 12 70 Diagnostic Impressions (Positions 815-855) Position Item description Counts Source and code M C P and notes ATTENTION: A MINUS SIGN WAS PLACED IN THE FOURTH POSITION WHEN ONLY 3 DIGITS WERE USED IN THE ICD CODING. 815 DIAGNOSTIC IMPRESSIONS (POSITIONS 815-855) See Appendix 1 None 6312 1103 2266 1.26 8 Blank but applicable 3 0 2 Blank Yes or physician's exam form blank 1147 254 566 816-819 Diagnostic impression-ICD Code See Appendix 0109-9593 1012 242 496 1.26 8888 Blank but applicable 3 0 2 See Note 26 Blank 6447 1115 2336 820 Diagnostic impression-basis for judgment 1 History 265 86 233 2 Physician's exam 234 43 59 3 Both 496 112 201 8 Blank but applicable 20 1 5 Blank 6447 1115 2336 821 Diagnostic impression-confidence in assessment 1 Certain 814 158 337 2 Likely 141 78 120 3 Uncertain 42 5 36 8 Blank but applicable 18 1 5 Blank 6447 1115 2336 822 Diagnostic impression-severity of condition 1 Mild 627 172 283 2 Moderate 333 59 178 3 Severe 38 10 31 8 Blank but applicable 17 1 6 Blank 6447 1115 2336 823 Diagnostic impression-Has a physician been consulted regarding this condition within the last year? 1 Yes 681 187 392 2 No 313 53 50 3 Don't know 4 0 52 8 Blank but applicable 17 2 4 Blank 6447 1115 2336 824-827 Diagnostic impression-ICD Code See Appendix 0119-9599 252 51 144 1.26 V451 Renal Dialysis Status 0 0 1 See Note 26 8888 Blank but applicable 3 0 2 Blank 7207 1306 2687 828 Diagnostic impression-basis for judgment 1 History 74 11 64 2 Physician's exam 55 12 16 3 Both 119 28 65 8 Blank but applicable 7 0 3 Blank 7207 1306 2686 829 Diagnostic impression-confidence in assessment 1 Certain 185 41 101 2 Likely 51 10 34 3 Uncertain 10 0 10 8 Blank but applicable 9 0 3 Blank 7207 1306 2686 830 Diagnostic impression-severity of condition 1 Mild 148 35 87 2 Moderate 85 10 50 3 Severe 15 6 8 8 Blank but applicable 7 0 3 Blank 7207 1306 2686 831 Diagnostic impression-Has a physician been consulted regarding this condition within the last year? 1 Yes 189 44 121 2 No 58 7 11 3 Don't know 1 0 13 8 Blank but applicable 7 0 3 Blank 7207 1306 2686 832-835 Diagnostic impression-ICD Code See Appendix 0119-9289 75 12 42 1.26 8888 Blank but applicable 3 0 2 See Note 26 Blank 7384 1345 2790 836 Diagnostic impression-basis for judgment 1 History 18 3 22 2 Physician's exam 20 4 3 3 Both 36 5 16 8 Blank but applicable 4 0 3 Blank 7384 1345 2790 837 Diagnostic impression-confidence in assessment 1 Certain 54 8 27 2 Likely 17 3 10 3 Uncertain 3 1 4 8 Blank but applicable 4 0 3 Blank 7384 1345 2790 838 Diagnostic impression-severity of condition 1 Mild 45 9 26 2 Moderate 27 3 14 3 Severe 2 0 1 8 Blank but applicable 4 0 3 Blank 7384 1345 2790 839 Diagnostic impression-Has a physician been consulted regarding this condition within the last year? 1 Yes 58 10 34 2 No 16 2 5 3 Don't know 0 0 3 8 Blank but applicable 4 0 2 Blank 7384 1345 2790 840-843 Diagnostic impression-ICD Code See Appendix 0119-7850 20 3 14 1.26 8888 Blank but applicable 3 0 2 See Note 26 Blank 7439 1354 2818 844 Diagnostic impression-basis for judgment 1 History 4 0 5 2 Physician's exam 4 1 1 3 Both 12 2 8 8 Blank but applicable 3 0 2 Blank 7439 1354 2818 845 Diagnostic impression-confidence in assessment 1 Certain 13 3 10 2 Likely 6 0 4 3 Uncertain 1 0 0 8 Blank but applicable 3 0 2 Blank 7439 1354 2818 846 Diagnostic impression-severity of condition 1 Mild 10 2 6 2 Moderate 10 1 8 3 Severe 0 0 0 8 Blank but applicable 3 0 2 Blank 7439 1354 2818 847 Diagnostic impression-Has a physician been consulted regarding this condition within the last year? 1 Yes 14 2 13 2 No 6 1 0 3 Don't know 0 0 1 8 Blank but applicable 3 0 2 Blank 7439 1354 2818 848-851 Diagnostic impression-ICD Code See Appendix 0160-6929 4 1 3 1.26 8888 Blank but applicable 3 0 2 See Note 26 Blank 7455 1356 2829 852 Diagnostic impression-basis for judgment 1 History 1 1 1 2 Physician's exam 0 0 1 3 Both 3 0 1 8 Blank but applicable 3 0 2 Blank 7455 1356 2829 853 Diagnostic impression-confidence in assessment 1 Certain 4 1 3 2 Likely 0 0 0 3 Uncertain 0 0 0 8 Blank but applicable 3 0 2 Blank 7455 1356 2829 854 Diagnostic impression-severity of condition 1 Mild 3 0 1 2 Moderate 1 1 1 3 Severe 0 0 1 8 Blank but applicable 3 0 2 Blank 7455 1356 2829 855 Diagnostic impression-Has a physician been consulted regarding this condition within the last year? 1 Yes 4 1 3 2 No 0 0 0 3 Don't know 0 0 0 8 Blank but applicable 3 0 2 Blank 7455 1356 2829 856 LEVEL OF REFERRAL See Appendix 1 Level I 2 0 0 1.27 2 Level II 259 55 98 3 Level III 7066 1290 2666 Blank 135 12 70 857-860 Blank GENERAL NOTES, SOCIODEMOGRAPHIC AND PHYSICAL EXAM DATA Family Questionnaire Missing A Family Questionnaire was to be completed for each eligible family in a household with sample persons. However, a few Family Questionnaires are missing. Data records for sample persons in families with missing questionnaires are flagged with a code = 1, and all family data are blank. Data records for sample persons in families with a Family Questionnaire are flagged with a code = 2. During the Mexican-American portion of the HHANES survey, a Family Questionnaire continuation booklet containing sample person information was lost for one sample person. Therefore, the sociodemographic data for this sample person are missing. The reference person, family composition, income, residence, and household data for this person were obtained from another person in the household. Examination Status Not all sample persons consented to come to a Mobile Examination Center to participate in the examination phase of the survey. In certain rare instances (less than 0.1%), sample persons who came to the Mobile Examination Centers did not participate in sufficient components of the examination to be considered as "examined." This data field contains code = 1 for those persons who participated fully in the examination phase, and code = 2 for those who did not come to the examination center or who did not satisfactorily complete the examination. Family Number In HHANES, all household members who were related by blood, marriage, or adoption were considered to be one "family." All sample persons in the same family unit have the same computer-generated family unit code. Head of Family Relationship of Sample Person to Head of Family (Pos. 44-45) Each family containing sample persons has a designated "head of family," and the relationship of each sample person to the head of his or her family is coded in tape positions 44-45. The first three categories of this variable describe the "head" of three different kinds of families. * Code '01' identifies sample persons who lived alone (i.e., "head" of one-person families, no unrelated individuals living in the household). * Code '02' identifies sample persons who lived only with unrelated persons. * Code '03' identifies sample persons who were "heads" of families containing at least one other person (whether or not the household included additional families unrelated to the sample person). Sociodemographic Data (Pos. 100-131) This data tape includes some sociodemographic data about the head of each sample person's family (Section F). Because there can only be one "head" per family, the data in this section (positions 100-131) are the same for all sample persons in the same family (i.e., with the same family number codes in positions 39-43). If the sample person is the head of his or her family, the data in positions 100-131 are the same as in the corresponding positions in Section E. Observed Race "Race" was observed by the interviewer for all sample persons actually seen. Rules for classification of observed race were consistent with those used in the NHANES II and the National Health Interview Survey at that time. The categories were coded as follows: White Includes Spanish origin persons unless they are definitely Black, Indian or other nonwhite. Black Black or Negro. Other Race other than White or Black, including Japanese, Chinese, American Indian, Korean, Eskimo. National Origin or Ancestry The value for national origin or ancestry is based on Item 2c in the Household Screener Questionnaire and was reported by the household respondent for all household members. In the Mexican-American portion of the survey, if "other Latin-American or other Spanish" (code 9) or "Other" (code 0) was recorded and the specified origin was "Spanish-American" or "Spanish (Spain)", a code of 10 or 11, respectively, was assigned. In all three portions of the survey, if more than one category was reported, the first appropriate "Hispanic" code, if any, was assigned (codes 1, 2, 3, 8, 10, or 11 in the Mexican-American portion; codes 6 or 7 in the Cuban-American portion; codes 4 or 5 in the Puerto Rican portion). If none of these codes was recorded, the first category entered was coded. Codes for States and Foreign Countries Code State or Foreign Country 001 Alabama 002 Alaska 004 Arizona 005 Arkansas 006 California 008 Colorado 009 Connecticut 010 Delaware 011 District of Columbia 012 Florida 013 Georgia 015 Hawaii 016 Idaho 017 Illinois 018 Indiana 019 Iowa 020 Kansas 021 Kentucky 022 Louisiana 023 Maine 024 Maryland 025 Massachusetts 026 Michigan 027 Minnesota 028 Mississippi 029 Missouri 030 Montana 031 Nebraska 032 Nevada 033 New Hampshire 034 New Jersey 035 New Mexico 036 New York 037 North Carolina 038 North Dakota 039 Ohio 040 Oklahoma 041 Oregon 042 Pennsylvania 044 Rhode Island 045 South Carolina 046 South Dakota 047 Tennessee 048 Texas 049 Utah 050 Vermont 051 Virginia 053 Washington 054 West Virginia 055 Wisconsin 056 Wyoming 060 American Samoa 093 Canada 061 Canal Zone 062 Canton and Enderbury Islands 091 Central America 095 Costa Rica 063 Cuba 064 Dominican Republic 065 El Salvador 062 Enderbury Islands 087 Germany 066 Guam 068 Guatemala 069 Haiti 088 Honduras 070 Jamaica 090 Japan 067 Johnston Atoll 080 Mexico 071 Midway Islands 081 Nicaragua 096 Palestine 097 Austria 098 Lebanon 099 Chile 100 Philippines 101 Brazil 102 Holland 103 Colombia 082 Panama 072 Puerto Rico 092 Saudi Arabia 083 Spain 094 Taiwan 089 Turkey 084 Uruguay 085 Venezuela 073 Ryukyu Islands, Southern 074 Swan Islands 075 Trust Territories of the Pacific Islands (includes Caroline, Mariana and Marshall Island groups) 076 U.S. miscellaneous Caribbean Islands (includes Navassa Islands, Quito Sueno Bank, Roncador Cay, Serrana Bank and Serranilla Bank) 077 U.S. miscellaneous Pacific Islands (includes Kingman Reef, Howland, Baker & Jarvis Islands, and Palmyra Atoll) 086 United States 078 Virgin Islands 079 Wake Island 104 Azores 105 Peru 106 England 107 Vietnam 108 Italy 109 Ecuador 110 North America 111 Surinam 112 Argentina 113 Portugal 114 Trinidad 115 Egypt 116 Sudan 117 British Honduras 118 China 888 Blank but applicable National Origin Recode In the HHANES, if any household member was identified as "Hispanic" (as defined below), all household members, regardless of origin, were eligible to be selected as sample persons. The national origin recode specifies whether a sample person is considered to be "Hispanic" or "not Hispanic" for purposes of analysis. "Hispanic" is defined as: Mexican-American, residing in selected counties of Texas, Colorado, New Mexico, Arizona, and California; Cuban-American, residing in Dade County (Miami), Florida; or Puerto Rican, residing in the New York City area, including parts of New Jersey and Connecticut The recode was assigned as follows: A. Southwest portion 1) If the original national origin or ancestry code on the Household Screener Questionnaire was 1, 2, 3, 8, 10, or 11, then National origin recode = 1; 2) If national origin or ancestry was 4, 5, 6, 7, 9, or 0 but the person specified Mexican/Mexicano, Chicano, or Mexican-American self-identification on the Adult Sample Person Questionnaire (question M10), or the person was the biological child of a household member with Recode equal to 1 (as determined by questions A-1/A-11 on the Family Questionnaire), then National origin recode = 1; 3) In all other cases, National origin recode = 2. B. Dade County, Florida portion 1) If the original national origin or ancestry code was 6 or 7, then National origin recode = 1; 2) In all other cases, National origin recode = 2. C. New York City area portion 1) If the original national origin or ancestry code was 4 or 5, then National origin recode = 1. 2) If national origin or ancestry was 1, 2, 3, 6, 7, 8, 9, or 0 but the person specified Boricuan or Puerto Rican self-identification on the Adult Sample Person Questionnaire (question M10), or the person was the biological child of a household member with Recode equal to 1 (as determined by questions A-1/A-11 on the Family Questionnaire), then National origin recode = 1. 