Scientific Data DocumentationPhysician's Exam, Ages 6 months - 74 years (1976-1980)DSN: CC37.HANES2.PHYSEXAM ABSTRACT Description of Survey A detailed description of the design, content, questionnaires, and operation of NHANES II is provided in the following report: Plan and Operation of the Second Health and Nutrition Examination Survey, 1976-1980, DHHS Pub. No. (PHS) 81-1317 Series 1, No. 15, Public Health Service, Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402. The stock number is 017-022-00752-5 and the cost is $5.50. One copy is provided with the documentation herein, and a general summary of the data collection techniques and content is given in Appendix A.TARGET POPULATION NHANES II was conducted on a nationwide probability sample of approximately 28,000 persons, ages 6 months-74 years, from the civilian, noninstitutional- ized population of the United States. The survey started in February 1976 and was completed in February 1980. The NHANES II sample was selected so that certain population groups thought to be at high risk of malnutrition (persons with low incomes, preschool children and the elderly) were oversampled. Adjusted sampling weights were then computed for 76 age, sex,and race categories in order to inflate the sample in such a manner as to closely reflect the estimated civilian noninstitutionalized U.S. population ages 6 months-74 years at the midpoint of the survey (March 1, 1978).DATA COLLECTION TECHNIQUES AND CONTENT The plan developed with respect to the content of NHANES II called for the following: A. Questionnaires completed in the household: (1) Household questionnaire: For each household member, questions referred to family relationships;certain demographic items such as age, sex, and race; selected housing information;occupation, income, education, veteran status; and an indication of participation in food stamp programs. (2) Medical history questionnaires: (a) For each sample person ages 6 months-11 years The questionnaire included items on birth weight, prematurity,congenital conditions, medication, neurological conditions, lead poisoning, accidents, hospital care, disability, diarrhea, pica, vision, and a variety of chronic conditions. In addition, data were collected on allergies, kidney and bladder disease, anemia, speech and hearing, lung and chest conditions, and participation in food programs. (b) For each sample person ages 12-74 years The questionnaire included items on medication; hospital care; tuberculosis; a variety of acute and chronic diseases; tobacco usage, physical activity; weight; height; vision disability, exposure to pesticides; gastrointestinal problems; and for females; a menstrual and pregnancy history. In addition, data were collected on anemia, diabetes, respiratory condition, hearing and speech, liver and gallbladder conditions, kidney and bladder disease, allergies, hypertension, cardiovascular conditions, stroke, arthritis (stressing middle and upper back and neck problems), and participation in food programs. Questionnaires and tests administered in the mobile examination center: (3) Dietary Questionnaires (a) For each examined person, a 24-Hour Recall was administered by trained dietary interviewers. Specific and quantitative detail of every food or drink consumed during the previous day was recorded and calculated, thus providing estimates of calories, protein, carbohydrates, fat, unsaturated fats, cholesterol, and specific vitamins and minerals consumed. (b) For each examined person, a Food Frequency interview was administered to ascertain usual patterns of food consumption. Daily and/or weekly consumption of foods within 26 subgroups were recorded. In addition, data were collected on usual vitamin-mineral supplement usage. (c) For each person ages 12-74 years, a Dietary Supplement form was self-administered and reviewed. This form provided information on special diets, recent medications and barriers to purchasing groceries or eating foods; it does not provide information on vitamin/mineral or other supplements to the diet. (4) Medication/Vitamin Usage Form provided information on the past week's usage of any medicines; vitamins or minerals for al examined persons. (5) Behavior Questionnaire elicited data on behavior which may be associated with coronary heart disease for examined persons ages 25-74. B. Examination by physician A physician performed and recorded the results of a medical examination giving special attention to specified findings related to nutrition, to hearing, to the thyroid gland,and to the cardiovascular, respiratory, neurological and musculoskeletal systems. C. Special clinical procedures and tests A specially trained health technician carried out the following on examined persons in the designated age ranges: 1. Spirometry trials of examined persons ages 6-24 years, were digitized and recorded on magnetic tape. Various pulmonary function indicators such as FVC (forced vital capacity), FEV1 (forced expiratory volume in one second), and peak flow rate were subsequently derived from these data. 2. Electrocardiograms Electrocardiographic signals of examined persons ages 25-74 years were digitized and recorded on magnetic tape providing normative data of amplitude, duration, interval and axis measurements and permitting interpretations of heart disease according to the Minnesota classification code. 3. Body Measurements were made on all examinees and included standing height, body weight, triceps and subscapular skinfolds, and several other anthropometric measurements. 4. Puretone audiometry Tests were carried out on examined persons between the ages of 4 and 19 years, permitting determination of threshold levels of hearing for frequencies of 500, 1000, 2000, and 4000 Hertz for right and left ears. 5. Speech recording, involving use of tape recording of the subject's repetition of specially developed sentences,was carried out on examined persons between the ages of 4 and 6 years, permitting interpretations as an indication of problems with articulation and language development. 6. Allergy tests, involving skin tests (prick test) with eight common allergens (housedust, alternaria, cat fur, dog fur, ragweed, oak, rye grass, and Bermuda grass).The tests were made on examined persons between the ages of 6 and 74 years, to obtain degrees of skin reaction. D. X-Rays For examined persons ages 25-74 years, two x-rays were made. No x-rays were taken of pregnant women and no lumbar x-rays were taken on women under 50 years of age. 1. X-ray of cervical and lumbar spine, were taken to provide evidence of osteoarthritis and degenerative disc disease, and 2. X-ray of chest, to be used in the diagnosis of respiratory diseases and to serve as a measure of left ventricular enlargement. E. Urine tests Tests as follows were performed on casual samples of urine: 1. N-Multistix tests for qualitative protein, glucose, ketones, bilirubin, blood, urobilinogen, pH, and bacteriuria (nitrite test) were done for examined persons ages 6-74 years. 2. Urinary sediments, including red cells, white cells, and casts, were measured for a subsample of examined adults ages 20-74 years. 3. Gonorrhea cultures, of urinary sediments were performed for male and female examined persons ages 12-40 years. However, of those females who received the Glucose Tolerance Test (GTT) only those ages 20-24 years had the gonorrhea test performed. 4. Analyses for pesticide residue and metabolite levels,were carried out on a subsample of examined persons ages 12-74 years, including measures of the body burdens from exposure to alkyl phosphate residues and metabolites, carbamate residues, phenolic compound residues and malathion metabolites. F. Tests on blood samples Samples of blood provide a broad range of information related to health and nutrition. The particular tests performed varied with the specific target condition and age group as described in the Series 1, No.15 program description (page 39). 1. Glucose tolerance test (GTT) This test involved collection of blood specimens while in a fasting state, as well as at one and two hours after glucose challenge. The test was performed on a specified subsample of examined adults to provide estimates of the prevalence of diabetes. 2. Tests related to liver function (a) Post-prandial liver bile acid test. This test measures the ability of the liver to remove bile acids from the blood following consumption of a food preparation which induces eventual addition of bile acids to the blood via contraction of the gallbladder. (b) Liver biochemistries performed include bilirubin, SGOT, and alkaline phosphatase tests. 3. Anemia-related laboratory tests The tests made to characterize anemia consisted of protoporphyrin,iron,total iron binding capacity (TIBC), zinc, copper, red cell folates, serum folates, serum ferritin, B12, and the determination of abnormal hemoglobin. 4. Other nutritional biochemistries These tests include albumin,Vitamin A and Vitamin C. 5. Serum lipids Because of their important relevance to cardiovascular disease, determinations were made of cholesterol, triglycerides, and high density lipoprotein (HDL). 6. Biochemistries for body burden from environmental exposures Determinations were made of body burden levels of lead and pesticide residues and metabolites.Tests were also performed for carboxyhemoglobin which reflects environmental exposure to carbon monoxide and the individual's smoking habits. 7. Hematology The hematology included determinations of hemoglobin, hematocrit,red blood cell count,white blood cell count and differential leukocyte analysis, and red blood cell morphology and hemoglobin phenotyping. 8. Kidney function The only quantitative test for kidney function performed on blood samples was the serum creatinine test. 9. Syphilis The serology determinations for syphilis included qualitative and quantitative ART, a FTA-ABS and MHA-TP.USE OF NHANES DATA NCHS requests the cooperation of recipients of data tapes in certain actions related to their use: 1. Any publication based on the data should acknowledge the National Center for Health Statistics (NCHS) as the original source.It should include a disclaimer which credits the authors for any analyses, interpretations, or conclusions, and not NCHS, which is responsible only for the data. 2. Consumers who wish to publish a technical description of the data should make a reasonable effort to ensure that the description is not inconsistent with that published by NCHS.This does not mean, however, that NCHS will review such descriptions. 3. The National Center for Health Statistics would appreciate receiving reprints of journal articles or other publications based upon find- ings from the NHANES II survey. Please forward copies to: Division of Health Examination Statistics National Center for Health Statistics Center Building, Room 2-58, 3700 East-West Highway Hyattsville, Maryland 20782EDITING OF THE DATA SETS The data users' tapes have been subjected to a great deal of careful editing. Some of the continuous data items have extremely high or low values and it has been verified that they do in fact appear that way on the original inter- view documents; that is, it has been verified that the values have not been incorrectly keyed.Within each data tape numerous consistency checks have been performed. However, due to the large volume of data collected in the survey, it is likely that a small number of errors or discrepancies remain undetected. The Division of Health Examination Statistics, NCHS would appreciate if any such errors are detected that they be brought to our attention so that errata sheets can be issued to previous purchasers and corrections made if new data tapes are created.USE OF SAMPLE WEIGHTS NHANES II uses a multistage sample designed to represent the civilian noninstitutionalized population of the United States,6 months-74 years of age. Since the sample is not a simple random one, it is necessary to incorporate the person's sample weight for proper analysis of the data.The sample weight is a composite of the individual selection probability, adjustments for nonresponese, and poststratification adjustments. NHANES II provides information on 20,322 interviewed and examined individuals. In addition to the general examination components, several more detailed examinations were performed on subsamples of the population. Therefore, instead of there being one sample weight per person,there are several sample weights for each person. If a person was not selected for a particular subsample, their associated subsample weight is zero. When analyzing the special subsamples, the analyst must be careful to select the appropriate sampling weight from the weights found in tape locations 282-317. For a more complete description of how the sample weights are calculated, see the detailed note section of this documentation.SAMPLE DESIGN, VARIANCE ESTIMATION, AND HYPOTHESIS TESTING The data collected in the Second National Health and Nutrition Examination Survey (NHANES II) were obtained through a complex sample design involving both clustering and stratification.Because of the complex design and the ratio adjustments applied to the sample weights (see previous section on use of sample weights), the direct application of standard statistical analysis methods for variance estimation and hypothesis testing may be very misleading. The modification of statistical analysis procedures to incorporate the effects of complex survey designs is an important area of research;however, the current methodologies appropriate for the analysis of data from such surveys have not been made readily available in the standard packaged statistical software. There are computer programs available which do provide the capability of variance estimation for complex sample designs. The balanced repeated replication approach 1/ is utilized in &REPERR-&PSALMS-OSIRIS.IV 2/ to calculate the variance-covariance matrix.SESUDAAN, SURREGR 3/ and SUPERCARP 4/ are programs that calculate the variance-covariance matrix using the linearization approach 5/ (Taylor series expansion). In order to provide the user with the capability of estimating the complex sample variances in the NHANES II data using the above procedures, we have provided Strata and Pseudo Primary Sampling Unit (PSU) codes on all data tapes in positions 324-326. These variables and the sample weights are necessary for the calculation of variances. Even though the overall number of examined persons in this survey is quite large for statistical inference purposes, subclass analyses can lead to estimaters that are unstable, particularly estimates of variances. Consequently, analyses of subclasses require that the user pay particular attention to the coefficient of variation for the estimates of means, proportions and totals.In addition, small sample sizes, or a small number of PSU's used in the variance calculations may produce unstable estimates of the variances using the above computer programs. An NCHS Series 2 publication discussing these issues is in publication.6/ REFERENCES 1. National Center for Health Statistics: Replication an Approach to the Analysis of Data from Complex Surveys by P.J. McCarthy. Vital and Health Statistics Series 2-No. 14. DHEW Pub. No.(PHS) 79-1269. Public Health Service. Washington, D.C. U.S. Government Printing Office, 1966. 2. Survey Research Center Computer Support Group, OSIRIS IV User's Manual, Institute for Social Research, 1979. 3. Holt, M.M.: SURREGR: Standard errors of regression coefficients from sample survey data. (unpublished) Research Triangle Institute, NC, 1977. 4. Hidiruglou, M.A.,Fuller,W.A.,Hickman, R.D.:(SUPERCARP) Survey Section, Statistical Laboratory,Iowa State University. Ames, Iowa. Sixth Edition. October 1980. 5. Woodruff, R.S.: A simple method for approximating the variance of a complicated estimate. JASA 66:411-414, 1971. 6. National Center for Health Statistics: A General Statistical Methodology for the Analysis of Data from a Complex Survey: NHANES I by J.R. Landis, J.H. Lepkowski, S.A. Stehouwer, and S.A. Eklund. Vital and Health Statistics, Series 2. (In publication)GENERAL NOTES, DEMOGRAPHIC INFORMATION, NHANES II An advance letter, announcing the forthcoming arrival of an interviewer from the U.S.Bureau of the Census,was mailed to each household that fell into the NHANES II probability sample. The interviewer subsequently visited the household to ascertain its composition and to administer a questionnaire,the primary purpose of which was to obtain demographic information. The questionnaire was administered to each potential sample person in each household that was available and competent enough to respond to questions.In the event that a potential sample person was not at home at the time of interview, any responsible adult in the household was asked to respond to the questions for the absent person.DEMOGRAPHIC DATA SUMMARY - NHANES II Tape Positions 1-33 Tape Positions Sample Sequence Number 1- 5 Catalog Number (5371-for Demographic Data only) 6- 9 Data user work area 10 Size of place 11 SMSA-not SMSA 12 Data user work area 13-23 Type of living quarters 24 Land usage 25 If rural, asked does this place have 10 acres or more? 26 If 10 acres or more, asked if in the last 12 months did sales of farm produce and livestock amount to $50 or more? 27 If 10 acres or more, asked to $250 or more? 28 Data user work area 29 Total number of persons in household 30-31 Total number of sample persons in household 32-33 Tape Positions 34-90 Sample Person Data Tape Positions Data user work area 34 Family relationship 35 Data user work area 36 Family unit number 37-41 Data user work area 42-44 Age-months (at interview) 45-46 Age-years (at interview) 47-48 Data user work area 49-50 Date of birth-month 51-52 Date of birth-year 53-54 Sex 55 Race 56 In what state was he/she born? 57-58 Is he/she married, widowed, divorced, separated or never married? 