3) In all other cases, National origin recode = 2. The national origin recode may be used in analysis in one of two ways: a. Selecting on Recode = 1 will restrict analysis to "Hispanics" only. In this case, in the Southwest portion of the survey, the weighted estimates by age and sex will approximately equal U.S. Bureau of Census population estimates of the number of Mexican Americans and a small proportion of other Hispanics assumed to be Hispano in the five Southwest States (Arizona, California, Colorado, New Mexico, and Texas) at the midpoint of the Mexican-American portion of HHANES - March 1983. The weighted estimates of Cuban Americans represents an independent estimate of the number of Cuban Americans in Dade County at the midpoint, February 1984. The weighted estimates of Puerto Ricans represents an independent estimate of the number of Puerto Ricans in the sample counties in New York, New Jersey, and Connecticut at the midpoint of the Puerto Rican portion - September 1984. b. Using Recode greater than 0, that is, all sample persons, will include "Hispanic" and "not Hispanic" persons and the Southwest weighted estimates by age and sex will overestimate the U.S. Bureau of the Census population estimates of Mexican Americans and other Hispanics by about 4.5 percent. In Dade County, using recode greater than 0 will increase the weighted estimates by about 5.3 percent over that for Cuban Americans only, using recode greater than 0 for the New York area will increase the weighted estimates by about 9.2 percent over that for Puerto Ricans only. Industry and Occupation Code Family Questionnaire questions B-12 through B-15 (see page 117 or 139 of Ref. No 1 in Section C) identified sample persons 17 years old or older who were in the labor force working for pay at a job or business or who worked without pay in a family business or farm operated by a related member of the household without receiving wages or salary for work performed. Questions B-17 through B-22 provided a full description of sample persons' current or most recent job or business. The detail asked for in these questions was necessary to properly and accurately code each occupation and industry. Interviewers were trained to define a job as a definite arrangement for regular work for pay every week or every month. This included arrangements for either regular or part-time or regular full-time work. If a sample person was absent from his or her regular job, worked at more than one job, was on layoff from a job or was looking for work during the two week reference period, interviewers were trained to use the following criteria to determine the job described: a. If a sample person worked at more than one job during the two week reference period or operated a farm or business and also worked for someone else, the job at which he or she worked the most hours was described. If the sample person worked the same number of hours at all jobs, the job at which he or she had been employed the longest was entered. If the sample person was employed at all jobs the same length of time, the job the sample person considered the main job was entered. b. If a sample person was absent from his or her regular job all of the two week reference period, but worked temporarily at another job, the job at which the sample person actually worked was described, not the job from which he or she was absent. c. If a sample person had a job but did not work at all during the two week reference period, the job he or she held was described. d. If a sample person was on layoff during the two week reference period, the job from which he or she was laid off, regardless of whether a full-time or part-time job, was described. e. If a sample person was looking for work or waiting to begin a new job within 30 days of the interview, the last full-time civilian job which lasted two consecutive weeks or more was described. The 1980 census of population Alphabetical Index of Industries and Occupations was used in the coding of both industry and occupation. This book has Library of Congress Number 80-18360, and is for sale by the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402 for $3.00. Its Stock Number is 003024049-2. Health Insurance a. In the Health Insurance section of the Family Questionnaire, up to three separate health insurance plans could be reported for a family. Each sample person could have been covered by any combination of the three, or by none at all. In order to simplify the health insurance coverage data, the information on all reported plans was combined to a single variable for each sample person, i.e., whether or not the person is covered by any plan (position 74). For all persons covered by at least one plan, information on the type of coverage is then indicated: position 75 specifies whether any of the sample person's plans pays hospital expenses and position 76 specifies whether any of the sample person's plans pays doctor's or surgeon's bills. b. For all sample persons who were not covered by Medicare or any health insurance plan, the reasons for not being covered were ascertained. Positions 77-78 contain the main or only reason reported. For persons with one or more additional reasons, the first (lowest) code entered on the questionnaire was coded in positions 79-80. Per Capita Income Per capita income was computed by dividing the total combined family income by the number of people in the family. Poverty Index The poverty index is a ratio of two components. The numerator is the midpoint of the income bracket reported for each family in the Family Questionnaire (E-11). Respondents were asked to report total combined family income during the 12 months preceding the interview. The denominator is a poverty threshold which varied with the number of persons in the family, the adult/child composition of the family, the age of the reference person, and the month and the year in which the family was interviewed. Poverty thresholds published in Bureau of the Census reports* are based on calendar years and were adjusted to reflect differences caused by inflation between calendar years and 12 month income reference periods to which question E-11 referred. Average Consumer Price Indexes for all Urban consumers (CPI-U) for the calendar year for which the poverty thresholds were published (see table below) and for the 12 months representing the income reference period for the respondent were calculated. The percentage difference between these two numbers represents the inflation between these two periods and was applied to the poverty threshold appropriate for the family (based on the characteristics listed above). For example, for a family interviewed in November, 1983, the 1982 poverty threshold was updated to reflect inflation by multiplying by the percent change in the average CPI-U for the 12 month reference period, which would have been November, 1982 through October, 1983, over the calendar year January through December, 1982, in this example. To compute poverty indexes, the midpoint of the total combined family income bracket was divided by the updated poverty threshold. *U.S. Bureau of the Census, Current Population Reports, Series P-60, No. 138, "Characteristics of the Population Below the Poverty Level: 1981", U.S. Government Printing Office, Washington, D.C., March 1983. U.S. Bureau of the Census, Current Population Reports, Series P-60, No. 144, "Characteristics of the Population Below the Poverty Level: 1982", U.S. Government Printing Office, Washington, D.C., March 1984. Average Consumer Price Index, all Urban consumers (CPI-U), U. S., city average, 1981-84 Month Year 1981 1982 1983 1984 January 260.5 282.5 293.1 305.2 February 263.2 283.4 293.2 306.6 March 265.1 283.1 293.4 307.3 April 266.8 284.3 295.5 308.8 May 269.0 287.1 297.1 309.7 June 271.3 290.6 298.1 310.7 July 274.4 292.2 299.3 311.7 August 276.5 292.8 300.3 313.0 September 279.3 293.3 301.8 October 279.9 294.1 302.6 November 280.7 293.6 303.1 December 281.5 292.4 303.5 Average 272.4 289.1 298.4 Source: U. S. Department of Labor, Bureau of Labor Statistics Members of families with incomes equal to or greater than poverty thresholds have poverty indexes equal to or greater than 1.0 and can be described as "at or above poverty"; those with incomes less than the poverty threshold have indexes less than 1.0 and can be described as "below poverty". Poverty thresholds used were computed on a national basis only. No attempt was made to adjust these thresholds for regional, State, or other variations in the cost of living. None of the noncash public welfare benefits such as food stamp bonuses were included in the income of the low income families receiving these benefits. Size of Place and SMSA Codes for size of place and SMSA were obtained from Bureau of Census summary tape files (STF1B). A place is a concentration of population. Most places are incorporated as cities, towns, villages or boroughs, but others are defined by the Bureau of the Census around definite residential nuclei with dense, city-type street patterns, with, ideally, at least 1,000 persons per square mile. The boundaries of Census defined places may not coincide with civil divisions. A Standard Metropolitan Statistical Area (SMSA) is a large population nucleus and nearby communities which have a high degree of economic and social integration with that nucleus. Generally, an SMSA includes one or more central cities, all urbanized areas around the city or cities, and the remainder of the county or counties in which the urbanized areas are located. SMSAs are designated by the Office of Management and Budget. The same place size and SMSA codes were assigned to all persons in the same segment (for the definition of segments see Ref. No. 1 in Section C). In a few cases segments were divided by place boundaries. In these cases codes were assigned after inspecting segment maps. If the segment was predominantly in one place, then the place code for that place was used. If the segment was approximately evenly divided, the code for the larger place was used. Home Heating Questions E-3 through E-6, pertaining to the main fuel and equipment used for heating the home, appear to have codes which are inconsistent. It has been verified that these are the codes that were recorded on the original document; that is, codes that appear inconsistent were not incorrectly keyed. Blank Records In this field a "1" indicates respondents who were included in the sample, but did not receive a physical exam. Although positions 407-860 are blank, demographic data are available for these respondents. Ear Drum and Eye The blank code has one of two meanings: 1) the respondent did not undergo a physical exam and consequently all fields 407-860 are blank (see note 16); or 2) the ear drum was adequately visualized or the eye was present. Fundus The fundus was not visualized either due to physical reasons, e.g., cataract, or lack of patient cooperation. Blood Pressure The fifth Korotkoff sound was used for the diastolic reading. Sections 1.10 through 1.10.2 contain a complete description of the techniques employed in the blood pressure readings. The use of enhancement methods for increasing the loudness of the blood pressure sounds, as described in the Appendix, is not reported on the tape. Before using this data for analytic purposes, it is advisable to ascertain the effects of examiner differences and digit preference. Chest The chest was divided into six (6) areas to facilitate reporting of physical findings. FOR DIAGRAM SEE ORIGINAL DOCUMENTATION. Breast Code 4 includes women with mastectomies. Abdomen The abdomen was divided into nine (9) areas to facilitate report of physical findings. FOR DIAGRAM SEE ORIGINAL DOCUMENTATION Uterus Code 4 includes women with hysterectomies. Males have a blank code. Added Questions These questions were not included during the first six locations of the Mexican-American portion of the survey. Extremities Code 7 indicates either a missing or immobilized limb. The form was not designed to identify all missing or immobilized limbs. Joints Code 1 indicates no abnormality in the present, non-immobilized joints. Code 7 indicates both joints are missing or immobilized. Code 8 indicates either data was not obtained on both joints or data was not obtained on one joint and the other joint was missing or immobilized. A blank has one of three meanings: 1) respondents with entire physician's exam form blank; 2) individuals less than 10 years of age; or 3) abnormality in at least one joint. ICD Code A minus sign was placed in the fourth position when only 3 digits were used in the ICD coding. APPENDIX EXCERPTED FROM PHYSICIAN'S EXAMINATION PROCEDURES MANUAL (Ref. No. 12) Introduction The objectives of the Hispanic HANES are to produce and publish health and nutritional data required to assess the status of nutrition, health and health care of Hispanics who are between the ages of six months and 74 years. All procedures, tests and measurements will be carried out in an objective, uniform and standard manner. Data from this study will be appropriate for the following major uses: * To compare to the data collected in previous NHANES; * To create a baseline of statistical information on nutrition and certain chronic diseases which can be used for comparison with corresponding information to be gathered in future studies; and * To produce data which generate reliable health status estimates of the three major Hispanic subgroups, Mexican-Americans, Puerto Ricans, and Cuban-Americans. In order to fulfill these purposes, the physician's examination must be conducted and recorded in as uniform a manner as possible. Instead of the general clinical examination performed in the manner familiar to examining physicians, this is a physical examination which is highly structured in order to collect consistent data on conditions pertinent to nutrition and certain chronic diseases. This is an examination designed to obtain information that is objective, measurable, and related to specific major physical diseases and defects. Neither the survey objective nor the structure and flow of the examination allow for definitive diagnosis. They do require consistency and speed for coordination with other examinations and measurements carried out in the MEC. This chapter of the manual provides the specific procedures to be followed for conducting and recording the examination. Approach to Training HHANES is an epidemiologic study. It is designed to determine the prevalence of certain diseases in the Hispanic population in the United States. Since its purpose is epidemiologic rather than diagnostic, the criteria used to determine a particular symptom or clinical sign may differ from those used in clinical practice. However, since these data will be compared with data collected in the future to determine trends in the prevalence of disease and nutritional status, it is critical that explicit definitions and criteria be used and that these criteria be documented so that they can be used in the future. Otherwise, differences found over time in the prevalence of disease that might be attributed to changes in nutritional status may actually be due to differences in criteria used. Similarly, because different examiners will be conducting the exam, it is critical that they all use the same procedures and criteria. Otherwise, differences found between age groups or geographic locations may actually be due to examiner differences. The training of the physicians involved in conducting and recording results of the physical examinations has a dual purpose. First, it provides the standardized methods for the examination; and second, it provides a consistent base of information for review of relevant physical examination procedures and definitions of physical conditions. We have tried to stress those areas of the examination with which examiners may have had less experience. For example, heart sounds, particularly the identification and classification of murmurs, are described in detail. The WHO classification of goiters is described. Standardized blood pressure measurement techniques are stressed. As in other epidemiologic studies, it is essential that the instructions for collection of information be clearly and completely presented and that these instructions be followed exactly. Examination Goals and Format The physician's examination for the survey has two goals: * To obtain information on the presence or absence of the physical signs listed on the form; and * To list and code conditions indicated by the physician's examination and the history. The physician's Examination Form is central to the Hispanic HANES data collection process. Several aspects of data collection should be considered before specifications for the completion of the form are discussed. There are two sources of error that may enter into a sample survey, sampling error and nonsampling error. The sampling error, error due to making measurements on a sample rather than on the entire population, can be quantified and is the concern of statisticians in sample survey design. Of equal importance is nonsampling error which is introduced during data collection and processing. Quality control centers on the control of nonsampling errors. Much time and effort in the HHANES will be invested in reducing nonsampling error and collecting data of high quality. Because examiners may inadvertently introduce variability and bias, all MEC examiners will be trained to conduct examinations and reach findings using standardized procedures and indices. Just as uniformity and standardization are important in performing the procedures of the examination, these same characteristics are vital in recording the observations or measurements. Accuracy and precision again are important, as well as an additional characteristic -- legibility. An entry that cannot be read is lost data. There will be some unavoidable loss of data; for example, X-rays will be contraindicated for some examinees, and children may not cooperate for certain procedures. The examining staff are expected to use discretion regarding these unavoidable losses, to stop procedures occasionally when it is apparent that examinees cannot cooperate. It is the avoidable loss of data that is the responsibility of each staff member to prevent. General specifications for completing the Physician's Examination Form are as follows: * Before the examination session begins, review the medical histories (the Sample Person Questionnaires) for all persons scheduled to be examined during the session and make any necessary notes. There are two versions of the questionnaire; one is for adults 12-74 years old and one is for children 6 months-11 years. They are printed on colored paper, yellow for adults, blue for children. If there are any significant findings, or questions, these may be reviewed with the examinee for additional clarification or amplification. The Sample Person Questionnaire contains numerous sections. The most significant sections for the physician to review are the Health Services, the Conditions List, and the Medically Prescribed Drug List. See Exhibits 1-1 and 1-2 for a summary of the medical history items to review. Return the Sample Person Questionnaire to the Supplement Interviewer who will use them during the session. * Fill out the Physician's Examination Form completely. There are 13 pages to the form. There are five additional forms used for tracking and documenting aspects of examination procedures. * Enter all information using a No. 2 black pencil. If an incorrect entry is made, circle the incorrect answer and fill in the correct response. Accuracy of the data is the most important consideration. Print legibly and do not use medical shorthand. * Note that the format of the form is similar to a check list in which the presence or absence of specific conditions and basic descriptive items are noted. Also, there is space to describe any additional findings or to expand on checked findings within each subsection of the form. Exhibit 1-1 Summary of Medical History Items from the Child Sample Person Questionnaire, Ages 6 Months - 11 Years PAGE QUESTION TOPIC 1 A 11, 12, 13 Birth 2 B 1, 3, 4 Health Services 4 B 14 5 B 22 6 B 28 7 B 35, 36 8 C 9-12 Dental and Anemia 8 D 1, 5, 6 Vision and Hearing 9 D 14, 15-21 10 D 29 10 E 1, 2, 5, 6 TB/Weight/Immunization/Pesticides 12 F 2-9 Functional Impairment 13 F 10-14 14 G 1-4, a-n Condition List 16 H 5-7 School Attendance and Language Use 21 K 5 Medicine/Vitamin Usage 22 K 6 28 M 8, 9-13 Sample Child Self-Response 29 N 1, 2 Medicine/Vitamin MEC Exhibit 1-2 Summary of Medical History Items from the Adult Sample Person Questionnaire, Ages 12-74 Years PAGE QUESTION TOPIC 1 A 1-6 Health Services 2 A 9, 14 3 A 17, 21 4 A 27 6 A 33-35 6 B 1-6 Selected Conditions 8-10 C 1-27 Diabetes 10 D 1-7 Vision and Hearing 11 D 11-17 11 E 1-3 Hypertension 12 E 7,8 13 E 22, 23 14 E 25-28 14-17 F 2-35 Gallbladder Disease 18-20 G 1-21 Cardiovascular Conditions 20 H 2-5 Smoking 22-25 J 2-42 Functional Impairment 25 K 1-3 Conditions List 35 P 5 Medicine/Vitamin Usage 36 P 6 43 R 1,2 Medicine/Vitamin MEC * Notice that certain procedures are to be deleted from the examination on the basis of the age of the examinee. Leave the item on the form blank when the procedure is deleted due to age. These procedures are indicated on the form and are listed below: - Blood pressure - only measured on persons six (6) years and older. - Breast mass(es) - only examined for persons ten (10) years and over. - P.M.I. - only measured on persons eighteen (18) years and older. - Gallbladder questions - only asked of examinees who are given the ultrasound examination. - Tanner Staging - only determined on examinees between the ages of ten (10) and seventeen (17). - Ortolani's Maneuver - only performed on examinees less than age three (3). - Joints - only performed on examinees ten (10) years and over. - Epiphysial enlargement, wrists - only examined on persons under age eighteen (18). - Straight leg raising test - only performed on examinees age eighteen (18) and over. * In some cases certain parts of the examination will not be applicable. This will occur when, for example, the examinee has had the part of the body removed that is to be examined. Since there is no code on the form for these situations, write N.A. to the immediate right of the appropriate "No" box but not inside the box. * If the examinee is uncooperative (for example, is a crying child), or cannot perform some portion of the examination (for example, is an eight month old infant who cannot walk and cannot have gait evaluated), then make a note in the column on the right side of the form and leave the coding boxes blank. * Notice that the position of the examinee for each procedure is stated on the form. * Record positive findings as soon as they are discovered. The physician does not have to stop to record any normals until the next recording point. If the examinee has no abnormal findings the points for recording are: - just before the first pulse and blood pressure measurement, - after completing the first pulse and blood pressure measurement, - after completing the heart examination, - just before the second pulse and blood pressure measurement, - after completing the second pulse and blood pressure measurement, - after checking the gait of the examinee at the end of the exam. * Complete the form while the examinee is in the examining room to allow for any necessary corrections. In this section of the manual, instructions for conducting the examination are organized as follows: * 1.x - Body Part or System.. * 1.x.1 - Procedure -- explaining the position of the examination and how to examine the particular body part or system, and * 1.x.2 - Recording of Findings and Definitions -- explaining how to complete the form and giving criteria for the conditions listed on the form. This format is used for the remainder of this chapter. Examinee Identification Procedure This information appears on the Control Record. It should be the same as that for the Sample Person Questionnaire and for the Control Record and it should be verified. The sample number is stamped on the bottom of the form. Recording of Findings and Definitions * Examiner No. - Insert your three digit identifier. * Reviewer No. - Leave blank. * Copy the following from the Control Record and verify with examinee: - Age - Month or years. Record in months if examinee is less than twelve months old; record in years if one year old or older. Use the age on the household interview day. - Sex - Check the appropriate box, Male or Female. Skull and Ears Procedure With examinee seated, inspect skull for bossing. Examine right ear first and then left ear: * Inspect external ear and canal for discharge, swelling or redness. * Inspect ear canal and eardrum using an otoscope. Use the largest speculum the examinee's ear canal will accommodate. * Inspect ear drum fully by sliding speculum slightly down and forward. Check color, shape and position of ear drum. Recording of Findings and Definitions * Bossing of skull - Record abnormal prominence or protrusion of frontal or parietal areas by checking "Yes" box. If normal, check "No." * Check "Right" and/or "Left" ear under "Otitis External" if evidence of inflammation is found in external ear canal. Check "No" if both canals are normal. * If there is a "Purulent discharge," check "Right" and/or "Left" as appropriate. If abnormality is not found in either ear canal, check the "No" box. * Under Ear Drums, check "Not visualized, canal completely occluded" in the right and/or left ear if the canal is totally sealed by cerumen or any other substance and skip to A4 to give the reason for the occlusion. This item will be used in interpreting the Tympanic Impedance Test results. * Check "Not visualized, other" in right and/or left ear if there is not sufficient tympanic membrane visible to characterize the membrane. For positive responses skip to A4 and write the cause of the obstruction under "Other." * Check as many structured responses as apply in the description of the membrane, e.g., "Dull," "Bulging," and "Fluid" may all be checked under right ear. If there is a healed perforation check "Right" and/or "Left" under "Scars" as appropriate. If abnormality is not found in either ear drum check the "No" box for each condition. If the membrane is perforated, check either "With discharge," or "Without discharge." * "Fluid" refers to an observable level of fluid behind the ear drum. * "Transparent" refers to an abnormally thin ear drum. * Write in under "Other" a description if the structured responses for the skull, auditory canal, and tympanic membrane need to be supplemented. Describe any causes of obstruction, e.g., cerumen, foreign body, discharge, or swelling. Nares Procedure With examinee still seated, examine right naris first, then left: * Test patency of each nostril with inspiration (mouth closed) during alternate unilateral occlusion of other nostril. * Examine vestibule for inflammation and anterior septum for deviation. * Gently insert the short wide nasal speculum of the otoscope. Inspect mucosa, septum and turbinates for abnormalities. Recording of Findings and Definitions * Obstruction is defined as the inability to breathe adequately through a single naris. Check "Right" and/or "Left" naris as appropriate if obstruction is present. If no obstruction is present in either naris check the "No" box. * For deviated septum check as "Right" or "Left" according to the direction of the deviation. * Nasal polyps are soft, smooth, pale, movable tumors, usually multiple. * Check additional boxes "Right" and/or "Left" as appropriate. Check "No" if the abnormality is not found in either naris. * Describe other significant findings under "Other" such as enlarged adenoids. Lips and Pharynx Procedure Continue with examinee seated. * Inspect lips and tongue for symmetry, color, ulcers, fissures or masses. * Using tongue blade to depress tongue and asking examinee to say "ah" or yawn, look at anterior and posterior pillars and observe tonsils for enlargement, redness or exudate. Recording of Findings and Definitions * Check "Yes" box if condition is present. Check "No" box if not. * Cheilosis - Reddened appearance of lips with fissures at the angles of the mouth. * Cyanosis of lips - Slightly bluish, grayish, slate-like, or dark purpose discoloration of the lips. * Tonsils are considered enlarged for adults if they protrude one centimeter beyond the fossa. For children, tonsils are considered enlarged if they protrude two centimeters beyond the fossa. * Describe other findings under "Other" such as abnormality of tongue, buccal mucosa, uvula or parotid glands. External Eyes Procedures Carry out all eye tests with the examinee seated. If the examinee wears glasses, have them removed for the following examinations. Contact lenses may be left in place. * Check for strabismus, muscle coordination or imbalance. Cover one eye while examinee looks at light, then uncover it. Note if each eye holds its position or if the eye that was covered swings back into position after being uncovered. Inspect eyelids, conjunctiva and sclera for redness, dryness, or other lesions. * Inspect cornea of each eye for opacities or other abnormalities. * Compare size of pupils and check with pen light for pupillary reflex. With the examinee seated, examine the fundus of each eye using an ophthalmoscope. * Set ophthalmoscope to 8- diopters. * Tell examinee to look straight ahead at a specific point on wall. * Use your right hand and right eye to examine examinee's right eye. * Place your left hand on examinee's forehead. * Shine light beam on examinee's pupil. * Locate red reflex noting any opacities interrupting the reflex. * Move in toward examinee and when the retina is seen, focus carefully and follow a blood vessel centrally to optic disc. * Check optic disc for normal color and shape and optic cup-to-disc ratio. * Follow vessels from disc into each of 4 quandrants. * Observe relative size of smaller arterioles to larger veins. * Check for changes such as nicking at arteriovenous crossing. * Examine surrounding retina for hemorrhages or exudates. * Lastly, examine macula which is about 2 disc diameters lateral to optic disc. * Repeat procedures on examinee's left eye using your left eye and left hand with your right hand on examinee's forehead. Recording of Findings and Definitions Indicate the presence of any of the following by checking the appropriate "Yes" box. If not present, check the "No" box for that condition. * Strabismus (squint) - A disorder in which optic axes cannot be directed to same object, due to lack of muscular coordination. Check "Yes" box if test is positive (eye moves into position when uncovered) or if there is an obvious squint. Check "No" if no abnormality in muscle imbalance is seen. * Conjunctival injection (bilateral) - Generalized increase in the vascularity of the bulbar conjunctivae in the absence of obvious infection. * Pale conjunctiva - Conjunctivae do not show the normal brightness and color, usually associated with