59 Natural origin or ancestry 60-61 Education level 62-63 Grade completed 64 What was he/she doing during most of the past 12 months? 65 What was he/she doing? 66 Did he/she work at a job or business at any time during the past three months? 67 Did he/she work full or part-time when working? 68 Was he/she working within last two weeks not counting work around the house? 69 Even though he/she did not work, does he/she have a job or business? 70 Was he/she looking for work or on layoff from a job? 71 Which, looking for work or on layoff from a job? 72 What kind of industry or business is this? 73- 75 What kind of work was he/she doing? 76- 78 Was he/she in private company or business or individual for wages, salary or commission? 79 Did he/she ever serve in the armed forces of the U.S.? 80 When did he/she serve? 81 Data user work area 82- 90 Tape Positions 91-246 Household Data Tape Positions How many rooms are in this...? Count the kitchen, but not the bathroom 91 How many bedrooms are in this...? 92 Ask only of unrelated household members. Do you have complete kitchen facilities in your living quarters, that is a kitchen sink with piped water, a refrigerator and a range or cookstove? 93 Do you have access to complete kitchen facilities in this house? 94 Do you have access to a range or cookstove? 95 Do you have access to a refrigerator? 96 Do you have access to a sink with piped water? 97 Is there piped water in this house (these living quarters)? 98 Is there both hot and cold water? 99 Are these kitchen facilities used by anyone not living in this household? 100 What is the main type of heating system you have? 101-102 Do you have air conditioning? 103 How many motor vehicles are owned or regularly used for transportation by members of your family? 104 Is any language other than English spoken by family members living here? 105 What language? 106 Which of these income groups represents your total combined family income for the past 12 months? 107-108 During the past 12 months, how much money did you and all members of your family receive in wages or salaries before deductions (under $7,000 only)? 109-112 Social security or railroad retirement? 113 Data user work area 114 If yes, how much? 115-118 Welfare payments or other public assistance? 119 Data user work area 120 If yes, how much? 121-124 Unemployment compensation or workmen's compensation? 125 Data user work area 126 If yes, how much? 127-130 Government employee pension or private pensions? 131 Data user work area 132 If yes, how much? 133-136 Dividends, interest or rent? 137 Data user work area 138 If yes, how much? 139-142 Net income from their own business (nonfarm) professional practice, or partnership? 143 Data user work area 144 If yes, how much? 145-148 Net income from a farm? 149 Data user work area 150 If yes, how much? 151-154 Veteran's payments? 155 Data user work area 156 If yes, how much? 157-160 Alimony, child support or other support from persons not in household? 161 Data user work area 162 If yes, how much? 163-166 Any other income? 167 Data user work area 168 If yes, how much? 169-172 Total amount 173-176 Check Item B 177 Are you certified to participate in the food stamp program? 178 Are you buying food stamps now? 179 What is the main reason you are not participating in the program? 180 Are you certified for commodity distribution program? 181 Are you receiving commodity foods now for your family? 182 Why aren't you participating in the program? 183 Date of exam 184-189 Age in years (at examination) 190-191 Data user work area 192-205 Race-sex recode for sample persons 206 Farm, nonfarm recode for sample person 207 Interview status 208 Region 209 Poverty index 210-212 Data user work area 213-246 Tape Positions 247-281 Head of Household Data Tape Positions Age in years 247-248 Data user work area 249-250 Date of birth-month 251-252 Date of birth-year 253-254 Sex 255 Race 256 In what state was he/she born? 257-258 Is he/she married, widowed, divorced, separated or never married? 259 Natural origin or ancestry? 260-261 Education level 262-263 Grade completed 264 What was he/she doing during most of the past 12 months? 265 What was he/she doing? 266 Did he/she work at a job or business at any time during the past three months? 267 Did he/she work full or part-time when working? 268 Was he/she working within last two weeks not counting work around the house? 269 Even though he/she did not work, does he/she have a job or business? 270 Was he/she looking for work or on layoff from a job? 271 Which?, looking for work or on layoff from a job? 272 Type of industry or business 273-275 What kind of work was he/she doing? 276-278 Was he/she in private company or business or individual for wages, salary or commission? 279 Did he/she ever serve in the armed forces of the U.S.? 280 When did he/she serve? 281 Tape Positions 282-350 Sample Weights Tape Positions Examined final weight 282-287 Medical history interview final weight 288-293 Glucose Tolerance Test final examined weight 294-299 Lead final examined weight 300-305 Carboxyhemoglobin final examined weight 306-311 Bile acids final examined weight 312-317 Data user work area 318-323 Strata code 324-325 Pseudo PSU code 326 Poverty, Nonpoverty segments 327 (Not coded on Intake, Recall, Anthro and Glucose tapes) Data user work area 328-350 1USE OF SPECIAL TERMS, DEMOGRAPHIC DATA, NHANES II The term "data user work area" refers to blank areas in the data tape which are reserved for the user as needed. The term "blank, but applicable",is used to indicate a data item that was to have a response for a sample person but none was given. The terms "blank" and "Not applicable"refer to data items where the sample person was not supposed to respond to the question or receive the examination component. To more fully understand the questionnaire skip patterns and the categorizations used,see the Plan and Operation of the Second National Health and Nutrition Examination Survey document included with this documentation. All the questionnaires are included in this document. RECORD LAYOUT, DEMOGRAPHIC DATA Tape Locations 1-50 NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY - NHANES II DEMOGRAPHIC DATA TAPE NHANES II DATA SOURCE LOC. ITEM DESCRIPTION & CODES OR NOTES 001- Sample Sequence Number 005 00001-27796 006- Catalog Number 009 5371 010 Data User Work Area 011 Size of Place See Detailed Notes 1 - Urbanized area with 3,000,000 or more 2 - Urbanized area 1,000,000 to 2,999,999 3 - Urbanized area with 250,000 to 999,999 4 - Urbanized area under 250,000 5 - Urban place 25,000 or more outside urbanized area 6 - Urban place 10,000-24,999 outside urbanized area 7 - Urban place 2,500 to 9,999 outside urbanized area 8 - Rural 012 SMSA-Not SMSA See Detailed Notes 1 - In SMSA, in central city 2 - In SMSA, not in central city 4 - Not in SMSA 013- Data User Work Area 023 024 Type of living quarters 1 - Housing unit 2 - Other unit 025 Land Usage 1 - Urban 2 - Rural 026 If rural, asked does this place have 10 acres or more? 1 - Yes 2 - No 9 - Not Applicable 027 If 10 acres or more, asked if in the last 12 months did sales of farm produce and livestock amount to $50 or more? 1 - Yes 2 - No 9 - Not Applicable 028 If less than 10 acres, asked if in the last 12 months did sales or farm produce and livestock amount to $250 or more? 1 - Yes 2 - No 9 - Not Applicable 029 Data User Work Area 030- Total Number Of Persons In Household 031 01 - 15 - As given 032- Total Number Of Sample Persons In 033 Household 01 - 06 - As Given Sample Person Data 034 Data User Work Area 035 Family Relationship 1 - Head one person living alone or with non-relatives 2 - Head 2 or more related persons in family 3 - Wife 4 - Child 5 - Other relative 6 - Foster child 7 - Husband 036 Examination Status 1 - Examined 037- Family Unit Code See Detailed Notes 041 00001-21050 - As Given 042- Data User Work Area 044 045- Age-Months At Interview 046 06-11 Months Blank, if greater than 11 months 047- Age-Years At Interview 048 01 - 74 Years 00, If less than 12 months 049- Data User Work Area 050 Tape Locations 51-100 051- Date-Of-Birth-Month 052 01 - 12 Month 053- Date-Of-Birth-Year 054 01 - 79 Year 055 Sex 1 - Male 2 - Female 056 Race See Detailed Notes 1 - White 2 - Black 3 - Other 057- In what state was he/she born? See Detailed Notes 058 01 - 97 88 - Blank, but applicable 059 Is he/she married, widowed, divorced, separated, or never married? 1 - Under 17 2 - Married 3 - Widowed 4 - Divorced 5 - Separated 6 - Never married 8 - Blank, but applicable 060- Natural Origin or Ancestry 061 01 - Countries of Central or South America 02 - Chicano 03 - Cuban 04 - Mexican 05 - Mexicano 06 - Mexican-American 07 - Puerto Rican 08 - Other Spanish 09 - Other European, such as German, French, English, Irish 10 - Black, Negro or Afro-American 11 - American Indian or Alaskan Native 12 - Asian or Pacific Islander Such as Chinese, Japanese, Korean, Philippino, Samoan 13 - Another Group Not Listed 88 - Blank, but applicable 062- Highest Grade Of School Attended 063 00 - None (regardless of age) 21 - 28 - Elementary Grades (1-8) 31 - 34 - High School (1-4) 41 - 45 - College (1-5+) 88 - Blank, but applicable 064 Grade Completed 1 - Yes 2 - No 8 - Blank, but applicable Blank 065 What was he/she doing during most of the past 12 months? 1 - Working 2 - Keeping house 3 - Something else 8 - Blank, but applicable Blank 066 What was he/she doing? 1 - Layoff 2 - Retired 3 - Student 4 - Ill 5 - Staying home 6 - Looking for work 7 - Unable to work 8 - Blank, but applicable 0 - Other Blank 067 Did he/she work at a job or business at any time during the past three months? 1 - Yes 2 - No 8 - Blank, but applicable Blank 068 Did he/she work full or part-time when working? 1 - Full time 2 - Part time 8 - Blank, but applicable Blank 069 Was he/she working within last two weeks not counting work around the house? 1 - Yes 2 - No 8 - Blank, but applicable Blank 070 Even though he/she did not work does he/she have a job or business? 1 - Yes 2 - No 8 - Blank, but applicable Blank 071 Was he/she looking for work or on layoff from a job? 1 - Yes 2 - No 8 - Blank, but applicable Blank 072 Which looking for work or on layoff from a job? 1 - Looking 2 - Layoff 3 - Both 8 - Blank, but applicable Blank 073- What kind of industry or business is See Detailed Notes 075 this? 017 - 998 (last digit 7, 8, 9) 000 - Blank, but applicable Blank 076- What kind of work was he/she doing? See Detailed Notes 078 001 - 992 - Occupation (last digit 0-6) 000 - Blank, but applicable Blank 079 Was he/she in private company or business or working for individual for wages, salary or commission? 1 - Private 2 - A Federal government employee 3 - A State government employee 4 - A local government employee 5 - Incorporated-Own 6 - Self-employed (or farm) 7 - Working without pay in family business or farm 8 - Never worked 0 - Blank, but applicable Blank 080 Did he/she ever serve in the armed forces of the U.S.? 1 - Yes 2 - No 8 - Blank, but applicable Blank 081 When did he/she serve? 1 - Vietnam 2 - Korean War 3 - World War II 4 - World War I 5 - Post Vietnam 6 - Other Service 8 - Blank, but applicable 9 - Do not know Blank 082- Data User Work Area 090 Household Data 091 How many rooms are in this..? Count the kitchen, but not the bath. 1 - 8 Rooms 9 - 9 Or More Rooms 092 How many bedrooms are in this - ? 0 - 7 Bedrooms - More than 7 bedrooms coded as 7 093 Ask only of unrelated household members. Do you have complete kitchen facilities in your living quarters, that is a kitchen sink with piped water, a refrigerator and a range or cookstove? 1 - Yes 2 - No Blank 094 Do you have access to complete kitchen facilities in this house? 1 - Yes 2 - No 8 - Blank, but applicable Blank 095 Do you have access to a range or cookstove? 1 - Yes 2 - No 8 - Blank, but applicable Blank 096 Do you have access to a refrigerator? 1 - Yes 2 - No 8 - Blank, but applicable Blank 097 Do you have access to a sink with piped water? 1 - Yes 2 - No 8 - Blank, but applicable Blank 098 Is there piped water in this house (these living quarters)? 1 - Yes 2 - No 8 - Blank, but applicable Blank 099 Is there both hot and cold water? 1 - Yes 2 - No 8 - Blank, but applicable Blank 100 Are these kitchen facilities used by anyone not living in this household? 1 - Yes 2 - No 8 - Blank, but applicable Blank Tape Locations 101-150 101- What is the main type of heating system 102 you have? 11 - Steam or hot water system 12 - Central warm air furnace with ducts to individual rooms or central heat pump (forced air) 13 - Built in electric units (permanently installed in wall, ceiling or baseboard 14 - Floor, wall or pipeless furnace 15 - Circulating, radiant or room heaters, with flue or vent, burning gas, oil, or kerosene 16 - Circulating, radiant, or room heaters (not portable) without flue or vent burning gas, oil or kerosene 17 - Fireplace or stoves burning coal, wood or coke 18 - Portable room heaters of any kind 19 - Some other type 20 - None, unit is not heated 88 - Blank, but applicable 103 Do you have air conditioning? 1 - Yes, individual room unit 2 - Yes, central air conditioning 3 - No 8 - Blank, but applicable 104 How many motor vehicles are owned or regularly used for transportation by members of your family? 0 - None 1 - 8 Vehicles (more than 8 coded as 8) 9 - Blank, but applicable 105 Is any language other than English spoken by family members living here? 1 - Yes 2 - No 8 - Blank, but applicable 106 What language? 0 - German 1 - Italian 2 - French 3 - Polish 4 - Russian 5 - Spanish 6 - Chinese 7 - Other language 8 - Blank, but applicable 9 - Not applicable 107- Which of these income groups represents See Detailed Notes 108 your total combined family income for the past 12 months? 11 - Under $1,000 12 - $1,000-1,999 13 - $2,000-2,999 14 - $3,000-3,999 15 - $4,000-4,999 16 - $5,000-5,999 17 - $6,000-6,999 18 - $7,000-9,999 19 - $10,000-14,999 20 - $15,000-19,999 21 - $20,000-24,999 22 - $25,000 and over 88 - Blank, but applicable 109- During the past 12 months, how much 112 money did you and all members of your family receive in wages or salaries before deductions? 0000 - 6999 Amount 8888 - Blank, but applicable Blank 113 Social security or railroad retirement? 1 - Yes 2 - No 8 - Blank, but applicable Blank 114 Data User Work Area 115- If yes, how much? 118 0038 - 6828 Amount 8888 - Blank, but applicable Blank 119 Welfare payments or other public assistance? 1 - Yes 2 - No 8 - Blank, but applicable Blank 120 Data User Work Area 121- If yes, how much? 124 0012 - 6800 Amount 8888 - Blank, but applicable Blank 125 Unemployment Compensation or Workman's Compensation 1 - Yes 2 - No 8 - Blank, but applicable Blank 126 Data User Work Area 127- If yes, how much? 130 0015 - 5640 Amount 8888 - Blank, but applicable Blank 131 Government Employee Pension or Private Pensions? 1 - Yes 2 - No 8 - Blank, but applicable Blank 132 Data User Work Area 133- If yes, how much? 136 0036 - 6000 Amount 8888 - Blank, but applicable Blank 137 Dividends, Interest or Rent? 1 - Yes 2 - No 8 - Blank, but applicable Blank 138 Data User Work Area 139- If yes, how much? 142 0001 - 5200 Amount 8888 - Blank, but applicable Blank 143 Net income from their own business (nonfarm) professional practice, or partnership? 1 - Yes 2 - No 3 - Loss 8 - Blank, but applicable Blank 144 Data User Work Area 145- If yes, how much? 148 0001 - 6800 Amount 8888 - Blank, but applicable Blank 149 Net income from a farm? 1 - Yes 2 - No 3 - Loss 8 - Blank, but applicable Blank 150 Data User Work Area Tape Locations 151-205 151- If yes, how much? 154 0000 - 6500 Amount 8888 - Blank, but applicable Blank 155 Veterans payments? 1 - Yes 2 - No 8 - Blank, but applicable Blank 156 Data User Work Area 157- If yes, how much? 160 0060 - 6000 Amount 8888 - Blank, but applicable Blank 161 Alimony, child support or other support from persons not in household? 1 - Yes 2 - No 8 - Blank, but applicable Blank 162 Data User Work Area 163- If yes, how much? 166 0020 - 6900 Amount 8888 - Blank, but applicable Blank 167 Any other income? 1 - Yes 2 - No 8 - Blank, but applicable Blank 168 Data User Work Area 169- If yes, how much? 172 0003 - 6403 Amount 8888 - Blank, but applicable Blank 173- Total Amount Q 21 & 22 176 0000 - 6999 Amount 8888 - Blank, but applicable Blank 177 Check Item B 2 - Food stamps available 4 - Both - Food Stamps and commodities 178 Are you certified to participate in the food stamp program? 1 - Yes 2 - No 8 - Blank, but applicable Don't know 179 Are you buying food stamps now? 1 - Yes, Regularly 2 - Yes, Occasionally 3 - No 8 - Blank, but applicable Blank 180 What is the main reason you are not participating in the program? 1 - No need 2 - Not enough money at the time 3 - No transportation 4 - Pride 5 - Other 8 - Blank, but applicable Blank 181 Are you certified for commodity distribution program? 1 - Yes 2 - No 9 - Do not know Blank 182 Are you receiving commodity foods now for your family? 1 - Yes, regularly 2 - Yes, occasionally 3 - No Blank 183 Why aren't you participating in the program? 