anemia. * Xerophthalmia - Xerophthalmia is recorded when the bulbar conjunctiva and cornea are dry and lusterless with a decrease in lacrimation. It is rarely associated with evidence of infection but in extreme cases is associated with keratomalacia. * Keratomalacia - Corneal softening with deformity, either localized (usually central part of lower half of cornea) or total. * Pterygium - Triangular thickening of the bulbar conjunctiva. * Corneal lesions - Any such lesions of the cornea as abrasions, ulcers, thickening, or opacities. Check the box corresponding to the eye(s) involved or the "No" box if not present. * Unequal pupils - Check larger pupil if pupils are of unequal size or "Equal" if they are the same size. * Pupillary light reflex - Check normal if on shining the light into the eye the iris contracts quickly and equally for both eyes, resulting in a smaller pupil. The pupil should return to normal quickly after light is removed. * Record positive findings by checking "Right" and/or "Left" box for each condition noted. Check "No" box if the condition is not present in either eye. * Globe absent - Recorded when the eye has been enucleated, regardless of the presence or absence of a prosthesis. If globe is present but examinee is blind in that eye note in "Other." * Red reflex - Through the ophthalmoscope, pupils appear to be red at a distance of one foot from the eye. If the red reflex is decreased or abnormal, check the box corresponding to the eye involved. If the red reflex is normal (that is, not decreased) check the "No" box. * Lens opacities - Well advanced cataracts appear as gray opacities in the lens. They will be seen with the ophthalmoscope held about 12 inches away. Small ones stand out as dark defects in the red reflex. A large cataract may obliterate the red reflex. * Papilledema (choked disk) - A swelling of the nerve head from increased intracranial pressure or interference with venous return from the eye. It is usually bilateral. Neck Procedure Continue with examinee seated. * Palpate the neck lymph nodes in the following areas: - In front of and behind the ear, - Occipital, - Submental, - Submaxillary, - In front of and behind the sternocleido-mastoid muscle, and - Supraclavicular. * Insert and palpate the thyroid gland for goiter as follows: - Stand in front of the examinee. - Observe the neck for thyroid gland visability with head in normal position and then have examinee extend his neck to expose the thyroid area by tippin his chin upward. - For each of these positions, observe the gland at rest and as the examinee swallows two or three times. - Palpate the gland with both hands simultaneously, the fingers on the occiput and the thumbs on the thyroid gland. - Palpate at rest and as examinee swallows two or three times for thyroid gland contour, tenderness or nodes. Recording of Findings and Definitions * Check "Yes" box as appropriate if abnormality is found. Check appropriate "No" box if abnormality is not present. * Thyroid gland evaluation - classify size of goiter using the WHO classification as follows: - Grade 0 - Persons without goiter. By definition these are persons whose thyroid glands are less than 4 to 5 times enlarged. - Grade 1 - Persons with palpable goiters. The thyroid gland is considered to be more than four to five times enlarged although not visible with head in normal position. Most of such glands will be readily visible with the head tilted back and neck fully extended. - Grade 2 - Persons with visible goiters. Persons with goiters that are easily visible with the head in normal position, but that are smaller than those in Grade 3. - Grade 3 - The goiters of persons in this category can be recognized at a considerable distance. They are grossly disfigured and may be of such size as to cause mechanical difficulties with respiration and the fit of clothing. Palpation may be helpful in determining the mass of the gland but is not needed for diagnosis. * Check "Right" and/or "Left" box(es) if tenderness or nodule is found. Check "No" box if either of these conditions is not found. * Describe other abnormal findings such as tracheal deviation and distended neck veins under "Other." Pulse and Blood Pressure Measurement The pulse and blood pressure will be measured by the physician. Although these tests appear quite simple, accurate and standardized measurements depend on many factors. Because the measurements must be obtained in a uniform manner for each examinee, it is critical that you always follow these procedures. For examinees who are age six and older the pulse and blood pressure are measured at two specified points in the physician's examination. Both blood pressure measurements are made with the examinee seated. The measurements are taken at specified points during the examination when the examinee is as quiet and undisturbed as possible. For examinees who are age five and younger only the pulse is measured. This one measurement should be made at the time when the second blood pressure would be measured for older examinees. Be sure that the examinee does not smoke or drink coffee during the examination since these could affect the blood pressure. If the examinee has had any alcohol, coffee, or cigarettes thirty minutes before the examination, record this on the form but still take the measurements. There are some situations where taking the blood pressure is contraindicated. For example, if there are any rashes, bandages, casts, puffiness, paralysis, tubes, open sores or wounds on both arms, do not take the blood pressure. If these conditions prevent measuring pulse, do not attempt taking the blood pressure. Give the reason why the blood pressure cannot be taken on the form. The blood pressure is to be measured in the right arm. If the examinee indicates any reason (such as needles or tubes in the arm during the last week) why this procedure should not be done in the right arm, use the left. Procedure There are five parts to the pulse and blood pressure measurement. these are: * Locate the pulse points, * Select and apply the cuff, * Determine the maximum inflation level, * Measure the pulse, and * Determine the blood pressure. Each of these is described below. For each of the procedures the arm should be placed at the level of the fourth intercostal space. The arm should be supported by the adjustable instrument table which should be elevated to the height necessary to bring the arm to this level. Locate the Pulse Points * Locating the radial pulse: With the examinee's right palm turned upward, place the first two fingers of your hand on the outer part of the crease of the wrist. * Locating the brachial pulse: Again, with the right palm of the examinee turned up, and the arm straightened (slightly bent at the elbow), place the first two fingers of your hand on the innermost (side toward the body) part of the crease of the elbow. If the brachial pulse is not felt, move your fingers slightly closer to the center of the arm, again press firmly in and hold. Continue this to the center arm. If the brachial pulse is still not felt, begin again from the center of the arm and work your way to the innermost (toward the body) part of the crease of the elbow. * Both pulse and blood pressure will be measured in the same arm. The right arm will always be used unless specific conditions prohibit its use. Use the following guidelines: - If the radial pulse is apparent, whether or not the brachial pulse can be felt, proceed with the measurement of the pulse. - If the radial pulse cannot be felt in the right arm, use the left arm. - If the radial pulse cannot be felt in either arm, terminate the pulse and blood pressure procedure and note this on the form. Select and Apply the Cuff * Select the proper cuff size. The five cuffs to be used are the infant cuff, child cuff, adult cuff, large arm cuff, and thigh cuff. The size of the cuff and bladder use influences the accuracy of the blood pressure readings. If the cuff is too narrow, the blood pressure will be too high, and if it is too wide, the reading will be too low when compared to measurements taken intra-arterially. The size of the arm, not the age, determines the size cuff used. The inside of the cuff is marked with an index line and range lines. If the index line along the edge of the cuff fits completely within the range lines inside the cuff, the cuff is the correct size. If the cuff is barely large enough, the next larger cuff will be used. If no cuff fits, the blood pressure will not be measured. Each cuff size will have a complete inflation system. These are easily attached by a twist connection to the manometer. It will not be necessary to exchange inflation bulbs and valves with the various cuffs. * After locating the pulse points, apply the cuff to the examinee's arm. Observe the examinee's arm and begin with the cuff that appears appropriate. Check the size before applying the cuff by making sure that the index line falls completely within the range lines. If the cuff is barely large enough, use the next larger size. The procedure for applying the cuff is as follows: - In selecting the proper cuff size, check the index line to determine if it lies completely within the size range lines marked on the cuff. - Position the rubber bladder over the brachial artery at least one inch above the natural crease across the inner aspect of the elbow. Place the marker on the inner part of the cuff directly over the brachial artery. - Wrap the cuff smoothly and snugly around the arm in a circular manner. No spiral direction of the cuff should be used. - Check the fit by placing both thumbs under the cuff and tugging gently. - For very large arms use the thigh cuff. Wrap the thigh cuff around the upper arm, not the thigh. If the thigh cuff covers the brachial artery at the arm crease, do not measure the examinee's blood pressure. - If a proper fit cannot be obtained with any of the cuffs, do not measure the blood pressure. Explain the reason to the examinee and note the problem on the form. Determine the Maximum Inflation Level (MIL) To measure the maximum inflation level (MIL), connect the inflation tubing to the manometer by twisting the two ends of the tubing together. The MIL is obtained to determine the highest level to which the cuff should be inflated. If the cuff is underinflated and the examinee has an auscultatory gap, a falsely low reading will result. If the cuff is overinflated a falsely high reading could result. The MIL will then be determine as follows: * Locate the radial pulse pressure point in the arm to be used. * Close the thumb valve. Palpate the radial pulse and watch the center of the mercury column of the manometer. * Inflate the cuff quickly to 80 mm Hg, then inflate in increments of 10 mm HG until the radial pulse disappears noting the reading of the mercury column at that point. Continue inflating the cuff at increments of 10 mm Hg, pausing briefly to make sure the pulse is absent. Continue 30 mm Hg higher to make sure the radial pulse has disappeared. * Rapidly deflate the cuff by opening the thumb valve completely and disconnecting the tubing. * The MIL is the reading at the point the radial pulse disappeared plus 30 mm Hg. * Wait 30 seconds before making a second attempt if the first is unsatisfactory. If the second attempt is unsatisfactory, terminate the procedure and note the problem on the form. This value is the maximum level to which the cuff should be inflated for measuring this examinee's blood pressure. If the examinee reports significant discomfort from the cuff during determination of the MIL, recheck the fit of the cuff and remeasure the MIL. If the discomfort persists, terminate the procedure and note the problem on the form. If the radial pulse is still felt at a level of 230 mm Hg or higher (MIL 260 mm Hg or higher) repeat the MIL. If the MIL is still 260 mm Hg or higher, terminate the blood pressure measurements and write in "260/MIL" on the Physician's Exam Form. On the Report of Findings I indicate the blood pressure as 230 palpated. Repeat the MIL if the first attempt was unsatisfactory or you have had to readjust the cuff after measuring the MIL. Wait at least 30 seconds after measuring the MIL and before starting the blood pressure measurement. When the MIL has been satisfactorily determined, do not remove or reapply the cuff. Wait at least 30 seconds before measuring the blood pressure; during the waiting period take the pulse. Measuring the Pulse The pulse will be measured by feeling the radial pulse point at the wrist. The pulse measurement should be taken in the interval between the MIL measurement and the blood pressure measurement. With the elbow and forearm resting comfortably on a stable surface and the palm of the hand turned upward, the radial pulse is felt and counted for 15 seconds exactly. The number of beats in 15 seconds is multiplied by 4, and the result recorded as the pulse on the form. Determine the Blood Pressure The following procedure will be used for the measurement of blood pressure: * Position the stethoscope ear pieces comfortably in your ears, turning them forward toward the nose. * Be sure the examinee's arm is positioned at the level of the fourth intercostal space at the sternum. * Feel the brachial pulse and place the stethoscope diaphragm directly over the pulse beat just below the cuff. The diaphragm should be applied with light pressure so there is no air between it and the skin. If the brachial pulse is too faint to be felt, place the stethoscope diaphragm over the innermost part of the crease of the elbow and proceed. If possible, avoid allowing the cuff, the tubing or diaphragm to touch. Also avoid allowing the stethoscope to touch the cuff, any tubing, or the gown. * Close the thumb valve. Rapidly and steadily inflate the cuff to the MIL. (If you inflate he cuff more than 10 mm Hg above the MIL open the thumb valve, rapidly deflate the cuff and disconnect the tubing. Discontinue this reading and wait 30 seconds before inflating again.) * When the MIL is reached, open the thumb valve and smoothly deflate the cuff at a constant rate near 2 mm Hg per second (one mark per second). * Be sure your eyes are level with the center of the manometer. Watching the top of the mercury column, note the reading at the point when pulse sounds first appear using the mark at or just above the top (meniscus) of the mercury column. Listen for at least two beats to eliminate recording a single erroneous sound. Note the reading at the point the first pulse sound appears, not at the second beat. * Continue deflation at 2 mm Hg per second. Note the reading when the sounds finally disappear, using the mark at or just above the top of the mercury column. * Continue steady deflation at 2 mm Hg per second for at least 20 mm Hg below the second reading; then open the thumb valve completely and disconnect the tubing. Let the cuff fully deflate. If you need to repeat the measurement, wait 30 seconds between measurements. * Use the first reading (appearance of sounds, first Korotkoff sound) as the systolic pressure and the second reading (disappearance of sounds, fifth Korotkoff sound) as the diastolic pressure. Use the nearest even digit. If the column fell between two digits, use the mark at or just above the top of the mercury column. If pulse sounds continue to be heard down to zero pressure, record the diastolic reading as "000." * If you have difficulty hearing the blood pressure sounds, there are two methods which can be used to increase the intensity and loudness of the sounds: - Have the examinee raise his/her arm and forearm for at least 60 seconds. Inflate the cuff, lower the arm, and take the blood pressure immediately. If raising the arm is difficult for the examinee, use the next method. - Instruct the examinee to open and close his/her fist 8-10 times AFTER the blood pressure cuff is inflated to the MIL, but before deflation is begun. If it was necessary to use one of these enhancement methods, make sure you record this fact on the Physician's Examination Form in the space designated for comments. Recording of Findings and Definitions For each of the two pulse and blood pressure measurements the same recording instructions apply. * Record the pulse rate as beats per minute. * Check the appropriate box to indicate whether or not the pulse was irregular. * Check the box corresponding to the cuff width used. * Record the systolic pressure (point when sounds appear) and the diastolic pressure (point when sounds disappear) using the nearest even digit. * Write in any variation, such as "left arm used," in the space for comments. * If the pulse and/or blood pressure are not measured, record the reason in the space for comments. * If the MIL is 260 then you should not take the blood pressure. Write "260" in the space for the systolic pressure and "MIL" in the space for diastolic pressure. Use the guidelines in Exhibit 1-3 for reporting the blood pressure measurement and MIL to the patient. The examinee should be told his/her blood pressure and what it means. Refer to the "Statement" column of Exhibit 1-3 for the recommended interpretation of the blood pressure reading. Use good medical judgment and observation when recommending that any action be taken in relation to these findings. Persons with quite high blood pressure (Exhibit 1-3) should have immediate medical attention. Persons with high blood pressure should see a physician within one week. Persons with above normal reading should see a physician for a recheck of blood pressure within three months. Exhibit 1-3 Guidelines for Blood Pressure Reporting to Examinees Systolic Diastolic MIL* Statement Under 150 and Under 90 Normal 150 and over and/or 90-95 Above normal - Recheck within 3 months (Level III Referral) Any and 96-114 High - Recheck within 1 week (Level II Referral) 115 and over or 260 Quite high - Immediate referral (Level I Referral) These guidelines are approved by the National High Blood Pressure Coordinating Committee, in the 1980 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure, p. 8. *Maximum Inflation Level Chest and CNA Procedure Continue with examinee seated. * Inspect anterior chest wall paying particular attention to the costochondral junctions, and sternum. Check for asymmetry of chest and observe A.P. diameter. * With your hands on examinee's lower ribs and your thumbs together on lower spine, ask examinee to take a deep breath. Compare excursion of left and right chest walls. * Test for CVA tenderness on right and left using closed fist to elicit response. * Auscultate lungs as follows: - Listen to posterior chest by asking examinee to breathe in and out through mouth more deeply than usual. - Start at apex proceeding downward and from left to right to compare sounds in at least 6 areas (3 on each side). - Listen to at least one entire breathing cycle at each location. - Listen for timing, pitch, intensity, and quality of breath sounds. Note extra or adventitious sounds. * While the examinee is still in a seated position, auscultate the base and apex of the heart for evidence of murmurs using the diaphragm of the stethoscope. Recording of Findings and Definitions * Check "Yes" box if abnormality is present or, as appropriate, indicate severity of condition. Check "No" box if particular condition is not noted. Indicate presence of other abnormalities such as asymmetrical motion of chest under "Other." * Beading of ribs - Definitely palpable and visible enlargement of the costochondral junctions. * Asymmetry - Check "Yes" if the chest is structurally asymmetrical. * Funnel breast - Sternal depression of chest wall resembling a funnel. * Pigeon breast - Deformity in which the sternum projects anteriorly. * Increased A.P. diameter - A.P. diameter increased to the point of appearing barrel-chested. * Auscultation: Circle the number(s) for the area(s) of the lung where abnormality is noted. Diagram of chest is from posterior view. - Diffuse wheezing - Harsh breathing with a prolonged wheezing expiration heard all over the chest. - Bronchial breath sounds - Harsh breathing with a prolonged high pitched expiration which has sometimes a tubular quality. - Rales - Abnormal, crackling respiratory sounds heard on either inspiration or expiration. - Ronchi - Dry, course rales in the bronchial tubes. - Wheeze - A whistling or sighing sound. Breast Mass(es) Procedure * For female examinees age 10 and over - With examinee seated, observe symmetry of size and shape of both breasts, areolae and nipples. With examinee first seated and then supine, palpate the right breast first and then the left breast using a semi-circular method. Begin at the outermost circle and palpate in smaller circles toward the areolae and including the nipple. Compress the nipple. * For the male examinees age 10 and over - With examinee in supine position, inspect the areolae and nipples for swelling or ulcerations, and palpate for nodules or masses. Recording of Findings and Definitions * Check "Yes" box if nodule or mass is found in "Right" and/or "Left" breast. Check "No" box if none is found. * Describe nodule, mass, or other abnormalities under "Other" breast finding, characterizing it with regard to location, size, consistency, tenderness, and mobility. Heart Procedure Continue with examinee in supine position. * Assess carotid pulse. Assess the right pulse first and then the left pulse: - Compress the carotid artery by hooking index and middle fingers around medial edge of sternocleidomastoid muscle. - Palpate carotid artery in lower half of neck to avoid carotid sinus. - Note amplitude and compare right with left pulse. - Auscultate carotid artery for bruits. * P.1.I. (Point of Maximum Intensity): Inspect chest wall first, then palpate for apical beat. If P.1.I. is felt, determine the closest interspace and its relation to the mid-clavicular line. Skip item 2a and 2b for examinees who are less than 18 years old. * With the palm of the hand, palpate for thrills at the apex, and at the base. * Auscultation for murmurs: Start with diaphragm and repeat with bell in following order: - Listen at the apex particularly for heart sounds S1 and S3, for systolic click and mitral murmurs. - Listen at second right interspace for S2 and aortic murmurs. - Listen at second left interspace for S2 and pulmonic murmurs. - Listen at third left interspace for S2 and aortic and pulmonic murmurs. - Listen just to the left of the ensiform cartilage for tricuspid murmurs. * Refer to Exhibit 1-2 through 1-4 for location and nature of the lesion. Exhibit 1-4 Cardiac Murmurs TIME OF SITE OF GREATEST DIRECTION OF SEAT OF NATURE OF OCCURRENCE INTENSITY TRANSMISSION LESION LESION Systolic At cardiac apex. Along left fifth Mitral Incompetency-- Use bell of and sixth ribs-- orifice Regurgitation stethoscope in the left axilla--in back, at inferior angle of left scapula Systolic At junction of To junction of Aortic Narrowing-- right second costal right clavicle orifice Obstruction cartilage with with sternum-- sternum in course of right carotid Systolic At ensiform carti- Feebly trans- Tricuspid Incompetency-- lage mitted orifice Regurgitation Systolic At left second Feebly trans- Pulmonary Narrowing-- intercostal space, mitted orifice Obstruction close to sternum Diastolic At junction of To midsternum-- Aortic Incompetency-- right second costal in course of orifice Regurgitation cartilage with sternum sternum. Use bell of stethoscope Diastolic At left second In course of Pulmonary Incompetency-- intercostal space, sternum orifice Regurgitation close to sternum (Diastolic) Over body of heart To apex of heart Mitral Narrowing-- presystolic orifice Obstruction (Diastolic) At ensiform carti- Feebly trans- Tricuspid Narrowing-- lage mitted orifice Obstruction presystolic- Recording of Findings and Definitions * Diminished carotid pulsations - If pulsations are unequal record the stronger one as normal, the weaker as diminished. * Carotid bruit - An adventitious sound of arterial origin heard on auscultation. Check "Yes" box if present, "No" box if not. * P.M.I. (Point of Maximum Intensity) - The point on the chest where the impulse of the left ventricle is felt most strongly, normally in the fifth costal interspace at the mid-clavicular line. Record whether felt or not, and check in which interspace and whether at inside, or outside midclavicular line. * Thrill - A sensation of vibration felt by the examiner on palpation of the heart, for example, over an incompetent heart valve. Check box indicating if present or absent and check the box indicating location. * Heart sounds: Check the structured responses which best describe: - First (S1) - Best heard at apex as dull and prolonged and occurring with the beginning of ventricular systole and closure of mitral and tricuspid valves. - Second (S2) - Best heard in second and third left interspaces as short and sharp and occurring with the closure of the aortic and pulmonic valves. A split second sound is sometimes audible at the left sternal border and is due to a slight asynchrony of right and left ventricular contraction. - Third (S3) - Best heard at apex as weak, low-pitched and dull following S2. It occurs in most children and in many young adults. It is thought to be caused by vibrations of the ventricular walls when they are suddenly distended by the rush of blood from the atria. - Systolic Click - A high pitched brief sound occurring in midsystole and usually loudest at apex. * Murmurs: Describe all murmurs heard according to when they are heard (systole or diastole), in which area they are heard best, whether they are functional or organic and their intensity. * The loudness or intensity of a murmur is indicated by a rating system that grades murmurs from 1 to 6: - Grade 1 - The softest audible murmur, it is not evident upon initial listening but requires a period of acoustic adjustment of "tuning in." - Grade 2 - Faint murmurs but audible without "tuning in." - Grades 3 & 4 - Murmurs of intermediate intensity. - Grade 5 - Murmurs are the loudest but cannot be heard through a stethoscope held off the chest wall. - Grade 6 - Murmur is so loud as to be audible through a stethoscope held off the chest wall. * If there are other significant cardiac findings, describe under "Other." Abdomen Procedure With examinee in supine position: * Inspect abdomen for swelling, masses, or scars. * Auscultate abdomen in the aortic, iliac and renal artery areas for bruits. * Palpate abdomen slowly in all quadrants and in suprapubic areas using a light, dipping motion. - Note areas of increased resistance or tenderness. - If there is history of pain or tenderness, palpate that area last. * Palpate with firm pressure more deeply in all four quadrants to identify masses and tenderness. * Support the lower rib cage from underneath with your left hand and check with your right hand for enlarged liver: - Percuss for the lower edge of the liver. - Place your right hand in right midclavicular line, below lower border of liver dullness. - Press in and up gently as the examinee inhales deeply. - Feel for liver edge as it descends and touches your fingertips. - Reposition your hand if you are unsuccessful or exert more pressure inward as examinee inhales. Note any tenderness. * Palpate for an enlarged spleen: - Reach across examinee and support left lower rib cage from underneath the body. - Place your right hand below left costal margin. - Ask examinee to inhale deeply and press firmly inwards trying to feel spleen descending toward your fingers. - If splenic enlargement is suspected, have examinee roll onto right side and repeat procedure. * During the examination of the abdominal area for examinees who are age twenty and over and are having the gallbladder ultrasound (the fasting group), ask questions that will allow you to answer the following questions (to determine if the examinee has symptoms of gallstones or gallbladder problems): 10a. During the past year has this examinee had an attacks of nausea and/or vomiting lasting more than 2 hours? 