1 - No need 2 - No transportation 3 - Pride 4 - Other 8 - Blank, but applicable Blank 184- Date of Exam Month Control Record 185 01 - 12 186- Date of Exam Day Control Record 187 00 - 31 188- Date of Exam Year Control Record 189 76 - 80 190- Age Years At Examination 191 01 - 75 Years 00 - If less than 12 months or non- examined 192- Data User Work Area 205 Tape Locations 206-250 206 Race Sex Recode For Sample Person See Detailed Notes 1 - Male, White 2 - Male, Black 3 - Male, Other 4 - Female, White 5 - Female, Black 6 - Female, Other 207 Farm, Non-Farm Recode For Sample Person See Detailed Notes 1 - Farm 2 - Non-Farm 208 Interview Status 1 - Interviewed 209 Region See Detailed Noted 1 - Northeast 2 - Midwest 3 - South 4 - West 210- Poverty Index (x.xx) See Detailed Notes 212 001 - 880 - As Given 999 - Unknown 213- Data User Work Area 246 Head of Household Data 247- Age Years 248 15 - 99 Years (more than 100 coded as 99) 249- Data User Work Area 250 Tape Locations 251-305 251- Date-Of-Birth-Month 252 01 - 12 Month 88 - Blank, but applicable 253- Date-Of-Birth-Year 254 00 - 99 Year 255 Sex 1 - Male 2 - Female 256 Race See Detailed Notes 1 - White 2 - Black 3 - Other 257- In what state was he/she born? See Detailed Notes 258 01 - 97 88 - Blank, but applicable 259 Is he/she married, widowed, divorced, separated, or never married? 1 - Under 17 2 - Married 3 - Widowed 4 - Divorced 5 - Separated 6 - Never married 8 - Blank, but applicable 260- Natural Origin or Ancestry? 261 01 - Countries of Central or South America 02 - Chicano 03 - Cuban 04 - Mexican 05 - Mexicano 06 - Mexican-American 07 - Puerto Rican 08 - Other Spanish 09 - Other European, such as German, French, English, Irish 10 - Black, Negro or Afro-American 11 - American Indian or Alaskan Native 12 - Asian or Pacific Islander Such as Chinese, Japanese, Korean, Philippino, Samoan 13 - Another Group Not Listed 88 - Blank, but applicable 262- Highest Grade Attended 263 00 - None (regardless of age) 21 - 28 - Elementary Grades (1-8) 31 - 34 - High School (1-4) 41 - 45 - College (1-5+) 88 - Blank, but applicable 264 Grade Completed 1 - Yes 2 - No 8 - Blank, but applicable Blank 265 What was he/she doing during most of the past 12 months? 1 - Working 2 - Keeping house 3 - Something else 8 - Blank, but applicable Blank 266 What was he/she doing? 1 - Layoff 2 - Retired 3 - Student 4 - Ill 5 - Staying home 6 - Looking for work 7 - Unable to work 8 - Blank, but applicable 0 - Other Blank 267 Did he/she work at job or business during past three months? 1 - Yes 2 - No 8 - Blank, but applicable Blank 268 Did he/she work full or part-time when working? 1 - Full time 2 - Part time 8 - Blank, but applicable Blank 269 Did he/she work at any time the last two weeks not counting work around the house? 1 - Yes 2 - No 8 - Blank, but applicable Blank 270 Even though he/she did not work, does he/she have a job or business? 1 - Yes 2 - No 8 - Blank, but applicable Blank 271 Was he/she looking for work or on layoff from a job? 1 - Yes 2 - No 8 - Blank, but applicable Blank 272 Which, looking for work or on layoff from a job? 1 - Looking 2 - Layoff 3 - Both 8 - Blank, but applicable Blank 273- Type of industry or business? See Detailed Notes 275 017 - 998 (last digit 7, 8, 9) 000 - Blank, but applicable Blank 276- What kind of work was he/she doing? See Detailed Notes 278 001 - 992 - Occupation (last digit 0-6) 000 - Blank, but applicable Blank 279 Was he/she in private company or business or working for individual for wages, salary or commission? 1 - Private 2 - A Federal government employee 3 - A State government employee 4 - A local government employee 5 - Incorporated-Own 6 - Self-employed (or farm) 7 - Working without pay in family business or farm 8 - Never worked 0 - Blank, but applicable Blank 280 Did he/she ever serve in the armed forces of the U.S.? 1 - Yes 2 - No 8 - Blank, but applicable Blank 281 When did he/she serve? 1 - Vietnam 2 - Korean War 3 - World War II 4 - World War I 5 - Post Vietnam 6 - Other Service 8 - Blank, but applicable 9 - Do not know Blank SEE DETAILED NOTES FOR POSITIONS 282-326 282- Examined Final Weight 287 001218 - 079634 288- Medical History Interview Final Weight 293 001171 - 071969 294- Glucose Tolerance Test Final Examined 299 Weight 003502 - 084477 000000 300- Lead Final Examined Weight 305 001218 - 084115 000000 Tape Locations 306-350 306- Carboxyhemoglobin Final Examined Weight 311 002546 - 110759 000000 312- Bile Acids Final Examined Weight 317 003519 - 087638 000000 318- Data User Work Area 323 324- STRATA 325 01 - 32 326 PSEUDO Primary Sampling Unit 1 OR 2 328 Poverty/Non-Poverty Segments 1-Non-Poverty 2-Poverty 328- Data User Work Area 350 DETAILED NOTES, DEMOGRAPHIC DATA Size of Place Size of place classification was derived from the 1970 census. According to the definition used in the 1970 census, the urban population was comprised of all persons living in (a) places of 2,500 inhabitants or more incorporated as cities, boroughs (except Alaska),villages and towns (except towns in New York, New England States,and Wisconsin),but excluding those persons living in the rural portions of extended cities; (b) unincorporated places of 2,500 inhabitants or more; and (c) other territories included in urbanized areas. the remaining population was classified as rural. Urban areas are further classified by population size for places within urbanized areas and other places outside urbanized areas. SMSA Except in New England,a standard metropolitan statistical area is basically a county or a group of contiguous counties which contains at least one city of 50,000 inhabitants or more, or "twin cities" with a combined population of at least 50,000. In addition to the county or counties containing such a city or cities, contiguous counties are included in an SMSA if, according to the 1970 census, they are socially and economically integrated with the central city. Each SMSA must include at least one central city,and the complete title of an SMSA identifies the central city or cities. In New England, SMSA's consist of towns and cities, rather than counties. Family Unit Code All related sample persons in the same family unit have the same computer generated family unit code. This will enable analysis of individual family units. Race The race of the respondent was marked by observation and the interviewers were instructed to assume the race of all related persons was the same as the respondent unless otherwise learned.The race categories were "White","Black" or "Other". If the appropriate category could not be marked by observation, then race was asked. Interviewers were instructed to record persons who responded with something other than White or Black,such as Japanese,Chinese, American Indian, Korean, Hindu, Eskimo, etc., as "Other"; and to include Mexicans,Puert Ricans and other persons of Latin American descent in "White", unless definitely Black, American Indian, or of other non-white race. Tape Positions 57-58 and 257-258 United States Name of Place Code Alabama 01 Alaska 02 Arizona 04 Arkansas 05 California 06 Colorado 08 Connecticut 09 Delaware 10 District of Columbia 11 Florida 12 Georgia 13 Hawaii 15 Idaho 16 Illinois 17 Indiana 18 Iowa 19 Kansas 20 Kentucky 21 Louisiana 22 Maine 23 Maryland 24 Massachusetts 25 Michigan 26 Minnesota 27 Mississippi 28 Missouri 29 Montana 30 Nebraska 31 Nevada 32 New Hampshire 33 New Jersey 34 New Mexico 35 New York 36 North Carolina 37 North Dakota 38 Ohio 39 Oklahoma 40 Oregon 41 Pennsylvania 42 Rhode Island 44 South Carolina 45 South Dakota 46 Tennessee 47 Texas 48 Utah 49 Vermont 50 Virginia 51 Washington 53 West Virginia 54 Wisconsin 55 Wyoming 56 Outlying Areas of the United States Name of Place Code Description American Samoa 60 U.S. territory in the Pacific Canal Zone 61 Territory in Panama leased by U.S. Canton and Enderbury Islands 62 Under common US-UK administration Guam 66 U.S. territory in the Pacific Johnston Atoll U.S. territory in the Pacific, includes Sand Island Midway Islands 71 U.S. territory in the Pacific Puerto Rico 72 Commonwealth associated with the U.S. Swan Islands 74 U.S. territory in the Caribbean Trust Territories of the Pacific 75 U.S. administered, includes Islands Caroline, Mariana, and Marshall Island Groups U.S. Miscellaneous Caribbean 76 Includes Navassa Islands, Quito Islands Sueno Bank, Roncador Cay, Serrana Bank, Serranilla Bank U.S. Miscellaneous Pacific 77 Includes Kingman Reef, Howland, Islands Baker and Jarvis Islands, Palmyra Atoll Virgin Islands 78 U.S. territory in the Caribbean Wake Island 79 U.S. territory in the Pacific Foreign Countries North America 91 South America 92 Europe 93 Africa 94 Asia 95 Australasia 96 Pacific Islands 97 Industry and Occupation Codes A person's occupation may be defined as his principal job or business. For this survey purpose, the principal job or business of a respondent is defined in one of the following ways: If the person worked during the two-week interview period or had a job or business, the question concerning his occupation (or work) applies to his job during that period.If the respondent held more than one job, the question is directed to the one at which he spent the most time. It refers to the one he considers most important when equal time is spent at each job. A person who has not begun work at a new job, is looking for work, or is on layoff from work is questioned about his last full-time civilian job.A full-time job is defined as one at which the person spent 35 or more hours per week and which lasted two consecutive weeks or more. A person who has a job to which he has not yet reported and has never had a previous job or business is classified as a "new worker". The 1970 census of population Alphabetical Index of Industries and Occupa- tion was used in the coding of both the industry and occupation. Library of Congress Number 74-612012. For sale by the Superintendent of Documents,U.S. Government Printing Office, Washington, D.C. 20402. $3.00. Stock Number 0301-2283. Family Income Group The respondent was handed a card with 12 income ranges listed as Group A to Group L and asked "Which of these income groups represents your total com- bined family income for the past 12 months,that is,yours, your ...'s, etc? include income from all sources such as wages,salaries,social security or retirement benefits, help from relatives, rent from property and so forth." If the respondent answered Group A through G,that is with an income less than $7,000,then questions 21 and 22 detailing exact sources and amounts of income were asked; otherwise, these questions were skipped. No effort was made to reconcile amounts reported in detailed questions 21 and 22 with the categorical response to the family income group question. During the survey time period, no adjustments to the income groups or $7,000 value were made to account for inflation. Land Land used for farming purposes (Code 1 in Tape Position 207) was identified as being rural land (Code 2 in Tape Position 25) consisting of 10 or more acres (Code 1 in Tape Position 26) with crop sales amounting to $50 or more (Code 1 in Tape Position 27), or rural land (Code 2 in Tape Position 25) consisting of less than 10 acres(Code 2 in Tape Position 26)with crop sales amounting to $250 or more (Code 1 in Tape Position 28).All other land is classified as nonfarm (Code 2 in Tape Position 207). Region The United States was divided into four broad geographic regions of approximately equal population. Those regions, which deviate somewhat from the groups used by the Bureau of Census, are as follows: Region States Included Northeast Maine, Vermont, New Hampshire, Massachusetts, Connecticut, Rhode Island, New York, New Jersey, and Pennsylvania South Delaware, Maryland, District of Columbia, West Virginia, Virginia, Kentucky, Tennessee, North Carolina, South Carolina, Georgia, Florida, Alabama, Mississippi, Louisiana, and Arkansas Midwest Ohio, Illinois, Indiana, Michigan, Wisconsin, Minnesota, Iowa, Missouri West Washington, Oregon, California, Nevada, New Mexico, Arizona, Texas, Oklahoma, Kansas, Nebraska, North Dakota, South Dakota, Idaho, Utah, Colorado, Montana, Wyoming, Alaska, Hawaii Poverty Index Income status was determined by the Poverty Income Ratio (PIR). Poverty statistics published in the Census Bureau reports 1-5 were based on the poverty index developed by the Social Security Administration (SSA) in 1964. (For a detailed discussion of the SSA poverty standards, see reference 6.) Modifications in the definition of poverty were adopted in 1969.7 The stand- ard data series in poverty for statistical use by all executive departments and establishments has been established.8 The two components of the PIR are the total income of the household (numera- tors the median of the income group for incomes $7,000 and above; the sum of the porponent parts of the income questions for incomes under $7,000) and a multiple of the total income necessary to maintain a family with given characteristics on a nutritionally adequate food plan3 (denominator). The dollar value of the denominator of the PIR is constructed from a food plan (economy plan) necessary to maintain minimum recommended daily nutritional requirements.The economy plan is designated by the Department of Agriculture for "emergency or temporary use when funds are low." For families of three or more persons,the poverty level was set at three times the cost of the economy food plan.For smaller families and persons living alone,the cost of the economy food plan was adjusted by the relatively higher fixed expenses of these smaller households. The denominator or poverty income cutoff adjusts the family poverty income maintenance requirements by the family size, the sex of the family head, the age of the family head in families with one or two members, and the place of residence (farm, nonfarm).Annual revisions of the poverty income cutoffs are based on the changes in the average cost of living as reflected in the Consumer Price Index. As shown in the tables, the annual income considered to be the poverty level increases as the family size increases. A family with any combination of characteristics and with the same income as shown in the table has been designated as having a PIR or poverty level of 1.0. The same family with twice the income found in the table would have a PIR of 2.0. Ratios of less than 1.0 can be described as "below poverty",ratios greater than or equal to 1.0, as "at or above poverty". Poverty thresholds are computed on a national basis only. No attempt has been made to adjust these thresholds for regional,state,or other variations in the cost of living (except for the farm, nonfarm difference).None of the noncash public welfare benefits such as food stamp bonuses are included in the income of the low income families receiving these benefits.PIR has been adjusted by year (see tables) and accounts in some part for inflation. 1 U.S. Bureau of the Census, Current Population Reports, Series P-60, No. 107, "Money Income and Poverty Status of Families and Persons in the United States: 1976" (Advance Report) U.S. Government Printing Office, Washington, D.C., 1977. 2 U.S. Bureau of the Census, Current Population Reports, Series P-60, No. 116, "Money Income and Poverty Status of Families and Persons in the United States: 1977" (Advance Report) U.S. Government Printing Office, Washington, D.C., 1978. 3 U.S. Bureau of the Census, Current Population Reports, Series P-60, No. 120, "Money Income and Poverty Status of Families and Persons in the United States: 1978" (Advance Report), U.S. Government Printing Office, Washington, D.C., 1979. 4 U.S. Bureau of the Census, Current Population Reports, Series P-60, No. 125, "Money Income and Poverty Status of Families and Persons in the United States: 1979" (Advance Report), U.S. Government Printing Office, Washington, D.C., 1980. 5 U.S. Bureau of the Census, Current Population Reports, Series P-60, No. 127, "MoneyIncome and Poverty Status of Families and Persons in the United States: 1980"(Advance Data from the March 1981 Current Population Survey), U.S. Government Printing Office, Washington, D.C., 1981. 6 Orshansky, M.: "Counting the Poor: Another Look at the Poverty Profile", Social Security Bulletin, January 1965; "Who's Who Among the Poor: A demographic View of Poverty", Social Security Bulletin, July 1965. 7 U.S. Bureau of the Census, Current Population Reports, Series P-23, No. 28 "Special Studies", U.S. Government Printing Office, Washington, D.C., August 12, 1969. 8 Circular No. A-46,Transmitted Memorandum No. 9,Executive Office of the President, Bureau of the Budget, August 29, 1969, and Exhibit L (rev.). Table 15 Weighted Average Thresholds-Poverty Cutoffs in 1976, by Size of Family and Sex of Head, By Farm-Nonfarm Residence NONFARM SIZE OF FAMILY UNIT Total Total Male Head Female Head (Dollars) (Dollars) (Dollars) (Dollars) 1 Person (Unrelated Individual). . . . . . . . . 2 877 2 884 3 016 2 788 14 to 64 Years . . . . . . . 2 954 2 959 3 069 2 840 65 Years And Over. . . . . . 2 720 2 730 2 758 2 722 2 Persons. . . . . . . . . . . 3 688 3 711 3 721 3 660 Head 14 to 64 Years. . . . . 3 806 3 826 3 846 3 733 Head 65 Years and Over . . . 3 417 3 445 3 447 3 428 3 Persons. . . . . . . . . . . 4 515 4 540 4 565 4 414 4 Persons. . . . . . . . . . . 5 786 5 815 5 818 5 790 5 Persons. . . . . . . . . . . 6 838 6 876 6 884 6 799 6 Persons. . . . . . . . . . . 7 706 7 760 7 766 7 709 7 Persons Or More. . . . . . . 9 505 9 588 9 622 9 375 FARM SIZE OF FAMILY UNIT Total Male Head Female Head (Dollars) (Dollars) (Dollars) 1 Person (Unrelated Individual). . . . . 2 438 2 532 2 348 14 to 64 Years . . . . . . . . . . . . 2 542 2 608 2 413 65 Years And Over. . . . . . . . . . . 2 322 2 344 2 313 2 Persons. . . . . . . . . . . . . . . . 3 128 3 133 3 033 Head 14 to 64 Years. . . . . . . . . . 3 267 3 271 3 159 Head 65 Years and Over . . . . . . . . 2 928 2 928 2 922 3 Persons. . . . . . . . . . . . . . . . 3 858 3 864 3 734 4 Persons. . . . . . . . . . . . . . . . 4 950 4 953 4 840 5 Persons. . . . . . . . . . . . . . . . 5 870 5 871 5 847 6 Persons. . . . . . . . . . . . . . . . 6 585 6 584 6 607 7 Persons Or More. . . . . . . . . . . . 