10b. During the past five years has this examinee had pain in this area (GALLBLADDER AREA) which lasted a half hour or more? 10c. If "Yes" ABOVE, ASK: Does this examinee usually feel sick to his/her stomach either before or after getting this pain? 11. What is your opinion of the likelihood of this examinee having gallstones? Recording of Findings and Definitions * Surgical scars - If scar(s) is/are present, check "Yes" box and circle the number(s) of the area(s) according to diagram. * Indicate by checking the "Yes" box, the presence of ascites or bruit. If not present, check "No" box. * Bruit - If bruit is present, check "Yes" box and circle the number(s) of the area(s) according to the diagram. * Hepatomegaly - If liver is palpated in right upper quadrant, 2 cms or more below right costal margin, indicate as enlarged by checking appropriate "Yes" box. * Splenomegaly - If spleen is felt in left upper quadrant, check "Yes" box; if not, "No" box. * Uterine enlargement - Record all enlarged uteri including those enlarged secondary to pregnancy by checking "Yes" box. If not enlarged, check "No" box. Write "N.A." in the right column for males. * Tenderness, masses in abdomen - Indicate if tenderness and/or masses are found by checking "Yes" box and by circling the number(s) of the area(s) where found (refer to diagram). Circle the number that locates the center of the mass. Write in a description of the mass(es), identifying location, size, shape, whether loose or fixed, firmness, etc. (for example, (7) 3 cm diameter firm, fixed, non-tender). * Describe any other significant abdominal findings such as hernias under "Other." Tanner Staging (Ages 10 through 17) Procedure * Skip this section for examinees who are not between the ages of 10 and 17. * Male - With examinee in supine position inspect pubic hair and genitalia. Inspect and then palpate the testicles. * Female - With examinee in supine position inspect pubic hair and breasts. Recording of Findings and Definitions * Classify pubic hair (male and female) and check appropriate box according to the following: - Stage 1 - Preadolescent. The vellus over the pubis is no further developed than that over the abdominal wall, i.e., no pubic hair. - Stage 2 - Sparse growth of long, slightly pigmented downy hair, straight or only slightly curled, appearing chiefly at the base of the penis or along the labia. - Stage 3 - Considerably darker, coarser, and more curled. The hair spreads sparsely over the junction of the pubis. - Stage 4 - Hair now resembles adult in type, but the area covered by it is still considerably smaller than in the adult. No spread to the medial surface of the thighs. - Stage 5 - Adult in quantity and type with distribution in the classically "male" or "female" pattern. Note: It is most important to grade genital maturation and pubic hair maturation separately. * Classify male genitalia and check appropriate box according to the following: - Stage 1 - Preadolescent. Testes, scrotum, and penis are of about the same size and proportion as in early childhood. - Stage 2 - Enlargement of scrotum and of testes. The skin of the scrotum reddens and changes in texture. Little or no enlargement of penis at this stage. - Stage 3 - Enlargement of penis (occurs at first mainly in length). Further growth of testes and scrotum. - Stage 4 - Enlargement of penis, with growth in breadth and development of glans. Further enlargement of testes and scrotum; increased darkening of scrotal skin. - Stage 5 - Genitalia adult in size and shape. No further enlargement takes place after Stage 5 is reached; it seems, on the contrary, that the penis size decreases slightly from the immediate postadolescent peak. * Classify female breasts and check appropriate box according to the following: - Stage 1 - Preadolescent. Elevation of papilla only. - Stage 2 - Breast bud stage. Elevation of breast and papilla as small mound. Enlargement of areolar diameter. - Stage 3 - Further enlargement and elevation of breast and areola with no separation of their contours. - Stage 4 - Projection of areola and papilla to form a secondary mound above the level of the breast. - Stage 5 - Mature stage. Projection of papilla only due to recession of the areola to the general contour of the breast. * Describe other abnormalities under "Other findings." Record as an undescended testicle only if the testicle cannot be felt either in the inguinal canal or scrotum or if the scrotal development shows no evidence of the testicle ever having descended previously. Retracted testicles due to heightened cremasteric reflex are not to be classified as undescended. * If breasts are not at the same stage, code the right breast in the boxes provided and code the left in "Other findings." Extremities Procedure With examinee supine, examine legs and knees for signs of swelling or deformities by carrying out the following: * Only if examinee is under age 3 - carry out Ortolani's maneuver to check abduction of hips. Ortolani's maneuver: With the infant lying supine, the examiner adducts and abducts the legs. The examiner's thumb rests along the inside and the other fingers extend along the outside of the infant's thigh. The hips and thighs are flexed at 90 degrees and one leg is then abducted with the examiner's fingers gently pressing the trochanter of the femur upward and forward. The normal hip in a relaxed infant can be abducted to almost 90 degrees. If dislocation is present, resistance may be felt between 45 and 60 degrees and a click felt as the dislocated femoral head slips into the acetabulum. * Palpate femoral pulsations simultaneously, and auscultate femoral arteries for presence of bruits. * Palpate dorsalis pedis pulsations simultaneously. * Inspect lower extremities for presence of ulcerations. * Test for edema by pressing thumb behind medial malleolus, over dorsum of foot and over shin. * Only if examinee is eighteen years or older, do straight leg raising test as follows: - Raise right leg to a 45 degree angle with knee extended and with foot in normal position, - If pain is not elicited, dorsiflex the foot, - Repeat with left leg. Note: If pain is elicited at any stage in this test, do not continue on that side. Recording of Findings and Definitions * Femoral pulsation - If pulsations are unequal, consider greater one to be normal. Record character of pulsation by checking appropriate box. Check "Yes" box if bruit is present, "No" box if not. * Dorsalis pedis pulsations - If pulsations are unequal, consider greater one to be normal. Record character of pulsations by checking appropriate box. * Leg ulceration - An open sore with loss of substance, sometimes accompanied by formation of pus. Check "Right" and/or "Left" box if present, "No" box, if not. * Edema - Record only if there is indentation of skin or soft tissue (pitting edema) by checking appropriate box: - Mild -- Pitting edema over medial malleolus and dorsum only. - Moderate -- Pitting edema up to mid-tibial line. - Severe -- Pitting edema above mid-tibial line. - None -- If there is swelling but no pitting, record as none. * Straight leg raising - Record as "Abnormal" if either straight leg raising test of right or left leg produces pain. Leave appropriate ankle dorsiflexion blank if straight leg raising test of right or left leg produces pain. Check "Yes" box if pain occurs on dorsiflexion of foot. Record as "Normal" and check "No" box if test produces no pain. * Describe other abnormalities under "Other." Joints 3Procedure If examinee is less than 10 years old, skip to Section N. With examinee in supine position test range of motion of lower extremity in a single movement. * Ask examinee to bend right knee to chest, placing right foot on left patella. Rotate hip externally and then internally by pulling knee laterally and then medially. * Repeat with left leg. With examinee seated, test range of motion of upper extremity in a single movement. * Ask examinee with arms straight to raise both hands over head, then place both hands behind neck with elbows out, and finally place hands behind small of back. If examinee is under 18 years of age, inspect wrists for signs of deformity due to epiphysial enlargement. Recording of Findings and Definitions * In carrying out range of motion tests observe examinee for evidence of any problems of tenderness, swelling, deformity of the joints, limitation of motion, paralysis or muscle weakness. Check all the boxes appropriate to findings indicating whether condition found is on right, left or both extremities. * Epiphysial enlargement of wrists - This can be more easily felt than seen and should be recorded by checking the "yes" box, particularly if present at the ulnar epiphysis. * If pain is elicited on any of the range of motion tests, stop immediately and record findings as much as possible. Under "Other" explain why you stopped range of motion test. * Specify under "Other" any congenital anomaly, joint injury, prosthesis, amputation, or other joint manifestation. Neurological Evaluation Procedure With examinee seated, test the following: * Coordination - Hand-wrist pronation, supination. Ask examinee to hold hands out in front of him and turn them over and back rapidly several times. * Sensory - Assess vibratory sensation using a tuning fork, asking examinee to tell what is felt and when sensation stops. Test on bony prominence of wrist and ankle on each side. * If no weakness is noted while examining the joints or doing the straight-leg raising, assess whether there is generalized muscle weakness or paralysis of arms and legs. * Speech evaluation - Throughout entire exam, note examinee's oral responses for evidence of stuttering, stammering, or other defects. * Tendon reflexes - Locate patellar tendon and tap it briskly just below patella to elicit knee jerk. Test both knees. - If reflexes are underactive, reinforce by having examinee lock hands and pull. Recording of Findings and Definitions * Coordination - Indicate any uncoordinated movements, or other abnormalities, e.g., tics, tremors, etc., by checking "Abnormal." If no abnormalities noted, check "Normal." * Sensory - Indicate if vibrations are not felt by checking right and/or left boxes as appropriate. If response is elicited and equal check "Normal." If responses are correct check "Normal." * Muscles - Check appropriate box if weakness is noted. Identify paralysis and indicate which extremity in space provided. * Speech evaluation - Check "Yes" box if speech is abnormal. use "Stuttering" box if this is noted; all other speech impediments such as slurred speech, lisp, aphasia should be described. * Tendon reflexes - "Yes" box is used only if knee reflexes are absent on both sides. If one or both are present check "No" box. If hyperactive or other abnormality noted, describe under "Other." Skin Evaluation Procedure While conducting the examination, the skin on the arms, legs, and hands and face will have been inspected. If there is need for rechecking any particular area, do it now to complete the evaluation of the examinee's skin. Recording of Findings and Definitions * Indicate presence of any of the specific skin abnormalities by checking "Yes" box. If not found check "No." * Follicular hyperkeratosis, of arms and of upper back: This lesion has been likened to "gooseflesh" which is seen on chilling, but is not generalized and does not disappear with brisk rubbing of the skin. Readily felt, it presents a "nutmeg grater" feel. Follicular hyperkeratosis is more easily detected by the sense of touch than by the eye. The skin is rough, with papillae formed by keratotic plugs which project from the hair follicles. The surrounding skin is dry and lacks the usual amount of moisture or oiliness. Differentiation from adolescent folliculosis can usually be made by recognition of the normal skin between the follicles in the adolescent disorder. Follicular hyperkeratosis is distinguished from perifolliculosis by the ring of capillary congestion which occurs about each follicle in scorbutic perifolliculosis. * Hyperpigmentation, hands and face: Asymptomatic with no inflammatory component. The skin shows increased coloration due to deposition of pigments, seen most frequently on the dorsum of the hands and lower forearms, particularly when skin hygiene is poor. There is not the sharp line of demarcation at the border of the lesion such as one sees in pellagra. Also, not to be confused with sun tan. Any other abnormality of pigmentation should be noted and described under "Other." * Dry or scaling skin (xerosis): Xerosis is a clinical term used to describe a dry and crinkled skin which is made more obvious by pushing the skin parallel to the surface. In more pronounced cases it is often mottled and pigmented and may appear as scaly or alligator-like pseudoplaques, usually not greater than 5 mm in diameter. The nutritional significance of it is not established. Differential diagnosis must be made between this condition and changes due to dirt, exposure, and ichthyosis. * Perifolliculosis: Congestion around the follicles which does not blanch upon pressure. (See discussion of follicular hyperkeratosis above.) There is an early ring of capillary engorgement around some hair follicles which does not disappear on pressure. It is more frequently encountered on the dependent parts such as the legs. Swelling and hypertrophy of the follicles may occur, at which time the skin becomes rough. Follicular hyperkeratosis may coexist. (This is indicated as perifolliculitis on the exam form.) * Petechiae: Minute hemorrhages under the skin which do not blanch with pressure. Record petechiae which you as a physician judge to be due to abnormalities of the examinee. Do not record normal responses to minor trauma as positives. Qualify by describing distribution and severity. * Mosaic skin: This is usually found on the lower legs and constitutes a dry, atrophic alteration of the skin with a mosaic-like pattern and a certain luster of the surface. It is associated with conditions where the superficial layers of the skin are subject to stretching (increased tension) due to underlying edema, e.g., in protein deficiency. * Pellagrous dermatitis: Areas of dry dermatitis-like lesions on the dorsal surface of hands, cheeks, forehead, and if exposed, on the neck (Casals necklace). * Ecchymoses: Small hemorrhage spots, larger than petechiae, in the skin or mucous membrane forming a nonelevated rounded or irregular, blue or purplish patch. Report ecchymoses which you as a physician judge to be due to abnormalities of the examinee. Do not report normal responses to known minor trauma. * Spider Angioma: A tumor whose cells tend to form blood vessels looking like a spider which blanch with pressure. * Eczema: A superficial inflammatory process involving primarily the epidermis, characterized early by redness, itching, minute papules and vessels, weeping, oozing and crusting, and later by scaling. * Inflammation: A localized response elicited by injury or destruction of tissues characterized by pain, heat, redness, swelling and loss of function. * Impetigo: A streptococcal infection of the skin characterized by fragile, grouped, pinhead-sized vesicles or pustules that become confluent and rupture early, forming rapidly enlarging and spreading erosions with bright yellow crusts that are attached in the center and have elevated margins. * Scars: Report only scars that are the result of trauma, infection or other similar abnormality. Do not include surgical scars of the face and scalp, extremities, chest, abdomen, etc. These should have been reported in the appropriate section of the examination. * Urticaria: A vascular reaction (hives) of the skin marked by the transient appearance of smooth, slightly elevated patches or wheals which are redder or paler than the surrounding skin and often attended by severe itching. * Infestation: Parasitic attack of the skin by insects or parasitic invasion of the tissues, for example, by helminths. * Describe other abnormalities of skin under "Other." Also describe listed conditions found in greater detail by extent, size, severity, location, etc. Pulse and Blood Pressure Measurement Repeat the pulse and blood pressure measurements using the procedures in Section 1.10. Measure and record only the pulse for examinees less than six years old. Back Procedure With examinee standing: * Inspect spinal profile, observing normal concave cervical, convex thoracic, and concave lumbar curves. * Inspect spine for lateral curvature. * Palpate spinous processes, sciatic notch and sacroiliac area for tenderness and spasm. * Test range of motion of lower spine by: - Asking examinee to bend knees slightly and touch toes. Note symmetry and ease of movement. - While stabilizing the examinee's pelvis with your hands have the examinee bend sideways and backwards and twist trunk. - Have examinee flex chin to chest, and then to extend head backward. Note: Do last part of this test cautiously if examinee is over 55 years old. Recording of Findings and Definitions * Scoliosis - Lateral curvature of the spine. Usually consists of two curves, the original one and a compensatory curve in the opposite direction. * Kyphosis - Exaggeration of angulation of normal posterior curve of spine or excessive curvature of the spine with convexity backward. * Lordosis - Abnormal anterior convexity of the spine. * Record abnormal findings by checking "Yes" boxes as appropriate. Check "No" box if no abnormality is found. Gait Procedure * Assess examinee's gait as he/she enters the room and during the entire examination. Gait should be relaxed with easy alternate arm swing. Face and head should lead rest of body on turns. * Examine lower extremities for evidence of bowed legs, knock knees, and varicose veins. Recording of Findings and Definitions * If examinee shows abnormality of gait such as staggering, limping, dragging one foot, shuffling, etc., check "Not normal" box. * Bowed legs (genu varum) - Bilateral concave deformities of the thighs and tibiae should be recorded, even if mild. * Knock knees (genu valgum) - Bilateral convex deformities of the knees and tibiae should be noted only if marked. * Varicose veins - Enlarged twisted veins of the lower legs. If present, record severity by checking the appropriate box for the affected leg(s): - Severe -- Varicosities with ulcerations, discolorations, swelling and edema. - Moderate -- Varicosities with discoloration and possibly swelling but no ulcerations. - Mild -- Simple varicosities with no other complication. - None -- No varicosities. * If no problems are evidenced, check "Normal" box. Health Status Procedure This is the examining physician's subjective impression of the health status of the examinee. Recording of Findings and Definitions On the basis of your examination and observation indicate your subjective opinion of the examinee's health status. Is it "excellent," "very good," "good," "fair," or "poor?" Check the box corresponding to your opinion. Nutritional Status Procedure This is the examining physician's subjective impression of the nutritional status of the examinee. Recording of Findings and Definitions Indicate your subjective opinion regarding your judgment of the examinee's nutritional status. Is it "Normal nutrition," or "Abnormal nutrition?" Check the box that indicates your judgment. Weight Status Procedure This is the examining physician's impression of the weight status of the examinee. Recording of Findings and Definitions Indicate your subjective opinion regarding your judgment of the examinee's nutritional status. Is it "Obesity," "Normal weight," or "Underweight?" Check the box that indicates your judgment. Diagnostic Impressions and Health Care Needs Procedure General The purpose of this page of the exam form is to identify the health status of the examinee. Current disorders, whether now receiving care or not, which require continuing physician care are to be noted and characterized. Based on the limited information that is available to the physician from the review of the Sample Person Questionnaire and the physical exam, give your impression of health care needs for conditions that appear to have any of the following characteristics: * Potentially or presently life threatening, or * Causing loss of functioning; or limitation of activity for the previous three months or longer, or * On a potentially downward course. As stated in Section 1.3 of this appendix, the second objective of the physician's examination is to list the conditions found on examination. The conditions to be coded include only those the physician finds from the history or examination. Do not code or list any condition that you learn about from other MEC staff members. The conditions that you code are to be characterized according to the type of condition, the basis for the judgment of the condition, the confidence in this determination, the severity of the condition, and whether or not a physician has been consulted about this condition. Central to this characterization is the assigning of ICD codes to the identified condition. ICD coding is important because it provides numerical abbreviations for the major conditions observed. These codes facilitate computer analysis of the conditions which will then be compiled and be compared to previous NHANES data. You will be looking up a condition you discover in the exam, finding the correct ICD code and entering it in the space provided. Only conditions which are either life threatening, or disabling, or are on a downward course should be listed and coded. Therefore, conditions such as transient upper respiratory infections, allergic rhinitis, and other minor or corrected conditions are not to be coded or listed, since they do not fit the criteria described above. The International Classification of Diseases (ICD) 1975 revision is in two volumes. These manuals contain listings of conditions along with the four digit ICD code. They are described below. Volume I: Tabular List Volume I, the Tabular List, should be regarded as the primary coding tool. It is arranged in 17 main sections which deal first with diseases caused by well-defined infective agents; these are followed by category sections for neoplasms, and endocrine, metabolic, and nutritional diseases. Most of the remaining diseases are arranged according to their principal anatomical site, with special sections for mental diseases, complications of pregnancy and childbirth, certain diseases originating in the perinatal period, and ill-defined conditions including symptoms and a chapter of injuries or trauma. The 17 chapters are further divided into sections, categories and subcategories. The titles of these chapters are as follows: I. Infectious and Parasitic Diseases II. Neoplasms III. Endocrine, Nutritional and Metabolic Diseases, and Immunity Disorders IV. Diseases of the Blood and Blood-forming Organs V. Mental Disorders VI. Diseases of the Nervous System and Sense Organs VII. Diseases of the Circulatory System VIII. Diseases of the Respiratory System IX. Diseases of the Digestive System X. Diseases of the Genitourinary System XI. Complications of Pregnancy, Childbirth, and the Puerperium XII. Diseases of the Skin and Subcutaneous Tissue XIII. Diseases of the Musculoskeletal System and Connective Tissue XIV. Congenital Anomalies XV. Certain Conditions originating in the Perinatal Period XVI. Symptoms, Signs and Ill-Defined Conditions XVII. Injury and Poisoning The Tabular List also contains the Supplementary Classification of External Causes of Injury and Poisoning (E Code) which is used in preference to a code from Chapter XVII in classifying the underlying cause of death. The ICD-9 Tabular List (Volume I) for the Disease and Nature of Injury Classification makes use of certain abbreviations, punctuation, symbols, and other conventions which need to be clearly understood. Abbreviations NOS: Not otherwise specified. This abbreviation is the equivalent of "unspecified." Punctuation Brackets are used to enclose synonyms, alternative wordings, or explanatory phrases. () Parentheses are used to enclose supplementary words which may be present or absent in the statement of a disease without affecting the code number to which it is assigned. They are also used to enclose numeric codes in the inclusion and exclusion notes and at the end of certain terms. Colons are used in the Tabular List after an incomplete term which needs one or more of the modifiers which follow in order to make it assignable to a given category. Braces are used to enclose a series of terms, each of which is modified by the statement appearing at the right of the brace. Symbols Daggers are used to indicate categories or subcategories for underlying cause of death use when the categories are subject to dual classification. * Asterisks are used to indicate categories and subcategories for morbidity or hospital use when the categories are subject to dual classification. Notations Includes: This note is used to further define or give examples of the content of material. This note sometimes appears under the chapter title, but most frequently appears under the section title or the category title. Excludes: This note is used to indicate terms which are classified elsewhere. It appears under chapter titles, section titles, category titles, and also under subcategories within the classification. Volume II: Alphabetic Index This volume is the Alphabetic Index to Volume I, Diseases: Tabular List, of the International Classification of Diseases, 9th Revision. The Alphabetic Index is an important supplement to the Tabular List since it contains many diagnostic terms which do not appear in Volume I. Terms listed in the categories of the Tabular List are not meant to be exhaustive; they serve as examples of the content of the category. The Index, however, includes most diagnostic terms currently in use. Arrangement The Alphabetic Index is divided into three sections: * Section I, Index to Diseases and Injuries: This section contains terms referring to diseases (categories 001-799), and injuries (categories 800-999, except for poisonings by drugs and chemicals), see pages 3-532. * Section II, Alphabetic Index to External Causes of Injury (E Code): This section is not used for HHANES. It contains external causes responsible for death. These terms are not medical terms, but usually terms which describe the circumstances under which an accident or an act of violence occurred. External causes include accidents, homicide, suicide, therapeutic misadventures, as well as deaths due to operations of war. * Section III, Table of Drugs and Chemicals: This table gives the code numbers for drugs, medications, and other chemical substances as the cause of poisoning. This section is not used for HHANES. Conventions Many of the conventions used in the Tabular List (Volume I) are lso used in the Index (Volume 2). NEC Not elsewhere classifiable. The category number for the term including NEC is to be used only when the coder lacks the information necessary to code the term to a more specific category. () Parenthesis are used to enclose supplementary words which may be present or absent in the statement of a disease without affecting the code number to which it is assigned. They are also used to enclose numeric codes in the inclusion and exclusion notes and at the end of certain terms. /* Daggers and asterisks are used to indicate categories or subcategories subject to dual classification. The dagger (/) indicates etiology and the asterisk (*) indicates manifestation. #/ These symbols direct the coder to special notes and instructions for coding neoplasms. As stated above, Volume I, the Tabular List, should be regarded as the primary coding tool. Volume II, the Alphabetical Index, is used simply as a means to direct the user to the appropriate category in Volume I. Reference should always be made back to Volume I to ensure that the code given by the Index fits the circumstances of a particular case. The Index is organized in the form of lead terms, which start at the extreme left column, and show various levels of indentation, progressing further and further to the right. A complete index term, therefore, may be comprised of several lines, sometimes quite widely separated. The lead term is usually the name of a disease or pathological condition. The terms indented underneath are either varieties of the condition, or anatomical sites affected. EXAMPLES: Congenital myocardial insufficiency is indexed: Insufficiency myocardial congenital 746.8 Senile brain disease is indexed: Disease brain senile 331.2 Acute appendicitis is indexed: Appendicitis acute 540.9 The index includes many cross-references. Cross-referencing by synonyms, closely related terms and code categories begin with "see" and "see also." "See" is an explicit direction to look elsewhere for the code assignment. "See also" directs the coder elsewhere if all the information is not listed under the main entry. Reference may be to another entry in the Index or to a category in Volume I. EXAMPLES: Paralysis, paralytic - cerebral --spastic infantile - see Palsy, cerebral It is necessary to refer to Cerebral palso for the code. Other modifiers may be found indented under "Cerebral palsy." Addiction - drug - (see also Dependence) 304.9 The Index indicates that if the only condition on the report is "drug addiction," the code is 304.9, but if any other information is present, such as a specified drug, the term "Dependence" should be looked up. Enlargement, enlarged - see also Hypertrophy - adenoids (and tonsils) 474.1 - alveolar ridge 525.8 etc. If the coder does not find the site of the enlargement among the indents beneath "Enlargement," he should look among the indents beneath "Hypertrophy" where a more complete list of sites is given. Anatomical sites and very general adjectival modifiers are not normally used as lead terms in the Index. Anatomical sites and some modifiers are listed with the note "see condition." This instructs the coder to look for the condition or disease (lead term) in the Index. The introduction of the Index contains more detailed explanations about the use of the Index, its general arrangements and conventions used. Steps for ICD Coding The following steps should be followed for ICD coding: 1. While the examinee is present write a complete description of the condition under item a. Complete the information requested for items b-e explained. 