8 072 8 068 8 428 Table 15 Weighted Average Thresholds-Poverty Cutoffs in 1977, by Size of Family and Sex of Head, By Farm-Nonfarm Residence NONFARM SIZE OF FAMILY UNIT Total Total Male Head Female Head (Dollars) (Dollars) (Dollars) (Dollars) 1 Person (Unrelated Individual). . . . . . . . . 3 067 3 075 3 214 2 969 14 to 64 Years . . . . . . . 3 147 3 152 3 267 3 023 65 Years And Over. . . . . . 2 895 2 906 2 936 2 898 2 Persons. . . . . . . . . . . 3 928 3 951 3 961 3 907 Head 14 to 64 Years. . . . . 4 054 4 072 4 095 3 981 Head 65 Years and Over . . . 3 637 3 666 3 670 3 646 3 Persons. . . . . . . . . . . 4 806 4 833 4 860 4 708 4 Persons. . . . . . . . . . . 6 157 6 191 6 195 6 162 5 Persons. . . . . . . . . . . 7 279 7 320 7 329 7 238 6 Persons. . . . . . . . . . . 8 208 8 261 8 268 8 197 7 Persons Or More. . . . . . . 10 137 10 216 10 249 9 995 FARM SIZE OF FAMILY UNIT Total Male Head Female Head (Dollars) (Dollars) (Dollars) 1 Person (Unrelated Individual). . . . . 2 588 2 672 2 498 14 to 64 Years . . . . . . . . . . . . 2 709 2 776 2 569 65 Years And Over. . . . . . . . . . . 2 475 2 495 2 563 2 Persons. . . . . . . . . . . . . . . . 3 318 3 325 3 176 Head 14 to 64 Years. . . . . . . . . . 3 466 3 474 3 278 Head 65 Years and Over . . . . . . . . 3 128 3 131 3 079 3 Persons. . . . . . . . . . . . . . . . 4 093 4 110 3 893 4 Persons. . . . . . . . . . . . . . . . 5 273 5 274 5 213 5 Persons. . . . . . . . . . . . . . . . 6 247 6 247 6 237 6 Persons. . . . . . . . . . . . . . . . 7 026 7 026 7 040 7 Persons Or More. . . . . . . . . . . . 8 708 8 706 8 738 Table A-3 Weighted Average Thresholds at the Poverty Level in 1978, by Size of Family and Sex of Head, By Farm-Nonfarm Residence NONFARM SIZE OF FAMILY UNIT Male Female Total Total Head1 Head1 1 Person (Unrelated Individual). . . . . . . . . $3,302 $3,311 $3,460 $3,196 14 to 64 Years . . . . . . . 3,386 3,392 3,516 3,253 65 Years And Over. . . . . . 3,116 3,127 3,159 3,118 2 Persons. . . . . . . . . . . 4,225 4,249 4,258 4,206 Head 14 to 64 Years. . . . . 4,363 4,383 4,407 4,286 Head 65 Years and Over . . . 3,917 3,944 3,948 3,923 3 Persons. . . . . . . . . . . 5,178 5,201 5,231 5,065 4 Persons. . . . . . . . . . . 6,628 6,662 6,665 6,632 5 Persons. . . . . . . . . . . 7,833 7,880 7,888 7,806 6 Persons. . . . . . . . . . . 8,825 8,891 8,895 8,852 7 Persons Or More. . . . . . . 10,926 11,002 11,038 10,765 FARM SIZE OF FAMILY UNIT Male Female Total Head1 Head1 1 Person (Unrelated Individual). . . . . $2,795 $2,898 $2,690 14 to 64 Years . . . . . . . . . . . . 2,913 2,987 2,764 65 Years And Over. . . . . . . . . . . 2,661 2,685 2,650 2 Persons. . . . . . . . . . . . . . . . 3,578 3,582 3,497 Head 14 to 64 Years. . . . . . . . . . 3,731 3,737 3,614 Head 65 Years and Over . . . . . . . . 3,352 3,354 3,313 3 Persons. . . . . . . . . . . . . . . . 4,413 4,430 4,216 4 Persons. . . . . . . . . . . . . . . . 5,681 5,683 5,622 5 Persons. . . . . . . . . . . . . . . . 6,714 6,714 6,700 6 Persons. . . . . . . . . . . . . . . . 7,541 7,543 7,462 7 Persons Or More. . . . . . . . . . . . 9,373 9,386 8,813 1 For one person (i.e., unrelated individual), sex of the individual. Table 17 Weighted Average Thresholds-Poverty Cutoffs in 1979, by Size and Type of Family, By Farm-Nonfarm Residence NONFARM Families With SIZE OF FAMILY UNIT Total Total Female HHLDR, No Husband1 All Other Present Families2 (Dollars) (Dollars) (Dollars) (Dollars) 1 Person (Unrelated Individual). . . . . . . . . 3 683 3 689 3 556 3 855 14 to 64 Years . . . . . . . 3 773 3 778 3 619 3 912 65 Years And Over. . . . . . 3 472 3 479 3 469 3 515 2 Persons. . . . . . . . . . . 4 702 4 725 4 669 4 737 Head 14 to 64 Years. . . . . 4 858 4 878 4 762 4 905 Head 65 Years and Over . . . 4 364 4 390 4 362 4 394 3 Persons. . . . . . . . . . . 5 763 5 784 5 624 5 820 4 Persons. . . . . . . . . . . 7 386 7 412 7 381 7 416 5 Persons. . . . . . . . . . . 8 736 8 775 8 690 8 785 6 Persons. . . . . . . . . . . 9 849 9 914 9 843 9 922 7 Persons Or More. . . . . . . 12 212 12 280 12 037 12 322 FARM Families With Female HHLDR, No Husband All Other SIZE OF FAMILY UNIT Total Present1 Families2 (Dollars) (Dollars) (Dollars) 1 Person (Unrelated Individual). . . . . 3 138 3 001 3 236 14 to 64 Years . . . . . . . . . . . . 3 254 3 076 3 324 65 Years And Over. . . . . . . . . . . 2 963 2 948 2 988 2 Persons. . . . . . . . . . . . . . . . 3 987 3 917 3 991 Head 14 to 64 Years. . . . . . . . . . 4 156 4 027 4 163 Head 65 Years and Over . . . . . . . . 3 730 3 686 3 732 3 Persons. . . . . . . . . . . . . . . . 4 917 4 680 4 928 4 Persons. . . . . . . . . . . . . . . . 6 329 6 261 6 332 5 Persons. . . . . . . . . . . . . . . . 7 492 7 509 7 492 6 Persons. . . . . . . . . . . . . . . . 8 424 8 309 8 428 7 Persons Or More. . . . . . . . . . . . 10 533 10 178 10 547 1 Includes female unrelated individuals. 2 Includes male unrelated individuals. Table 17 Weighted Average Thresholds-Poverty Cutoffs in 1980, by Size and Type of Family, By Farm-Nonfarm Residence NONFARM Families With SIZE OF FAMILY UNIT Total Total Female HHLDR, No Husband1 All Other Present Families2 (Dollars) (Dollars) (Dollars) (Dollars) 1 Person (Unrelated Individual). . . . . . . . . 4 184 4 190 4 037 4 379 14 to 64 Years . . . . . . . 4 286 4 290 4 109 4 441 65 Years And Over. . . . . . 3 941 3 949 3 938 3 990 2 Persons. . . . . . . . . . . 5 338 5 363 5 316 5 373 Head 14 to 64 Years. . . . . 5 518 5 537 5 415 5 568 Head 65 Years and Over . . . 4 954 4 983 4 946 4 988 3 Persons. . . . . . . . . . . 6 539 6 565 6 388 6 605 4 Persons. . . . . . . . . . . 8 385 8 414 8 382 8 418 5 Persons. . . . . . . . . . . 9 923 9 966 9 878 9 976 6 Persons. . . . . . . . . . . 11 215 11 269 11 227 11 274 7 Persons Or More. . . . . . . 13 883 13 955 13 767 13 986 FARM Families With Female HHLDR, No Husband All Other SIZE OF FAMILY UNIT Total Present1 Families2 (Dollars) (Dollars) (Dollars) 1 Person (Unrelated Individual). . . . . 3 539 3 392 3 680 14 to 64 Years . . . . . . . . . . . . 3 693 3 492 3 773 65 Years And Over. . . . . . . . . . . 3 359 3 347 3 392 2 Persons. . . . . . . . . . . . . . . . 4 502 4 302 4 513 Head 14 to 64 Years. . . . . . . . . . 4 714 4 497 4 721 Head 65 Years and Over . . . . . . . . 4 233 4 185 4 237 3 Persons. . . . . . . . . . . . . . . . 5 573 5 271 5 587 4 Persons. . . . . . . . . . . . . . . . 7 170 7 152 7 170 5 Persons. . . . . . . . . . . . . . . . 8 472 8 373 8 474 6 Persons. . . . . . . . . . . . . . . . 9 613 9 168 9 625 7 Persons Or More. . . . . . . . . . . . 11 915 12 133 11 389 1 Includes female unrelated individuals. 2 Includes male unrelated individuals. Tape Positions 282-323 A multistage estimation procedure was used to calculate the various NHANES II subsample sample weights that are necessary to use in any analysis of the data.The procedure has three basic components:(1) inflation by reciprocals of the probabilities of selection, (2) adjustment for nonresponse, and (3) poststratification ratio adjustment by age-sex-race. A brief description of each component is as follows: Inflation by reciprocals of the sampling probabilities.Since the survey utilized a three-stage sample design, there were three probabilities of selection: (1) the probability of selecting the PSU,(2) the probability of selecting a segment (housing unit),and (3) the probability of select- ing a sample person. Adjustment for nonresponse. Estimates from the NHANES II data were adjusted to account for sample persons who were not examined. The estimates were inflated by a multiplication factor calculated within five selected income groups, three age groups, four regions, and standard metropolitan statistical area (SMSA) or non-SMSA. The numerator of these factors was the sum of the weights for sample persons resulting from the reciprocal of the probability of selection, and the denominator was the sum of the weights for examined persons also resulting from the reciprocals of the sampling probabilities. Poststratification by age-sex-race. The estimates were ratio adjusted within each of 76 age-sex-race cells to an independent estimate,provided by the U.S. Bureau of the Census, of the population of each cell as of March 1, 1978, (approximate mid-point of the survey). The ratio adjustment was a multiplication factor of which the numerator was the U.S.population and the denominator was the sum of the weights adjusted for nonresponse for examined persons. This ratio estimation process makes the sample more closely representative of the civilian, noninstitutionalized population of the U.S. Potential bias of nonresponse.Usually a sizeable number of sample persons who initially are willing to complete the household information and some of the medical history questionnaire subsequently will not participate in the examination.This creates the potential for bias if these persons differ from other sample persons with respect to the variables being studied. Intense efforts were undertaken during NHANES II to develop and implement standard procedures and inducements that would reduce the number of nonrespondents and thereby reduce the potential for bias. The user needs to be aware of and should explore the potential bias for nonresponse in any analysis of the NHANES II data. GENERAL MEDICAL EXAMINATION DATA SUMMARY - NHANES II Tape Positions 401-499 Tape Positions Catalog number.................................................... 401-404 Physician's examination form blank.................................... 407 Pulse............................................................. 408-410 BLOOD PRESSURE Systolic blood pressure........................................... 411-413 Diastolic blood pressure.......................................... 414-416 Cuff ........................................................ 417 Examiner number................................................... 418-419 HEAD, EYES, EARS, NOSE, AND THROAT Dry, staring hair..................................................... 421 Dyspigmented hair..................................................... 422 Easily pluckable hair................................................. 423 Abnormal texture or loss of curl...................................... 424 Circumcorneal injection............................................... 425 Conjunctival injection................................................ 426 Angular aritis................................................... 427 Pupils and is....................................................... 428 Xerosis............................................................. . 429 Lesions of cornea (other)............................................. 430 Bitot's ........................................................ 431 Conjugate e........................................................ 432 Keratomalacia....................................................... . 433 Strabismus.......................................................... . 434 Xerophthalmia....................................................... . 435 Conjunctiva other)................................................... 436 Lids and sclera (other)............................................... 437 Angular lesions of lips............................................... 438 Angular scars of lips................................................. 439 Cheilosis........................................................... . 440 Filiform papillary atrophy of tongue.................................. 441 Fungiform papillary hypertrophy of tongue............................. 442 Geographic ngue..................................................... 443 Fissures of ongue.................................................... 444 Serrations or swelling of tongue...................................... 445 Scarlet beefy tongue.................................................. 446 Magenta e........................................................ 447 Bleeding ........................................................ 448 Diffuse marginal inflammation......................................... 449 Swollen red apillae.................................................. 450 Recession........................................................... . 451 Naso-labial borrhea.................................................. 452 Visible enlarged parotids............................................. 453 Bossing of ull...................................................... 454 EXTERNAL EAR Right ........................................................ 456 Left ........................................................ 457 Operative scar - Left................................................. 458 Operative scar - Right................................................ 459 Pierced ears - Left................................................... 462 Pierced ears - Right.................................................. 463 AUDITORY CANAL Right auditory canal.................................................. 464 Left auditory canal................................................... 465 Occluded - ght...................................................... 466 Occluded - ft....................................................... 467 Occluded by - Right................................................... 468 Occluded by - Right................................................... 469 DRUM Right ........................................................ 470 Left ........................................................ 471 Dull/Transparent - Right.............................................. 472 Dull/Transparent - Left............................................... 473 Bulging/Retracted - Right............................................. 474 Bulging/Retracted - Left.............................................. 475 Calcium plaques - Right............................................... 476 Calcium plaques - Left................................................ 477 Red - ........................................................ 478 Red - ........................................................ 479 Fluid - ........................................................ 480 Fluid - ........................................................ 481 Scars - ........................................................ 482 Scars - ........................................................ 483 Perforated - Right.................................................... 484 Perforated - Left..................................................... 485 Nares Right ........................................................ 488 Left ........................................................ 489 Obstruction - Right................................................... 490 Obstruction - Left.................................................... 491 Deviated septum - Right............................................... 492 Deviated septum - Left................................................ 493 Swollen turbinates - Right............................................ 494 Swollen turbinates - Left............................................. 495 Chronic inflammation - Right.......................................... 496 Chronic inflammation - Left........................................... 497 Polyps - t........................................................ 498 Polyps - ........................................................ 499 Tape Positions 502-591 NECK Neck................................................................ . 502 Adenopathy.......................................................... . 503 Tracheal ation.................................................... 504 THYROID EVALUATION WHO ation.................................................... 506 OTHER THYROID FINDINGS Other thyroid findings................................................ 507 Tenderness.......................................................... . 508 Nodule.............................................................. . 509 Isthmus............................................................. . 510 CHEST EVALUATION Findings/No indings.................................................. 512 Beading of bs....................................................... 513 Follicular hyperkeratosis of upper back............................... 514 Wheezing on auscultation - diffuse.................................... 515 Wheezing on auscultation - focal...................................... 516 Decreased breath sounds (diffuse)..................................... 517 Masses t)....................................................... 518 Auscultation........................................................ . 519 Right Chest - Upper Lobe Diminished breath sounds.............................................. 520 Bronchial breath sounds............................................... 521 Rales............................................................... . 522 Rhonchi............................................................. . 523 Wheeze.............................................................. . 524 Right Chest - Middle Lobe Diminished breath sounds.............................................. 525 Bronchial breath sounds............................................... 526 Rales............................................................... . 527 Rhonchi............................................................. . 528 Wheeze.............................................................. . 529 Right Chest - Lower Lobe Diminished breath sounds.............................................. 530 Bronchial breath sounds............................................... 531 Rales............................................................... . 532 Rhonchi............................................................. . 533 Wheeze.............................................................. . 534 Left Chest - Upper Lobe Diminished breath sounds.............................................. 535 Bronchial breath sounds............................................... 