2. After the examinee has left the room, locate the main term for the listed condition in the Alphabetic Index (Volume II). 3. Refer to any notes under the main term. 4. Refer to any modifiers of the main term. 5. Refer to any subterms indented under the main term. 6. Follow any cross-reference instructions. 7. Verify the code number in the Tabular List (Volume I). 8. Read and obtain guidance from any instructional terms in the Tabular List. 9. Assign the code thus obtained. 10. Write in the code using three digits or four digits as listed, with a decimal point after the third digit, if appropriate. Check to make sure these entries are legible. For quality control purposes, a percentage of the codes will be checked by NCHS and by Westat. You will receive feedback on your coding based on the quality control checks. What Conditions to Code Code all conditions that fall into any one of the following categories: * Potentially or presently life threatening, or * Causing loss of functioning or limitation of activity for the previous three months or longer, or * On a potential downward course. Conditions included in these criteria are controlled and uncontrolled hypertension, controlled and uncontrolled diabetes, cancer that has been treated within the past five years, crippling arthritis, severe asthma, and similar other conditions. Conditions which are excluded are successful heart valve implant, corrected cleft palate, minor deformities such as flat feet, fallen arches, minor arthritis, colds, hay fever, and other similar trivial conditions. Recording of Findings and Results * Conditions: Write the name of the suspected condition which requires health care. Diagnostic impressions may be on the basis of the physical exam and/or the history (S.P.Q.). Not all findings should be listed, only those deemed significant in relation to the criteria detailed in Section 1.25.1. * If no conditions are presented that are included in the criteria, check the box next to "None" and go to the next page of the examination form. * Basis for Judgment: Mark the appropriate box according to whether the condition is determined from the Adult or Child Sample Person Questionnaire, physician's exam or both. * Confidence in Assessment: Indicate the certainty of each condition as to whether it is certain, likely, or uncertain. * Severity of Condition: For each listing, indicate the seeming severity of each, checking whether it appears to be mild, moderate, or severe. This will be strictly subjective and based on your own appraisal. Should there arise some difficulty in deciding between two of the possible classifications, the lesser should be selected. All conditions listed are not to be considered severe despite the criteria listed earlier (the criteria do not include severity). For example, an examinee with a blood pressure of 132/92 should be listed as having hypertension with the severity coded as "Mild." If an examinee with the same reading as above has a history of hypertension, is taking medication, and has seen a physician recently, the severity code would depend on the types and dose(s) of medication(s). A third example of a hypertensive examinee is one whose blood pressure is 148/96. For this examinee the condition should be coded as "Severe." For a diabetic examinee who does not take any insulin but who controls the condition with diet, the condition would be coded as "Mild." For a diabetic who is insulin dependent and who has physiological changes due to the diabetes, the code would be "Severe." * Has a Physician Been Consulted Regarding This Condition Within the Last Year? -- If it is known from the medical history that the examinee has seen a physician about a particular condition do not ask this question but check "Yes." -- If it is not clear from the medical history that a physician has been seen for the particular condition. It is important that any existing physician/patient rapport not be disrupted. Also, this information may be sensitive in cases where a condition exists and the physician and/or the family have decided not to reveal the diagnosis to the examinee. To the examinee say, "I'm interested in getting some information about several health conditions. Please tell me if a doctor has ever said you have: (1) cataracts?, (2) diabetes?, (3) arthritis?, (4) (insert the particular condition in question)?". If the examinee has one or more of these mock conditions substitute other mock conditions. Be sure to add some mock conditions in addition to asking about the true conditions. * ICD code for condition: Each condition should be coded according to the Ninth Revision of the International Classification of Diseases, (ICD). These numeric codes will be used to facilitate computer analysis of the conditions. Use the two ICD unabbreviated volumes to locate the condition. Enter the code on the form. * Make sure that the conditions listed are legible and do not use medical shorthand. * This section of the Physician's Exam Form contains space for five conditions to be identified. Additional copies of this page will be available for use when an examinee has more than five conditions. * The physician also must ICD code any dental conditions which meet any of the three criteria (life threatening, or limitation of activity for three months or longer, or on a potentially downward course). Ask the dentist at the end of each exam session if any examinees had any such conditions. Substantiating Comments on Diag. Impressions and Health Care Needs Procedure In this section the physician should write in the Level of Referral for this examinee along with any additional comments about conditions s/he found or changes in medical care s/he would recommend if the examinee were her/his patient. This would include all the abnormalities found or additional diagnoses and treatment. The condition outlined need not be one in which a diagnosis is already available, but may be a collection of symptoms, signs, etc. The levels of referral are: Level I - emergency; Level II - needs medical care within one month; Level III - no major medical findings. Also on this page the dentist will record oral soft tissue pathology if it is found during the dental exam and Level II vision referrals. The dentist will record after all the exams for the session are completed. Recording of Findings and Definitions There are three types of information the physician records on this page. They are: * The Level of Referral (I, II or III) for this examinee, check the appropriate box, * Any substantiating comments which relate to the conditions found during the examination, * Any important additional questions that were asked of the examinee, the answers to which were used to determine the diagnosis of the condition. *U.S. GOVERNMENT PRINTING OFFICE:1987-173-732 REFERENCES 1. National Center for Health Statistics: Maurer, K. R. and others: Plan and Operation of the Hispanic Health and Nutrition Examination Survey, 1982-84. Vital and Health Statistics. Series 1, No. 19. DHHS Pub. No. (PHS) 85-1321. Public Health Service. Washington. U.S. Government Printing Office. Sept., 1985. 2. National Center for Health Statistics: McCarthy, P. J.: Replication: An Approach to the Analysis of Data from Complex Surveys. Vital and Health Statistics. Series 2, No. 14. PHS Pub. No. 1000. Public Health Service. Washington. U.S. Government Printing Office. Apr., 1966. 3. Survey Research Center Computer Support Group: OSIRIS IV User's Manual, Institute for Social Research, University of Michigan, Ann Arbor, MI, 1979. 4. Holt, M. M.: SURREGR: Standard Errors of Regression Coefficients from Sample Survey Data. Research Triangle Institute, Research Triangle Park, NC, 1977. (Revised Apr., 1982 by B. V. Shah). 5. Hidiroglou, M. A., Fuller, W. A., and Hickman, R. D.: SUPERCARP. Sixth Edition. Survey Section, Statistical Laboratory, Iowa State University, Ames, IA. Oct., 1980. 6. Woodruff, R. S.: A Simple Method for Approximating the Variance of a Complicated Estimate. Journal of the American Statistical Association, 66:411-414, 1971. 7. Shah, B. V.: SESUDAAN: Standard Errors Program for Computing of Standardized Rates from Sample Survey Data. RTI/5250/00-01S. Research Triangle Institute, Research Triangle Park, NC. Apr., 1981. 8. Helnig, J. T. and Council, K. A., eds.: SAS Users' Guide: Basics. SAS Institute, Inc. Cary, NC, 1982. 9. National Center for Health Statistics: Landis, J. R., Lepkowski, J. M., Eklund, S. A., and Stehouwer, S. A. A Statistical Methodology for Analyzing Data from a Complex Survey: The First National Health and Nutrition Examination Survey. Vital and Health Statistics. Series 2, No. 92. DHHS Pub. No. (PHS) 82-1366. Public Health Service. Washington. U.S. Government Printing Office. Sept., 1982. 10. Kovar, M. G. and Johnson, C.: Design Effects from the Mexican-American Portion of the Hispanic Health and Nutrition Examination Survey: A Strategy for Analysts. Proceedings of the Social Statistics Section, American Statistical Association, 1986 (in press). 11. Freeman, D. H. and Brock, D. B.: The Role of Covariance Matrix Estimation in the Analysis of Complex Sample Survey Data. In N. Krishnan Namboodiri, ed., Survey Sampling and Measurement. Symposium on Survey Sampling, 2d, University of North Carolina. New York, Academic Press, 1978. 12. National Center for Health Statistics: Instruction Manual Part 15h, Household Interviewer's Manual for the Hispanic Health and Nutrition Examination Survey, 1982-84. Hyattsville, MD. 1986. 13. National Center for Health Statistics: Instruction Manual Part 15g, Mobile Examination Center Interviewer's Manual for the Hispanic Health and Nutrition Examination Survey, 1982-84. Hyattsville, MD. 1986. 14. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (DSM-III), Third Edition, Washington, D.C., PA, 1980. 15. Freedman, D. X.: Psychiatric Epidemiology Counts. Arch Gen Psychiatry, 44:931-933, 1984. 16. Holzer, C. E., Eaton, W. W., Von Korff, M., Anthony, J. C., et al.: The Design of the Epidemiology Catchment Area Surveys. Arch Gen Psychiatry, 41:942-948, 1984. 17. Myers, J. K. Weissman, M. M., Tischler, G. L., Holzer, C. E., et al.: Six-month Prevalence of Psychiatric Disorders in Three Communities. Arch Gen Psychiatry, 41:959-967, 1984. 18. Regier, D. A., Myers, J. K., Kramer, M., Robins, L. N., et al.: The NIMH Epidemiologic Catchment Area Program. Arch Gen Psychiatry, 41:934-941, 1984. 19. Shapiro, S., Skinner, E. A., Kessler, L. G., Von Korff, M., et al.: Utilization of Health and Mental Health Services. Arch Gen Psychiatry, 41:971-978, 1984. 20. Robins, L. N., Helzer, J. E., Weissman, M. M., Orvashel, H., et al.: Lifetime Prevalence of Specific Psychiatric Disorders in Three Sites. Arch Gen Psychiatry, 41:949-958, 1984. 21. Boyd, J. H., Burke, J. D., Gruenberg, E., Holzer, C. E., et al.: Exclusion Criteria of DSM-III. Arch Gen Psychiatry, 41:983-989, 1984. 22. Eaton, W. W., Kessler, L. G. (eds.): Epidemiologic Field Methods in Psychiatry: The NIMH Epidemiologic Catchment Area Program. Orlando, Florida: Academic Press, 1985. 23. Anthony, J. C., Folstein, M., Romanoski, A. J., Von Korff, M. R., et al.: Comparison of the Lay Diagnostic Interview Schedule and a Standardized Psychiatric Diagnosis. Arch Gen Psychiatry, 42:667-675, 1985. 24. Helzer, J. E., Robins, L. N., McEvoy, L. T., Spitznagel, E. L., et al.: A Comparison of Clinical and Diagnostic Interview Schedule Diagnoses. Arch Gen Psychiatry, 42:657-666, 1985. 25. Hesselbrock, V., Stabenau, J., Hesselbrock, M., Mirkin, P., et al.: A Comparison of Two Interview Schedules. Arch Gen Psychiatry, 39:674-677, 1982. 26. Klerman, G. L.: Diagnosis of Psychiatric Disorders in Epidemiologic Field Studies. Arch Gen Psychiatry, 42:723-724, 1985. 27. Robins, L. N., Helzer, J. E., Ratcliff, K. S., Seyfried, W.: Validity of the Diagnostic Interview Schedule, Version II: DSM-III Diagnoses: Psychological Medicine, 12:855-870, 1982. 28. Wittchen, H. U., Semler, G., von Zerssen, D.: A Comparison of Two Diagnostic Methods. Arch Gen Psychiatry, 42:677-684, 1985. 29. Weissman, M. M., Sholomskas, D., Pottenger, M., Prusoff, A., et al.: Assessing Depressive Symptoms in Five Psychiatric Populations: A Validation Study. Amer J of Epidemiology, 106:203-214, 1977. 30. Burnam, M. A., Karrio, M., Hough, R. L. Escobar, J. I., et al.: The Spanish Diagnostic Interview Schedule. Arch Gen Psychiatry, 40:1189-1196, 1983. 31. Karno, M., Burnam, M. A., Escobar, J. I., Hough, R. L., et al.: Development of the Spanish-Language Version of the National Institute of Mental Health Diagnostic Interview Schedule: Arch Gen Psychiatry, 40:1183-1188, 1983. 32. Radloff, L. S.: The CES-D Scale: A Self-Report Depression Scale for Research in the General Population. Applied Psychological Measurement, 1:3, 385-401, 1977. 33. Radloff, L. S., Locke, B. Z.: The Community Mental Health Assessment Survey and the CES-D Scale. Community Surveys, (In press), 1985. 34. Comstock, G. W. Helsing, K. J.: Symptoms of Depression in Two Communities, Psychological Medicine, 6:551-563, 1976. 35. Craig, T. J., Van Natta, P. A.: Presence and Persistence of Depression Symptoms in Patient and Community Populations. Am J Psychiatry, 133:12, 1426-1429, 1976. 36. Clark, V. A., Aneshensel, C. S., Frerichs, R. R., Morgan, T. M.: Analysis of Effects of Sex and Age in Response to Items on the CES-D Scale, Psychiatry Research, 5:171-181, 1981. 37. Eaton, W. W., Kessler, L. G.: Rates of Symptoms of Depression in a National Sample. Amer J of Epidemiology, 114:4, 528-538, 1981. 38. Frerichs, R. R., Aneshensel, C. S., Clark, V. A.: Prevalence of Depression in Los Angeles County. Amer J of Epidemiology, 113:6, 691-699, 1981. 39. Roberts R. E., Vernon, S. W.: The Center for Epidemiologic Studies Depression Scale: Its use in a Community Sample. Am J Psychiatry, 140:1, 41-46, 1983. 40. Vernon, S. W., Roberts, R. E.: Prevalence of Treated and Untreated Psychiatric Disorders in Three Ethnic Groups. Soc Sci Med., 16:1575-1582, 1982. 41. Vernon, S. W., Roberts, R. E., Lee, E. S.: Response Tendencies, Ethnicity, and Depression Scores. Amer J of Epidemiology, 116:482-495, 1982. 42. Roberts, R. E.: Reliability of the CES-D Scale in Different Ethnic Contexts. Psychiatry Research, 2:125-133, 1980. 43. Boyd, J. H., Weissman, M. M., Thompson, W. D., Myers, J. K.: Screening for Depression in a Community Sample. Arch Gen Psychiatry, 39:1195-1200, 1982. 44. Husaini, B. A., Neff, J. A., Harrington, J. B., Hughes, M.D., et al.: Depression in Rural Communities: Validating the CES-D Scale. J of Community Psychology, 8:20-27, 1980.