536 Rales............................................................... . 537 Rhonchi............................................................. . 538 Wheeze.............................................................. . 539 Left Chest - Lower Lobe Diminished breath sounds.............................................. 540 Bronchial breath sounds............................................... 541 Rales............................................................... . 542 Rhonchi............................................................. . 543 Wheeze.............................................................. . 544 Heart P.M.I............................................................... . 546 Interspace.......................................................... . 547 Midclavicular line.................................................... 548 Thrills............................................................. . 549 Thrills - tolic.................................................... 550 Thrills - stolic................................................... 551 First heart ound..................................................... 552 Second heart sound.................................................... 553 Murmurs............................................................. . 554 Systolic ur(s).................................................... 555 Diastolic mur(s)................................................... 556 Apex - ic....................................................... 557 Apex - lic...................................................... 558 Midprecordium - systolic.............................................. 559 Midprecordium - diastolic............................................. 560 Left base - ystolic.................................................. 561 Left base - iastolic................................................. 562 Right base - Systolic................................................. 563 Right base - Diastolic................................................ 564 Origin - al....................................................... 565 Origin - ic....................................................... 566 Origin - uspid.................................................... 567 Origin - onic..................................................... 568 Origin - Atrial septal defect......................................... 569 Origin - Ventricular septal defect.................................... 570 Origin - r........................................................ 571 Origin.............................................................. . 572 Other cardiac or cardiovascular findings.............................. 573 Edema............................................................... . 574 Cyanosis............................................................ . 575 Irregular se....................................................... 576 Neck vein tension.................................................. 578 PULSE - ARTERIAL EVALUATION Palpatation Right ........................................................ 579 Right ........................................................ 580 Right dorsalis pedis.................................................. 581 Left ........................................................ 582 Left ........................................................ 583 Left dorsalis pedis................................................... 584 Pulsations Right ........................................................ 585 Right ........................................................ 586 Right dorsalis pedis.................................................. 587 Left ........................................................ 589 Left ........................................................ 590 Left dorsalis pedis................................................... 591 Tape Positions 593-699 ABDOMINAL EVALUATION AND KIDNEY Findings/No indings.................................................. 593 Hepatomegaly........................................................ . 594 Splenomegaly........................................................ . 595 Uterine gement................................................... 596 Inguinal ia....................................................... 597 Femoral a........................................................ 598 Umbilical nia...................................................... 599 Pot ........................................................ 600 Mass(es)............................................................ . 601 Areas............................................................. 606-610 Surgical s........................................................ 612 Area.............................................................. 613-617 Costovertebral tenderness............................................. 619 JOINTS Findings/No indings.................................................. 620 Shoulder Tender.............................................................. . 621 Swelling............................................................ . 622 Deformity........................................................... . 623 Pain on n........................................................ 624 Other............................................................... . 625 Elbow Tender.............................................................. . 626 Swelling............................................................ . 627 Deformity........................................................... . 628 Pain on n........................................................ 629 Other............................................................... . 630 Wrist Tender.............................................................. . 631 Swelling............................................................ . 632 Deformity........................................................... . 633 Pain on n........................................................ 634 Other............................................................... . 635 Metacarpophalangael Tender - t........................................................ 636 Tender - ........................................................ 637 Swelling - ght...................................................... 638 Swelling - ft....................................................... 639 Deformity - ight..................................................... 640 Deformity - eft...................................................... 641 Pain on Motion - Right................................................ 642 Pain on Motion - Left................................................. 643 Other - ........................................................ 644 Other - ........................................................ 645 Proximal Interphalangeal Tender - t........................................................ 646 Tender - ........................................................ 647 Swelling - ght...................................................... 648 Swelling - ft....................................................... 649 Deformity - ight..................................................... 650 Deformity - eft...................................................... 651 Pain on Motion - Right................................................ 652 Pain on Motion - Left................................................. 653 Other - ........................................................ 654 Other - ........................................................ 655 Distal Interphalangeal Tender - t........................................................ 656 Tender - ........................................................ 657 Swelling - ght...................................................... 658 Swelling - ft....................................................... 659 Deformity - ight..................................................... 660 Deformity - eft...................................................... 661 Heberden's nodes - Right.............................................. 662 Heberden's nodes - Left............................................... 663 Pain on Motion - Right................................................ 664 Pain on Motion - Left................................................. 665 Other - ........................................................ 666 Other - ........................................................ 667 Ankle Tender.............................................................. . 668 Swelling............................................................ . 669 Deformity........................................................... . 670 Pain on n........................................................ 671 Other............................................................... . 672 Feet Tender.............................................................. . 673 Swelling............................................................ . 674 Deformity........................................................... . 675 Pain on n........................................................ 676 Other............................................................... . 677 Knees Tender.............................................................. . 678 Swelling............................................................ . 679 Deformity........................................................... . 680 Pain on n........................................................ 681 Other............................................................... . 682 Hips Tender.............................................................. . 683 Swelling............................................................ . 684 Deformity........................................................... . 685 Pain on n........................................................ 686 Other............................................................... . 687 Back No indings.................................................. 688 Scoliosis........................................................... . 689 Kyphosis............................................................ . 690 Lordosis............................................................ . 691 Tenderness - Sciatic notch............................................ 692 Tenderness - Sacroiliac............................................... 693 Limitation of Motion Thoracic e........................................................ 695 Lumbar spine, Right lateral flexion................................... 696 Lumbar spine, Left lateral flexion.................................... 697 Full n........................................................ 698 Pain on n........................................................ 699 Tape Positions 700-778 Pain on flexion - Location Cervical - Severity of pain........................................... 700 Thoracic............................................................ . 701 Low ........................................................ 702 Diffuse............................................................. . 703 Uncertain........................................................... . 704 Pain on extension - Location Cervical - Severity of pain........................................... 705 Thoracic............................................................ . 706 Low ........................................................ 707 Diffuse............................................................. . 708 Uncertain........................................................... . 709 Pain on right lateral bending - Location Thoracic............................................................ . 710 Low ........................................................ 711 Diffuse............................................................. . 712 Uncertain........................................................... . 713 Pain on left lateral bending - Location Thoracic............................................................ . 714 Low ........................................................ 715 Diffuse............................................................. . 716 Uncertain........................................................... . 717 Pain on right rotation - Location Thoracic............................................................ . 718 Low ........................................................ 719 Diffuse............................................................. . 720 Uncertain........................................................... . 721 Pain on left rotation - Location Thoracic............................................................ . 722 Low ........................................................ 723 Diffuse............................................................. . 724 Uncertain........................................................... . 725 STRAIGHT LEG RAISING TEST Right ........................................................ 726 Left ........................................................ 727 Increase on ankle dorsiflexion Right ........................................................ 728 Left ........................................................ 729 MUSCULOSKELETAL EVALUATION Findings/No indings.................................................. 731 Bowed ........................................................ 732 Knock ........................................................ 733 Epiphysial enlargement, wrists........................................ 734 Abduction of hips..................................................... 735 NEUROLOGICAL EVALUATION Findings/No indings.................................................. 737 Absent knee erks..................................................... 738 Absent ankle jerks.................................................... 739 Positive Chvostek sign................................................ 740 Apathy.............................................................. . 741 Marked rritability.............................................. 742 SKIN EVALUATION Findings/No indings.................................................. 744 Follicular hyperkeratosis, arms....................................... 745 Hyperpigmentation, hands and face..................................... 746 Dry or scaling skin................................................... 747 Perifolliculosis.................................................... . 748 Petechiae........................................................... . 749 Mosiac ........................................................ 750 Pellagrous rmatitis................................................. 751 Ecchymoses.......................................................... . 752 Edema............................................................... . 753 EXAMINER'S SUBJECTIVE IMPRESSION OF NUTRITIONAL STATUS Normal/Abnormal nutrition............................................. 755 Obesity............................................................. . 756 BLOOD PRESSURE Cuff ........................................................ 757 Time - Hour....................................................... 758-759 Time - Minutes.................................................... 760-761 Time - ........................................................ 762 Systolic - Recumbent.............................................. 763-765 Diastolic - Recumbent............................................. 768-770 Systolic - Sitting................................................ 771-773 Diastolic - Sitting............................................... 774-776 Examiner No....................................................... 777-778 Tape Positions 780-871 SUMMARY OF DIAGNOSTIC IMPRESSIONS Severity............................................................ . 780 Certainty........................................................... . 781 ICDA Code a....................................................... 782-785 Severity............................................................ . 786 Certainty........................................................... . 787 ICDA Code b....................................................... 788-791 Severity............................................................ . 792 Certainty........................................................... . 793 ICDA Code c....................................................... 794-797 Severity............................................................ . 798 Certainty........................................................... . 799 ICDA Code d....................................................... 800-803 Severity............................................................ . 804 Certainty........................................................... . 805 ICDA Code e....................................................... 806-809 Severity............................................................ . 810 Certainty........................................................... . 811 ICDA Code f....................................................... 812-815 Severity............................................................ . 816 Certainty........................................................... . 817 ICDA Code g....................................................... 818-821 Severity............................................................ . 822 Certainty........................................................... . 823 ICDA Code h....................................................... 824-827 Severity............................................................ . 828 Certainty........................................................... . 829 ICDA Code i....................................................... 830-833 Severity............................................................ . 834 Certainty........................................................... . 835 ICDA Code j....................................................... 836-839 Severity............................................................ . 840 Certainty........................................................... . 841 ICDA Code k....................................................... 842-845 Severity............................................................ . 846 Certainty 847 ICDA Code l....................................................... 848-851 Severity............................................................ . 852 Certainty........................................................... . 853 ICDA Code m....................................................... 854-857 Severity............................................................ . 858 Certainty........................................................... . 859 ICDA Code n....................................................... 860-863 Severity............................................................ . 864 Certainty........................................................... . 865 ICDA Code o....................................................... 866-869 Examiner Number................................................... 870-871 RECORD LAYOUT, PHYSICIAN EXAMINATION DATA Tape Positions 401-450 NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY - NHANES II Physician Examination Data POSITION ITEM DESCRIPTION AND CODES COUNTS SOURCE AND NOTES 401-404 Catalog number 5302 20,322 405-406 Blank 20,322 407 Physician's examination form blank See detailed notes 1 form is blank 14 blank 20,308 408-410 Pulse All ages See detailed 033-200 beats per minute 19,995 notes 888 blank but applicable 313 blank 14 411-413 Systolic blood pressure Age 6 years and over 065-300 mm Hg 16,109 See detailed 888 blank but applicable 88 notes blank 4,125 414-416 Diastolic blood pressure 035-150 mm Hg 16,055 888 blank but applicable 142 blank 4,125 417 Cuff width 1 Adult 14,462 See detailed 2 Child 1,598 notes 8 blank but applicable 137 blank 4,125 418-419 Examiner number 30-49 physician number 16,193 88 blank but applicable 4 blank 4,125 HEAD, EYES, EARS, NOSE, AND THROAT 420 1 findings 15,713 See detailed 2 no findings 4,593 notes 8 blank but applicable 2 blank 14 421 Dry, staring hair 1 yes 4 blank 20,318 422 Dyspigmented hair 1 yes 0 blank 20,322 423 Easily pluckable hair 1 yes 2 blank 20,320 424 Abnormal texture or loss of curl 1 yes 5 blank 20,317 425 Circumcorneal injection 1 yes 30 blank 20,292 426 Conjunctival injection 1 yes 1,319 blank 19,003 427 Angular blepharitis 1 yes 15 blank 20,307 428 Pupils and iris 1 yes 73 blank 20,249 429 Xerosis 1 yes 4 blank 20,318 430 Lesions of cornea (other) 1 yes 42 blank 20,280 431 Bitot's spots 1 yes 4 blank 20,318 432 Conjugate gaze 1 yes 6 blank 20,316 433 Keratomalacia 1 yes 2 blank 20,320 434 Strabismus 1 yes 79 blank 20,243 435 Xerophthalmia 1 yes 3 blank 20,319 436 Conjunctiva (other) 1 yes 152 blank 20,170 437 Lids and sclera (other) 1 yes 23 blank 20,299 438 Angular lesions of lips 1 yes 33 blank 20,289 439 Angular scars of lips 1 yes 17 blank 20,305 440 Cheilosis 1 yes 49 blank 20,273 441 Filiform papillary atrophy of tongue 1 yes 89 blank 20,233 442 Fungiform papillary hypertrophy of tongue 1 yes 971 blank 19,351 443 Geographic tongue 1 yes 138 blank 20,184 444 Fissures of tongue 1 yes 939 blank 19,383 445 Serrations or swelling of tongue 1 yes 1,002 blank 19,320 446 Scarlet beefy tongue 1 yes 26 blank 20,296 447 Magenta tongue 1 yes 4 blank 20,318 448 Bleeding gums 1 yes 5 blank 20,317 449 Diffuse marginal inflammation 1 yes 142 blank 20,180 450 Swollen red papillae 1 yes 101 blank 20,221 Tape Positions 451-501 POSITION ITEM DESCRIPTION AND CODES COUNTS SOURCE AND NOTES 451 Recession 1 yes 535 blank 19,787 452 Naso-labial seborrhea 1 yes 9 blank 20,313 453 Visible enlarged parotids 0 yes 20 blank 20,302 454 Bossing of skull 1 yes 28 blank 20,294 455 Blank 20,322 EXTERNAL EAR 456 Right ear See detailed notes 1 no findings 16,261 2 findings 4,044 8 blank but applicable 3 blank 14 457 Left ear See detailed notes 1 no findings 15,966 2 findings 4,339 8 blank but applicable 3 blank 14 458 Operative scar - Left mastoid 1 yes 20 blank 20,302 459 Operative scar - Right mastoid 1 yes 17 blank 20,305 460-461 Blank 20,322 462 Pierced ears - Left 1 yes 4,028 blank 16,294 463 Pierced ears - Right 1 yes 4,325 blank 15,997 AUDITORY CANAL 464 Right auditory canal See detailed notes 1 no findings 17,914 2 findings 2,391 8 blank but applicable 3 blank 14 465 Left auditory canal See detailed notes 1 no findings 17,977 2 findings 2,328 8 blank but applicable 3 blank 14 466 Occluded - Right 1 partially 793 2 completely 1,409 8 blank but applicable 189 blank 17,931 467 Occluded - Left 1 partially 756 2 completely 1,381 8 blank but applicable 191 blank 17,994 468 Occluded by - Right 1 cerumen 2,072 2 other 206 8 blank but applicable 113 blank 17,931 469 Occluded by - Left 1 cerumen 2,020 2 other 197 8 blank but applicable 111 blank 17,994 DRUM 470 Right drum See detailed notes 1 no findings 17,537 2 findings 1,329 3 not visible 1,439 8 blank but applicable 3 blank 14 471 Left drum See detailed notes 1 no findings 17,439 2 findings 1,487 3 not visible 1,379 8 blank but applicable 3 blank 14 472 Dull/Transparent - Right 1 dull (opaque) 407 2 transparent 5 blank 19,910 473 Dull/Transparent - Left 1 dull (opaque) 470 2 transparent 6 blank 19,846 474 Bulging/Retracted - Right 1 bulging 6 2 retracted 92 blank 20,224 475 Bulging/Retracted - Left 1 bulging 7 2 retracted 136 blank 20,179 476 Calcium plaques - Right 1 yes 117 blank 20,205 477 Calcium plaques - Left 1 yes 130 blank 20,192 478 Red - Right 1 red 184 2 other discolorations 41 blank 20,097 479 Red - Left 1 red 238 2 other discolorations 43 blank 20,041 480 Fluid - Right 1 fluid 18 blank 20,314 481 Fluid - Left 1 fluid 9 blank 20,313 482 Scars - Right 1 scars 508 blank 19,814 483 Scars - Left 1 scars 524 blank 19,798 484 Perforated - Right 1 with discharge 23 2 without discharge 75 blank 20,224 485 Perforated - Left 1 with discharge 21 2 without discharge 58 blank 20,243 486-487 Blank 20,322 NARES 488 Right nares See detailed notes 1 no findings 18,061 2 findings 2,244 8 blank but applicable 3 blank 14 489 Left nares See detailed notes 1 no findings 18,169 2 findings 2,136 8 blank but applicable 3 blank 14 490 Obstruction - Right 1 acute 143 2 chronic 85 blank 20,094 491 Obstruction - Left 1 acute 146 2 chronic 86 blank 20,090 Other Significant Findings 492 Deviated septum - Right 1 yes 453 blank 19,869 493 Deviated septum - Left 1 yes 267 blank 20,055 494 Swollen turbinates - Right 1 yes 1,457 blank 18,865 495 Swollen turbinates - Left 1 yes 1,532 blank 18,790 496 Chronic inflammation - Right 1 yes 343 blank 19,979 497 Chronic inflammation - Left 1 yes 345 blank 19,977 498 Polyps - Right 1 yes 20 blank 20,302 499 Polyps - Left 1 yes 17 blank 20,305 500-501 Blank 20,322 Tape Positions 502-550 POSITION ITEM DESCRIPTION AND CODES COUNTS SOURCE AND NOTES NECK 502 1 no findings 19,805 See detailed 2 findings 500 note 8 blank but applicable 3 blank 14 503 Adenopathy 1 yes 492 blank 19,830 504 Tracheal deviation 1 yes 8 blank 20,314 505 Blank 20,322 THYROID EVALUATION 506 WHO Classification 1 Group 0 19,294 See detailed 2 Group 1 826 notes 3 Group 2 99 4 Group 3 15 8 blank but applicable 74 blank 14 Other Thyroid Findings 507 1 findings 117 See detailed 2 no findings 20,188 notes 8 blank but applicable 3 blank 14 508 Tenderness 1 right 8 2 left 0 3 both 7 blank 20,307 509 Nodule 1 right 55 2 left 25 3 both 15 blank 20,227 510 Isthmus 1 right 22 2 left 0 3 both 0 blank 20,300 511 Blank 20,322 CHEST EVALUATION 512 1 findings 723 See detailed 2 no findings 19,570 notes 8 blank but applicable 15 blank 14 513 Beading of ribs 1 yes 9 blank 20,313 514 Follicular hyperkeratosis of upper back 1 yes 75 blank 20,247 515 Wheezing on auscultation - Diffuse See detailed notes 1 yes 193 blank 20,129 516 Wheezing on auscultation - Focal See detailed notes 1 yes 83 blank 20,239 517 Decreased breath sounds (diffuse) See detailed notes 1 yes 254 blank 20,068 518 Masses (breast) 1 right 45 2 left 50 3 both 48 blank 20,179 519 Auscultation See detailed notes 1 no findings 19,145 2 findings 1,148 8 blank but applicable 15 blank 14 Right Chest - Upper Lobe 520 Breath sounds See detailed notes 1 diminished breath sounds 203 2 absent breath sounds 4 blank 20,115 521 Bronchial breath sounds 1 yes 141 blank 20,181 522 Rales 1 yes 101 blank 20,221 523 Rhonchi 1 yes 105 blank 20,217 524 Wheeze 1 yes 168 blank 20,154 Right Chest - Middle Lobe 525 Breath sounds See detailed notes 1 diminished breath sounds 133 2 absent breath sounds 2 blank 20,187 526 Bronchial breath sounds 1 yes 125 blank 20,197 527 Rales 1 yes 106 blank 20,216 528 Rhonchi 1 yes 110 blank 20,212 529 Wheeze 1 yes 160 blank 20,162 530 Breath sounds See detailed notes 1 diminished breath sounds 152 2 absent breath sounds 5 blank 20,165 531 Bronchial breath sounds 1 yes 155 blank 20,167 532 Rales 1 yes 237 blank 20,085 533 Rhonchi 1 yes 155 blank 20,167 534 Wheeze 1 yes 192 blank 20,130 Left Chest - Upper Lobe 535 Breath sounds See detailed notes 1 diminished breath sounds 199 2 absent breath sounds 10 blank 20,113 536 Bronchial breath sounds 1 yes 135 blank 20,187 537 Rales 1 yes 112 blank 20,210 538 Rhonchi 1 yes 107 blank 20,215 539 Wheeze 1 yes 170 blank 20,143 Left Chest - Lower Lobe 540 Breath sounds See detailed notes 1 diminished breath sounds 139 2 absent breath sounds 11 blank 20,172 541 Bronchial breath sounds 1 yes 159 blank 20,163 542 Rales 1 yes 258 blank 20,064 543 Rhonchi 1 yes 149 blank 20,173 544 Wheeze 1 yes 190 blank 20,132 545 Blank 20,322 HEART 546 P.M.I. - Point of maximum impulse Age 18 years and over 1 felt 5,532 See detailed 2 not felt 6,966 notes 8 blank but applicable 1 blank 7,823 547 Interspace 4 th 640 5 th 4,637 6 th 227 7 th 7 blank 14,811 548 Midclavicular line 1 at 3,615 2 inside 1,697 3 outside 158 blank 14,852 549 Thrills 1 absent 20,272 2 present 33 8 blank but applicable 3 blank 14 550 Thrills - Systolic 1 base 20 2 apex 8 blank 20,294 Tape Positions 551-600 POSITION ITEM DESCRIPTION AND CODES COUNTS SOURCE AND NOTES 551 Thrills - Diastolic 1 base 13 2 apex 6 blank 20,303 552 First heart sound 1 normal 19,365 2 accentuated 144 3 diminished 712 8 blank but applicable 87 blank 14 553 Second heart sound 1 normal 19,287 2 accentuated 245 3 diminished 680 8 blank but applicable 96 blank 14 554 Murmurs See detailed notes 1 none 19,120 8 blank but applicable 3 blank 1,199 555 Systolic murmur(s) 1 functional 327 2 organic 708 8 blank but applicable 27 9 don't know 76 blank 19,184 556 Diastolic murmur(s) 1 functional 2 2 organic 103 8 blank but applicable 27 9 don't know 2 blank 20,188 Location 557 Apex - Systolic 1 grade 1 107 2 grade 2 180 3 grade 3 163 4 grade 4 61 5 grade 5 12 6 grade 6 3 blank 19,796 558 Apex - Diastolic 1 grade 1 1 2 grade 2 13 3 grade 3 25 4 grade 4 7 5 grade 5 1 6 grade 6 1 blank 20,274 559 Midprecordium - Systolic 1 grade 1 63 2 grade 2 157 3 grade 3 121 4 grade 4 25 5 grade 5 10 6 grade 6 2 blank 19,944 560 Midprecordium - Diastolic 1 grade 1 0 2 grade 2 3 3 grade 3 23 4 grade 4 5 5 grade 5 0 6 grade 6 2 blank 20,289 561 Left base - Systolic 1 grade 1 58 2 grade 2 131 3 grade 3 131 4 grade 4 31 5 grade 5 7 6 grade 6 1 blank 19,963 562 Left base - Diastolic 1 grade 1 0 2 grade 2 5 3 grade 3 17 4 grade 4 5 5 grade 5 0 6 grade 6 1 blank 20,294 563 Right base - Systolic 1 grade 1 50 2 grade 2 162 3 grade 3 149 4 grade 4 50 5 grade 5 13 6 grade 6 0 blank 19,898 564 Right base - Diastolic 1 grade 1 1 2 grade 2 3 3 grade 3 10 4 grade 4 8 5 grade 5 0 6 grade 6 0 blank 20,300 565 Origin - Mitral 1 systolic 308 2 diastolic 30 3 both 20 blank 19,964 566 Origin - Aortic 1 systolic 320 2 diastolic 14 3 both 27 blank 19,961 567 Origin - Tricuspid 1 systolic 21 2 diastolic 0 3 both 0 blank 20,301 568 Origin - Pulmonic 1 systolic 86 2 diastolic 1 3 both 1 blank 20,234 569 Origin - Atrial septal defect 1 systolic 12 2 diastolic 0 3 both 1 blank 20,309 570 Origin - Ventricular septal defect 1 systolic 79 2 diastolic 0 3 both 0 blank 20,243 571 Origin - Other 1 systolic 24 2 diastolic 1 3 both 5 blank 20,292 572 Origin 9 don't know 209 blank 20,113 Other Cardiac or Cardiovascular Findings 573 1 no 19,636 See detailed 2 yes 672 notes blank 14 574 Edema 1 yes 222 blank 20,100 575 Cyanosis 1 yes 51 blank 20,271 576 Irregular pulse 1 yes 415 blank 19,907 577 Blank 20,322 578 Neck vein distension 1 yes 53 blank 20,269 PULSE - ARTERIAL EVALUATION Age 18 years and over See detailed notes Palpation 579 Right radial 1 normal 12,074 2 sclerotic 324 3 tortuous 19 4 sclerotic and tortuous 27 5 absent 23 8 blank but applicable 32 blank 7,823 580 Right femoral 1 normal 12,005 2 sclerotic 323 3 tortuous 15 4 sclerotic and tortuous 23 5 absent 58 8 blank but applicable 75 blank 7,823 581 Right dorsalis pedis 1 normal 11,279 2 sclerotic 405 3 tortuous 10 4 sclerotic and tortuous 23 5 absent 659 8 blank but applicable 123 blank 7,823 582 Left radial 1 normal 12,037 2 sclerotic 330 3 tortuous 17 4 sclerotic and tortuous 25 5 absent 22 8 blank but applicable 68 blank 7,823 583 Left femoral 1 normal 11,987 2 sclerotic 327 3 tortuous 15 4 sclerotic and tortuous 21 5 absent 66 8 blank but applicable 83 blank 7,823 584 Left dorsalis pedis 1 normal 10,815 2 sclerotic 365 3 tortuous 10 4 sclerotic and tortuous 22 5 absent 686 8 blank but applicable 601 blank 7,823 Pulsations 585 Right radial 1 normal 12,150 2 diminished 201 3 bounding 86 4 absent 28 8 blank but applicable 34 blank 7,823 586 Right femoral 1 normal 12,042 2 diminished 251 3 bounding 87 4 absent 59 8 blank but applicable 60 blank 7,823 587 Right dorsalis pedis 1 normal 11,214 2 diminished 404 3 bounding 59 4 absent 718 8 blank but applicable 104 blank 7,823 586 Blank 20,322 589 Left radial 1 normal 12,139 2 diminished 205 3 bounding 86 4 absent 24 8 blank but applicable 45 blank 7,823 590 Left femoral 1 normal 12,029 2 diminished 249 3 bounding 83 4 absent 68 8 blank but applicable 70 blank 7,823 591 Left dorsalis pedis 1 normal 11,187 2 diminished 397 3 bounding 60 4 absent 740 8 blank but applicable 115 blank 7,823 592 Blank 20,322 ABDOMINAL EVALUATION AND KIDNEY 593 1 findings 5,294 See detailed 2 no findings 15,011 notes 8 blank but applicable 3 blank 14 594 Hepatomegaly 1 yes 131 blank 20,191 595 Splenomegaly 1 yes 21 blank 20,301 596 Uterine enlargement 1 yes 64 blank 20,258 597 Inguinal hernia 1 yes 90 blank 20,232 598 Femoral hernia 1 yes 1 blank 20,321 599 Umbilical hernia 1 yes 427 blank 19,895 600 Pot belly 1 yes 59 blank 20,263 Tape Positions 601-650 POSITION ITEM DESCRIPTION AND CODES COUNTS SOURCE AND NOTES 601 Mass(es) 1 yes 82 blank 20,240 602-605 Blank 20,322 606-610 Areas See detailed notes Areas 1-9 indicated 82 00000 blank but applicable 0 blank 20,240 611 Blank 20,322 Surgical Scars 612 1 yes 4,688 blank 15,634 613-617 Areas See detailed notes Areas 1-9 indicated 4,688 00000 blank but applicable 0 blank 15,634 618 Blank 20,322 619 Costovertebral tenderness 1 yes 35 blank 20,287 JOINTS Age 10 and over 620 1 findings 12,225 See detailed 2 no findings 2,831 notes 8 blank but applicable 4 blank 5,262 Shoulder 621 Tender 1 right 55 2 left 38 3 both 59 blank 20,170 622 Swelling 1 right 5 2 left 1 3 both 9 blank 20,307 623 Deformity 1 right 6 2 left 4 3 both 5 blank 20,307 624 Pain on motion 1 right 90 2 left 61 3 both 91 blank 20,080 625 Other 1 right 13 2 left 9 3 both 4 blank 20,296 Elbow 626 Tender 1 right 25 2 left 13 3 both 44 blank 20,240 627 Swelling 1 right 5 2 left 5 3 both 7 blank 20,305 628 Deformity 1 right 34 2 left 17 3 both 8 blank 20,263 629 Pain on motion 1 right 34 2 left 19 3 both 46 blank 20,223 630 Other 1 right 3 2 left 3 3 both 1 blank 20,315 Wrist 631 Tender 1 right 29 2 left 12 3 both 40 blank 20,241 632 Swelling 1 right 8 2 left 6 3 both 14 blank 20,294 633 Deformity 1 right 28 2 left 12 3 both 18 blank 20,264 634 Pain on motion 1 right 27 2 left 17 3 both 49 blank 20,229 635 Other 1 right 2 2 left 3 3 both 0 blank 20,317 Metacarpophalangael Number involved 636 Tender - Right 1-5 joints involved 73 blank 20,249 637 Tender - Left 1-5 joints involved 66 blank 20,256 638 Swelling - Right 1-5 joints involved 62 blank 20,260 639 Swelling - Left 1-5 joints involved 55 blank 20,267 640 Deformity - Right 1-5 joints involved 125 blank 20,197 641 Deformity - Left 1-5 joints involved 113 blank 20,209 642 Pain on motion - Right 1-5 joints involved 65 blank 20,257 643 Pain on motion - Left 1-5 joints involved 64 blank 20,258 644 Other - Right 1-5 joints involved 5 blank 20,317 645 Other - Left 1-5 joints involved 5 blank 20,317 Proximal Interphalangeal Number involved 646 Tender - Right 1-5 joints involved 106 blank 20,216 647 Tender - Left 1-5 joints involved 95 blank 20,227 648 Swelling - Right 1-5 joints involved 108 blank 20,214 649 Swelling - Left 1-5 joints involved 98 blank 20,224 650 Deformity - Right 1-5 joints involved 230 blank 20,092 Tape Positions 651-700 POSITION ITEM DESCRIPTION AND CODES COUNTS SOURCE AND NOTES 651 Deformity - Left 1-5 joints involved 198 blank 20,124 652 Pain on motion - Right 1-5 joints involved 102 blank 20,220 653 Pain on motion - Left 1-5 joints involved 92 blank 20,220 654 Other - Right 1-5 joints involved 4 blank 20,318 655 Other - Left 1-5 joints involved 4 blank 20,318 Distal Interphalangeal Number involved 656 Tender - Right 1-5 joints involved 79 blank 20,243 657 Tender - Left 1-5 joints involved 70 blank 20,252 658 Swelling - Right 1-5 joints involved 59 blank 20,263 659 Swelling - Left 1-5 joints involved 52 blank 20,270 660 Deformity - Right 1-5 joints involved 175 blank 20,147 661 Deformity - Left 1-5 joints involved 151 blank 20,171 662 Heberden's nodes - Right 1-5 joints involved 1,395 blank 18,927 663 Heberden's nodes - Left 1-5 joints involved 1,277 blank 19,045 664 Pain on motion - Right 1-5 joints involved 65 blank 20,257 665 Pain on motion - Left 1-5 joints involved 62 blank 20,260 666 Other - Right 1-5 joints involved 6 blank 20,316 667 Other - Left 1-5 joints involved 7 blank 20,315 Ankle 668 Tender 1 right 30 2 left 24 3 both 55 blank 20,213 669 Swelling 1 right 25 2 left 23 3 both 48 blank 20,226 670 Deformity 1 right 37 2 left 37 3 both 37 blank 20,211 671 Pain on motion 1 right 34 2 left 19 3 both 59 blank 20,210 672 Other 1 right 6 2 left 4 3 both 4 blank 20,308 Feet 673 Tender 1 right 17 2 left 9 3 both 52 blank 20,244 674 Swelling 1 right 7 2 left 5 3 both 28 blank 20,282 675 Deformity 1 right 17 2 left 14 3 both 107 blank 20,184 676 Pain on motion 1 right 13 2 left 11 3 both 51 blank 20,247 677 Other 1 right 3 2 left 2 3 both 6 blank 20,311 Knees 678 Tender 1 right 83 2 left 69 3 both 149 blank 20,021 679 Swelling 1 right 50 2 left 43 3 both 86 blank 20,143 680 Deformity 1 right 35 2 left 41 3 both 174 blank 20,072 681 Pain on motion 1 right 127 2 left 93 3 both 206 blank 19,896 682 Other 1 right 24 2 left 29 3 both 76 blank 20,193 Hips 683 Tender 1 right 52 2 left 33 3 both 86 blank 20,151 684 Swelling 1 right 2 2 left 2 3 both 9 blank 20,309 685 Deformity 1 right 18 2 left 13 3 both 21 blank 20,270 686 Pain on motion 1 right 79 2 left 70 3 both 151 blank 20,022 687 Other 1 right 19 2 left 13 3 both 21 blank 20,269 BACK 688 1 no findings 17,389 See detailed 2 findings 2,916 notes 8 blank but applicable 3 blank 14 689 Scoliosis 1 yes 685 blank 19,637 690 Kyphosis 1 yes 873 blank 19,449 691 Lordosis 1 yes 264 blank 20,058 692 Tenderness - Sciatic notch 1 right 42 2 left 29 3 both 49 blank 20,203 693 Tenderness - Sacroiliac 1 right 58 2 left 37 3 both 76 blank 20,151 694 Blank 20,322 Limitation of Motion 695 Thoracic spine 1 yes 858 blank 19,464 696 Lumbar spine, right lateral flexion 1 yes 986 blank 19,336 697 Lumbar spine, left lateral flexion 1 yes 977 blank 19,345 698 Full extension 1 yes 1,011 blank 19,311 PAIN ON MOTION 699 1 negative 2,024 See detailed 2 positive 891 notes 8 blank but applicable 1 blank 17,406 Pain on flexion - Location 700 Cervical - Severity of pain 0 None 30 1 doubtful 16 2 minimal 112 3 moderate 152 4 maximal 14 8 blank but applicable 567 blank 19,431 Tape Positions 701-750 POSITION ITEM DESCRIPTION AND CODES COUNTS SOURCE AND NOTES 701 Thoracic 1 yes 92 blank 20,230 702 Low Back 1 yes 235 blank 20,087 703 Diffuse 1 yes 96 blank 20,226 704 Uncertain 1 yes 8 blank 20,314 Pain on extension - Location 705 Cervical - Severity of pain 0 none 24 1 doubtful 15 2 minimal 129 3 moderate 168 4 maximal 14 8 blank but applicable 541 blank 19,431 706 Thoracic 1 yes 99 blank 20,223 707 Low Back 1 yes 283 blank 20,039 708 Diffuse 1 yes 93 blank 20,229 709 Uncertain 1 yes 7 blank 20,315 Pain on right lateral bending - Location 710 Thoracic 1 yes 98 blank 20,224 711 Low Back 1 yes 270 blank 20,052 712 Diffuse 1 yes 85 blank 20,237 713 Uncertain 1 yes 5 blank 20,317 Pain on left lateral bending - Location 714 Thoracic 1 yes 98 blank 20,224 715 Low Back 1 yes 301 blank 20,021 716 Diffuse 1 yes 82 blank 20,240 717 Uncertain 1 yes 5 blank 20,317 Pain on right rotation - Location 718 Thoracic 1 yes 100 blank 20,222 719 Low Back 1 yes 202 blank 20,120 720 Diffuse 1 yes 80 blank 20,242 721 Uncertain 1 yes 2 blank 20,320 Pain on left rotation - Location 722 Thoracic 1 yes 98 blank 20,224 723 Low Back 1 yes 195 blank 20,127 724 Diffuse 1 yes 80 blank 20,242 725 Uncertain 1 yes 2 blank 20,320 STRAIGHT LEG RAISING TEST 726 Right leg 1 negative 19,888 2 positive 312 8 blank but applicable 108 blank 14 727 Left leg 1 negative 19,871 2 positive 332 8 blank but applicable 105 blank 14 Increase on ankle dorsiflexion 728 Right 1 yes 208 2 no 16,230 8 blank but applicable 3,870 blank 14 729 Left 1 yes 224 2 no 16,218 8 blank but applicable 3,866 blank 14 730 Blank 20,322 MUSCULOSKELETAL EVALUATION See detailed notes 731 1 findings 1,567 2 no findings 18,738 8 blank but applicable 3 blank 14 732 Bowed legs 1 yes 812 blank 9,510 733 Knock knees 1 yes 755 blank 19,567 734 Epiphysial enlargement, wrists 1 yes 1 blank 20,321 735 Abduction of hips (Ortoloni's maneuver) Under age 3 1 yes 0 blank 20,322 736 Blank 20,322 NEUROLOGICAL EVALUATION See detailed notes 737 1 findings 2,027 2 no findings 18,278 8 blank but applicable 3 blank 14 738 Absent knee jerks 1 yes 589 blank 19,733 739 Absent ankle jerks 1 yes 707 blank 19,615 740 Positive Chvostek sign 1 yes 998 blank 19,324 741 Apathy 1 yes 33 blank 20,289 742 Marked hyperirritability 1 yes 89 blank 20,233 743 Blank 20,322 SKIN EVALUATION 744 1 findings 671 See detailed 2 no findings 19,634 notes 8 blank but applicable 3 blank 14 745 Follicular hyperkeratosis, arms 1 yes 137 blank 20,185 746 Hyperpigmentation, hands and face 1 yes 60 blank 20,262 747 Dry or scaling skin 1 yes 362 blank 19,960 748 Perifolliculosis 1 yes 17 blank 20,305 749 Petechiae 1 yes 60 blank 20,262 750 Mosaic skin 1 yes 7 blank 20,315 Tape Positions 751-799 POSITION ITEM DESCRIPTION AND CODES COUNTS SOURCE AND NOTES 751 Pellagrous dermatitis 1 yes 3 blank 20,319 752 Ecchymoses 1 yes 67 blank 20,255 753 Edema 1 yes 53 blank 20,269 754 Blank 20,322 EXAMINER'S SUBJECTIVE IMPRESSION OF NUTRITIONAL STATUS 755 1 normal nutrition 17,754 2 abnormal nutrition 2,527 8 blank but applicable 27 blank 14 756 1 obesity 2,949 2 no obesity 17,337 8 blank but applicable 22 blank 14 BLOOD PRESSURE See detailed notes Cuff Width 757 1 adult 14,478 2 child 1,580 8 blank but applicable 139 blank 4,125 Time 758-761 0001-1259 16,113 8888 blank but applicable 84 blank 4,125 762 1 AM 8,538 See detailed 2 PM 7,524 notes 8 blank but applicable 135 blank 4,125 Blood Pressure 763-765 Systolic - Recumbent Age 6 & over 68-300 mm Hg 16,084 888 blank but applicable 113 blank 4,125 766-767 Blank 20,322 768-770 Diastolic - Recumbent 35-150 mm Hg 16,020 888 blank but applicable 177 blank 4,125 771-773 Systolic - Sitting 65-300 mm Hg 16,074 888 blank but applicable 123 blank 4,125 774-776 Diastolic - Sitting 35-150 mm Hg 16,035 888 blank but applicable 162 blank 4,125 777-778 Examiner no. 02-88 Examiner Number 16,196 00 blank but applicable 1 blank 4,125 SUMMARY OF DIAGNOSTIC IMPRESSIONS 779 1 normal: no abnormal findings 8,671 See detailed 2 abnormal: significant findings noted 11,632 notes 8 blank but applicable 5 blank 14 Code a 780 Severity 1 minimal 4,806 2 moderate 5,304 3 severe 1,360 8 blank but applicable 162 blank 8,690 781 Certainty 0 Not at all certain - 9 Extremely certain 11,047 "-" blank but applicable 135 blank 8,690 782-785 ICDA code Code a 11,632 8888 blank but applicable 0 blank 8,690 Code b 786 Severity 1 minimal 2,382 2 moderate 3,186 3 severe 813 8 blank but applicable 110 blank 13,831 787 Certainty 0 Not at all certain - 9 Extremely certain 6,439 "-" blank but applicable 52 blank 13,831 788-791 ICDA code Code b 6,491 8888 blank but applicable 0 blank 13,831 Code c 792 Severity 1 minimal 1,265 2 moderate 1,905 3 severe 462 8 blank but applicable 71 blank 16,619 793 Certainty 0 Not at all certain - 9 Extremely certain 3,662 "-" blank but applicable 41 blank 16,619 794-797 ICDA code Code c 3,703 8888 blank but applicable 0 blank 16,619 Code d 798 Severity 1 minimal 659 2 moderate 1,145 3 severe 294 8 blank but applicable 34 blank 18,190 799 Certainty 0 Not at all certain - 9 Extremely certain 2,106 "-" blank but applicable 26 blank 18,190 Tape Positions 800-851 POSITION ITEM DESCRIPTION AND CODES COUNTS SOURCE AND NOTES 800-803 ICDA code Code d 2,132 blank 18,190 Code e 804 Severity 1 minimal 374 2 moderate 635 3 severe 176 8 blank but applicable 24 blank 19,113 805 Certainty 0 Not at all certain - 9 Extremely certain 1,196 '-' blank but applicable 13 blank 19,113 806-809 ICDA code Code e 1,209 8888 blank but applicable 0 blank 19,113 Code f 810 Severity 1 minimal 180 2 moderate 359 3 severe 97 8 blank but applicable 16 blank 19,670 811 Certainty 0 Not at all certain - 9 Extremely certain 643 '-' blank but applicable 9 blank 19,670 812-815 ICDA code Code f 652 8 blank but applicable 0 blank 19,670 Code g 816 Severity 1 minimal 102 2 moderate 193 3 severe 52 8 blank but applicable 8 blank 19,967 817 Certainty 0 Not at all certain - 9 Extremely certain 349 '-' blank but applicable 6 blank 19,967 818-821 ICDA code Cde g 355 8888 blank but applicable 19,967 Code h 822 Severity 1 minimal 48 2 moderate 86 3 severe 28 8 blank but applicable 4 blank 20,156 823 Certainty 0 Not at all certain - 9 Extremely certain 164 '-' blank but applicable 2 blank 20,156 824-827 ICDA code Code h 166 blank 20,156 Code i 828 Severity 1 minimal 24 2 moderate 45 3 severe 17 8 blank but applicable 4 blank 20,232 829 Certainty 0 Not at all certain - 9 Extremely certain 87 '-' blank but applicable 3 blank 20,232 830-833 ICDA code Code i 90 8888 blank but applicable 0 blank 20,232 Code j 834 Severity 1 minimal 5 2 moderate 19 3 severe 10 8 blank but applicable 1 blank 20,287 835 Certainty 0 Not at all certain - 9 Extremely certain 34 '-' blank but applicable 1 blank 20,287 836-839 ICDA code Code j 35 blank 20,287 Code k 840 Severity 1 minimal 4 2 moderate 6 3 severe 3 blank 20,309 841 Certainty 0 Not at all certain - 9 Extremely certain 13 blank 20,309 842-845 ICDA code Code k 13 blank 20,309 Code l 846 Severity 1 minimal 3 2 moderate 1 blank 20,318 847 Certainty 0 Not at all certain - 9 Extremely certain 4 blank 20,318 848-851 ICDA code Code l 4 blank 20,318 Code m Tape Positions 852-900 POSITION ITEM DESCRIPTION AND CODES COUNTS SOURCE AND NOTES 852 Severity 2 moderate 2 8 blank but applicable 0 blank 20,320 853 Certainty 0 Not at all certain - 9 Extremely certain 2 '-' blank but applicable 0 blank 20,320 854-857 ICDA code Code m 2 blank 20,320 Code n 858 Severity blank 20,322 859 Certainty blank 20,322 860-863 ICDA code blank 20,322 Code o 864 Severity blank 20,322 865 Certainty blank 20,322 866-869 ICDA code blank 20,322 870-871 Examiner number 30-49 Physician number 20,288 88 blank but applicable 20 blank 14 872-900 Blank 20,322 DETAILED NOTES, PHYSICIAN EXAMINATION DATA Physician's examination form blank Survey participants who completed other components of the examination but for whom the physician's examination form is blank are indicated with a "1" in this position. Their records are blank in positions 408-900. Pulse Any pulse value less than 30 was changed to "888", blank but applicable. Pulse values greater than 150 were left as stated by the examiner; typically, values in the higher ranges were accompanied by comments such as "crying baby". Blood Pressure At the beginning of the physical examination the physician took the sample person's blood pressure while the sample person was in a sitting position. The sample person's blood pressure was taken twice more at the end of the exam, once while the sample person was recumbent and again while sitting. The following guidelines, based on the American Heart Association's "Recommendations for Human Blood Pressure Determinations by Sphygmomanometers" (Committee to Revise Standardization of High Blood Pressure Readings, New York, American Heart Association, October 1951) were generally observed: 1. The cuff was at least 20 percent wider than the diameter of the arm or covered approximately two-thirds of the arm. (An adult 13 cm. cuff and a pediatric 9.5 cm. cuff were provided.) 2. The manometer was at eye level with the physician. 3. The meniscus of the mercury instruments was checked weekly for zero-level calibration. 4. While measuring, the rate of falling pressure was maintained 2-3 mm. Hg per heartbeat, which was slow enough to detect the first and last sounds but sufficiently rapid to avoid intermittent trapping of blood between systolic and diastolic levels. 5. For diastolic pressure, the level was recorded at the point of complete cessation of Korotkoff's sounds or, if there was no cessation, the point of muffling. 6. Measurements were recorded to the nearest 2 mm. on the scale. Cuff Width Cuff width was not edited for consistency with measured arm girth for anthropometric data. Tape Positions 420-779 Tape Positions 420, 456, 457, 464, 465, 470, 471, 488, 489, 502, 507, 512, 519, 546, 554, 573, 593, 620, 688, 699, 731, 737, 744, 779 "Blank" in these findings/ no findings fields represents participants for whom demographic data exist but for whom there is no examination data; these participants have a "1" in position 407. "Blank but applicable" ("8") indicates a survey partially completed. This field and the range of tape positions subordinate to this field were not completed on the form; "8" is imputed in this field and the subordinate positions are left blank. Ear Drum If the auditory canal was indicated as "completely occluded", a "not visible" finding was imputed for the ear drum. Thyroid Evaluation The World Health Organization (WHO) criteria used for grading goiter are: Group 0: Persons without goiter. By definition, these are persons whose thyroid glands are less than 4 to 5 times enlarged. Group 1: Persons with palpable goiters. The thyroid is considered to be more than 4 to 5 times enlarged although not visible with head in normal position. Most of these will be readily visible with the head thrown back and the neck fully extended. Group 2: Persons with visible goiters. Persons with goiters which are easily visible with the head in normal position, but which are smaller than those in Group 3. Palpation may be helpful in determining the mass of the gland, but is not needed for diagnosis. Group 3: Persons with very large goitrs. 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 wearing of clothes. (Perez, C., Scrimshaw, N.S., and Munoz, J.A., Technique of endemic goitre surveys. In endemic Goitre; p. 369, see esp. p. 376, World Health Organization Monograph Series No. 44, Geneva, 1960.) Wheezing on auscultation No attempt was made to correlate on auscultation and decreased breath sounds with entries in section H.6, ascultation. Chest Evaluation If breath sounds were "absent", the description of the breath sounds were left blank. Heart Murmurs No attempt was made to correlate the location of murmur with a type of murmur or origin of murmur. Pulse - Palpation The form did not provide a place to record "absent palpation" in this section. Where "absent pulse" was recorded in the next question, "normal", "tortuous", or "blank" in this field were changed to a new code, "5", to indicate absent palpation. The form does not provide any place to record missing limbs. Some observations on extremities may be missing because sample persons were amputees. Although we know that there are amputees in the sample population, the number is unknown. Area(s) of Mass(es) -- Positions 606-610 If masses were present, the number(s) of the location(s), using the numbers on the body diagram, were recorded. The number used was the one which located the center of the mass. Area(s) of Surgical Scar(s) -- Positions 613-617 If scars were present the number(s) of the location(s), using the numbers on the body diagram, were recorded. The number used was the one which located the center of the scar. Time - AM/PM If this section was left blank, but a corresponding time was entered, a AM/PM value is imputed if appropriate. The rule followed is: between 12:00 and 07:00 - "PM" is imputed; between 09:00 and 11:59 - "AM" is imputed; other ranges are ambiguous, and a value of "8", blank but applicable, is entered. ICDA Codes Physicians were instructed to record their findings of abnormal conditions on the examination form and to code these using the first 3 digits of the Eighth Revision of the International Classification of Diseases, Adapted for Use in the United States. Identified conditions were coded at the end of medical examination forms. Since the examination emphasized the cardiovascular, respiratory and musculoskeletal systems, codes relating to these systems are expected to be more frequent. APPENDIX B - PHYSICIAN'S EXAMINATION PROCEDURES General HANES is designed to gather data for statistical analysis. Rather than have a general clinical examination performed in the manner most familiar to the examining physician, we have a physical examination structured to gather data on physical conditions pertinent to nutrition and certain chronic diseases. This section of the manual, which describes the method of performing the examination and specifies the method of recording findings, should be followed explicitly. Other chapters of the manual (Responsibilities of Examination Staff Members, and Emergency Medical Procedures) describe the other obligations and duties of the examining physician. Format for the Examination Certain procedures are to be deleted on the basis of age and are indicated on the examination form. Sitting Blood pressure and pulse HEENT Hair, skin, skull, glands Ears Nose Eyes Mouth Neck Nodes and trachea Chest (including heart) Inspect Auscult Reclining Heart Inspect Palpate Auscult Abdomen Inspect Percuss Palpate Arteries Musculoskeletal Knee Hip Straight leg raising Sitting Extremities Lower Upper Neurological DTR's Chvostek Standing Inguinal Hernia Musculoskeletal Back Knees Skin General appearance and behavior Supine and Sitting Blood pressure Examination Procedure 1. Blood pressure and pulse: While the examinee is sitting, check his blood pressure and pulse in the right extremity. (Count the pulse for at least 30 seconds.) 2. HEENT examination: Perform a routine HEENT. Make a special note of characterizing the hair, checking the skin for seborrhea, the skull for bossing, and looking for parotid enlargement. Inspect the external ear and, with an otoscope, examine the auditory canal and tympanic membrane. Check each nostril for patency with inspiration during alternate unilateral occlusion and examine each nostril with an otoscope. Check the eyes (lids, conjunctiva, cornea) and mouth (lips, tongue, buccal mucosa) for findings linked with malnutrition and other pathology. 3. Neck examination: Observe the neck at rest for thyroid visibility during swallowing of small aliquots of water. Repeat with the neck extended to judge thyroid size and contour. Palpate the neck for thyroid contour & tenderness, lymph nodes, & tracheal deviation. 4. Chest examination: Inspect the chest paying particular attention to the skin of the upper back and to the costochondral junctions for signs attributable to malnutrition. Auscult the chest with care to cover representative areas for all lung segments. 5. Cardiovascular examination: While the examinee is sitting, & then when he is supine, palpate & auscult the heart. Check especially for cyanosis and venous distention. Check the peripheral pulses-- note the character of the artery as well as the quality of the pulsation. 6. Abdominal examination: Inspect the abdomen for evidence of past surgery and for stigmata of malnutrition. During quiet respiration in the supine position, percuss the liver. Use palpation and fist percussion to elicit CVA tenderness. With the examinee's knees and hips flexed to relax the abdominal musculature, palpate the abdomen. While he is standing erect, palpate for hernia. 7. Musculoskeletal examination: Examine the knees and hips for deformities and signs of inflammation, check for tenderness & for pain with active and passive motion, and perform the straight leg raising test. With the examinee seated check the legs for calf tenderness and check the extremities for evidence of arthritis and epiphyseal swelling. Also at this time check the extremities for pretibial edema, hyperpigmentation and pellagrous dermatitis, follicular hyperkeratosis, xerosis, mosaic skin, petechiae, and ecchymoses. With the examinee standing check the cervical, thoracic, and lumbar spine for deformities, limited range of motion, and pain with motion by having the examinee flex, extend, laterally bend, & rotate the spine. Check for sciatic notch and sacro-iliac tenderness. With the examinee bending forward (as in touching toes) check for exacerbation or relief of scoliosis (including rotary component). While the examinee is standing, again check the knees for deformities (and the legs for varicosities). 8. Neurological examination: While the examinee is seated test for knee jerks, ankle jerks, and facial spasm (Chvostek sign). 9. Dermatological examination: Check the skin regionally during the other parts of the examination as described previously--see "Folder I" on the trailer for illustrations of findings linked with malnutrition. 10. General appearance and behavior: Take special note of the general appearance and behavior of the examinee which might reflect organic or functional disorders (e.g., endocrine imbalance, chromosomal disorders, psychosis) which would confound evaluation of nutritional status or reflect malnutrition. 11. Blood pressure: At the close of the physician's examination, the blood pressure should be taken while examinee is both in the supine and sitting positions. Recording of Findings The examination forms contain spaces for structured responses, open ended responses, & summaries of diagnostic impressions. Since the structured responses will be used for computer analysis, certain criteria for and/or definitions of these responses will be given below to ensure comparability of data collected by numerous physicians. The open ended responses are for recording both common and rare findings (which have not been put into structured form because of rarity or secondary importance to the goals of the survey) so that a more complete medical record will be available if information beyond the structured responses is needed in the future. The summary and diagnostic impressions allows a reviewer to quickly synthesize the physician's findings on a given examinee and to ascertain the physician's subjective as well as objective evaluations. Unless otherwise noted in the instructions, positive responses should be recorded with checks in the appropriate boxes. A correction should be made by circling the response to be negated and checking the correct box. Either the "Findings" or "No findings" box should be checked when they occur. If there are no findings for any section of the examination, check the "No findings" box; if there are findings check the "Findings" box as well as the individual boxes for whatever findings there are. The letters "R" or "Rt.," "L" or "Lt.," and "B" mean right, left, and both, respectively. At the end of the chart are forms for reporting findings to physicians. Record there any significant medical findings which need to be reported to a physician or check the box to indicate that there are no significant new medical findings to be reported. Criteria and Definitions 1. Pulse and blood pressure: Record the pulse as the number of radical pulsations per minute and the systolic and diastolic blood pressure in even digits to the nearest 2 mm. pressure. 2. HEENT a. Dry staring hair: Dry, wirelike, unkempt, stiff, and often brittle hair which sometimes may exhibit some bleaching of the normal color. b. Dyspigmented hair: Definite change from normal pigment of the hair, most usually evident & best seen by carefully combing hair strands upward & viewing the orderly array of hair in good light. Dyspigmentation includes both change of pigment (usually lightening of color) & depigmentation--not to be confused with dyed or tinted hair. Dyspigmentation is always bandlike in character and is usually associated with some change in texture of hair in the dyspigmented band. In some ethnic groups, particularly Negroid groups, the pigment may be slightly reddish in color. In others, especially among straight black-haired peoples, the bandlike depigmentation ("flag sign") is common. Dyspigmentation is only rarely observed in adults. c. Easily pluckable hair: A condition in which the shafts of hair are readily removed with a minimal tug when a few strands are grasped between the finger and thumb and gently pulled. In such cases there is no reaction from the child, indicating a lack of pain associated with removal of the hair. d. Abnormal texture or loss of curl: Changes in texture of the hair to a soft, silk-like hair. Loss of curl is self-explanatory. e. Circumcorneal injection (bilateral): Increase in vascularity by new ingrowth of capillary loops, with particular concentration around the cornea in the absence of obvious causes other than nutrition. f. Conjunctival injection (bilateral): Generalized increase in the vascularity of the bulbar conjunctivae in the absence of obvious infection. g. Angular blepharitis: A fissure located in the lateral palpebral angle of the eyelids which presents as a crack in the epidermis similar to the cracks found at the angles of the mouth in angular stomatitis. h. Pupils and Iris: Irregularity of pupil contour. i. Xerosis (conjunctivae): The conjunctivae, upon exposure when holding the examinee's lids open and having the examinee rotate his eyes, appear dull, lusterless, and exhibit a striated or roughened surface. j. Lesions of cornea (other): Use oblique moving illumination with small flashlight to look for opacities, surface debris, deposits in the anterior chamber and cataract. k. Bitot's spots: Small circumscribed, grayish or yellowish-gray, dull, dry, foamy, superficial lesions of the conjunctivae. Seen most often at the lateral aspect of the bulbar conjunctivae of children. Usually bilateral. Not to be confused with pterygium. l. Keratomalacia: Corneal softening with deformity, either localized (usually central part of lower half of cornea) or total. m. Xerophthalmia: Xerophthalmia is recorded when the bulbar conjunctiva and cornea are dry and lusterless with a decrease in lacrimination. It is rarely associated with evidence of infection but in extreme cases is associated with keratomalacia. n. Lids and Sclera: Lid edema, lid infection, and ptosis. o. Angular lesions of lips: Record only if definitely present bilaterally when the examinee's mouth is held half open. May appear as pink or moist, whitish, macerated, angular lesions which blur the mucocutaneous junction. Angular lesions are recorded only when there is definite break in continuity of epithelium at the angles of the mouth. p. Angular scars of lips: Scars at the angles which, if recent, may be pink; if old, may appear blanched. q. Cheilosis: Different from ordinary chapping. The lips are swollen or puffy and appear as if the buccal mucosa extends out onto the lip. There may be desquamation. This category may be used to include vertical fissuring of the lips. If associated with herpes labialis, note under "Other findings." r. Filiform papillary atrophy of tongue: The filiform papillae are exceedingly low or absent, giving the tongue a smooth or "slick" appearance which remains after scraping slightly with an applicator stick. s. Fungiform papillary hypertrophy of tongue: The fungiform papillae can be seen and felt when a tongue blade is drawn lightly over the anterior two-thirds of the tongue. t. Geographic tongue: Irregularly outlined and distributed areas of atrophy with irregular white patches resembling leukoplakia. u. Fissures of tongue: Linear lesions or cracks with a definite break in the continuity of the epithelium. v. Serrations or swelling of tongue: Tooth impressions at sides of tip, often noted when tongue is swollen. w. Scarlet, beefy tongue: Entire tongue is red, angry in appearance, with or without denudation or fissures. Not just a modification of the natural color due to the loss of papillae. Associated almost always with subjective symptoms of hypersensitivity, burning, and even taste changes. x. Magenta tongue: A tongue the color of alkaline phenolphthalein. y. Nasolabial seborrhea: A definite greasy, yellowish scaling or filiform excrescences in the nasolabial area which become more pronounced on slight scratching with the fingernail or a tongue blade. z. Visible enlarged parotids: Due to difficulties in assessing parotid enlargement, record as positive the presence of bilateral enlargement only if clearly visible. aa. Bossing of skull: Record abnormal prominence or protrusion of frontal or parietal areas. 3. Thyroid evaluation The World Health Organization (WHO) criteria used for grading goiter are: 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 is considered to be more than 4 to 5 times enlarged although not visible with head in normal position. Most of these will be readily visible with the head thrown back and the neck fully extended. Grade 2: Persons with visible goiters. Persons with goiters which are easily visible with the head in normal position, but which are smaller than those in Grade 3. Palpation may be helpful in determining the mass of the gland, but is not needed for diagnosis. Grade 3: Persons with very large goiters. 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 wearing of clothes. (Perez, C., Scrimshaw, N.S., and Munoz, J.A., Technique of endemic goitre surveys. In endemic Goitre; p. 369, see esp. p. 376, World Health Organization Monograph Series No. 44, Geneva, 1960.) Other thyroid findings: Record any tenderness, nodularity, enlargement of the isthmus, or other abnormal thyroid findings not included in grading thyroid size. 4. Chest evaluation: a. Beading of ribs: A definitely palpable & visible enlargement of the costochondral junctions. b. Follicular hyperkeratosis 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 skin. Readily felt, it presents a "nutmeg grater" feel. Follicular 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 hypereratosis is distinguished from perifolliculosis by the ring of capillary congestion which occurs about each follicle in scorbutic perifolliculosis. c. Wheezing on auscultation: Record any wheezing, inspiratory or expiratory, as focal or diffuse. d. Decreased breath sounds: Record if there is diffusely decreased breath sounds. (Focal or discrete areas of decreased breath sounds should be recorded under "Other findings.") e. Breast Masses: Palpate in both upright and supine positions. If a mass is found, characterize with regard to location, size, contour, consistency, tenderness and mobility. 5. Cardiovascular evaluation: a. Cyanosis: Record definite cyanosis which is thought to be related to generalized hemoglobin desaturation. (Focal phenomena, e.g., one extremity cyanotic should be recorded under "Other findings.") b. Irregular pulse: Record any irregularities of pulse except physiological variations. c. Cardiac murmur: Record all murmurs. Grade, location, radiation, and any other pertinent description should be given as well as an opinion as to the origin of the murmur. 6. Abdominal evaluation: a. Hepatomegaly: Record livers palpable 2 centimeters or more below the right costal margin. b. Splenomegaly: Record all palpable spleens. c. Uterine enlargement: Record all enlarged uteri including those enlarged secondary to pregnancy. d. Umbilical hernia: Record all umbilical hernias. If a hyrocele is present write it in under "Summary of Diagnostic Imressions" with its ICDA code. e. Inguinal and femoral hernias: Record all hernias and note next to boxes if bilateral. f. Potbelly: Record if abdomen appears abnormally distended and enlarged with due recognition of the usual contour of the young child. g. Masses: If masses are present, check box 287. Record the number(s) of the location(s) (see diagram for number of locations) of the mass(es) to the right of 288. Use the number which locates the center of the mass. Check box 289 and write in a description of the masses, identify each by its number location, e.g., (7) 3 cm. diameter firm, fixed, nontender. h. Scars: If scars are present, check box 290. Record the number(s) of the location(s) of the scar(s) to the right of 291. Use the number which locates the center of the scar. Check box 292 and write in a description of the scars, identifying each by its number location, e.g., (7) 3 cm well-healed appendectomy scar. 7. Musculoskeletal evaluation: a. Bowed legs (genu varum): Bilateral concave deformities of the thighs and tibiae should be recorded, even if mild. b. Knock knees (genu valgum): Bilateral convex deformities of the knees and tibiae should be noted only if marked. c. Epiphysial enlargement of wrist: This can be more easily felt than seen and should be recorded, particularly if present at the ulnar epiphysis. d. Ortolani's maneuver: With the infant lying supine, the examiner straightens and adducts the legs. The examiner's thumb rests along the inside & the other fingers extend along the outside of the infant's thigh. The hips and thighs are flexed to 90* 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*. If dislocation is present, resistance may be felt between 45* and 60* and a click felt as the dislocated femoral head slips into the acetabulum. 8. Neurological evaluation a. Absent knee jerks: Record bilaterally absent knee jerks--unilateral absence should be described under "Other findings." b. Absent ankle jerks: Record bilaterally absent ankle jerks--unilateral absence should be described under "Other findings." c. Positive Chvostek sign: When in tapping the malar process of the temporal bone on both sides of the face with a percussion hammer, a twitching of the perioral muscles of the same side is elicited, this is a positive Chvostek sign. A positive sign indicates hyperirritability of the neuromuscular system as found in spasmophilia (tetany) due to calcium deficiency. d. Apathy: This should be noted and recorded if it is marked, particularly in young children. It has importance in relation to protein-calorie deficiency (PCD). e. Marked hyperirritability: This refers to behavior (not to reflexes) and should be recorded only if marked. 9. Skin evaluation a. Follicular hyperkeratosis, arms: See 4b. b. Hyperpigmentation, hands and face: Asymptomatic with no inflammatory component. It is seen most frequently on the dorsum of the hands and lower forearms, particularly when skin hygiene is poor. The skin is rough, dry & often has a grayish, cyanotic base. There is not the sharp line of demarcation at the border of the lesion such as one sees in pellagra. c. Dry or scaling skin (xerosis): Xerosis is a clinical term used to describe a dry & crinkled skin which is made more obvious by pushing the skin parallel to the surface. In more pronounced cases it is often mottled & pigmented & 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. d. 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 and perifolliculosis may coexist. e. Petechiae: 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, e.g., minimal pigmented purpuric eruption on the legs. If deemed contributory, a tourniquet test may be performed on the upper extremity with the blood pressure cuff adjusted between systolic & diastolic pressures for 5 minutes, and the results described. f. 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. g. Pellagrous dermatitis: Areas of dry dermatitis-like lesions on the dorsal surface of hands, cheeks, forehead, and if exposed on the neck (Casals necklace). h. Ecchymoses: Record ecchymoses which you as a physician judge to be due to abnormalities of the examinee. Do not record normal minor responses to known minor trauma. 10. Examiner's subjective impression of nutritional status: This will be the examining physician's subjective appraisal of the state of nutrition of the examinee. Indicate whether or not you judge the examinee to have "normal nutrition" or "abnormal nutrition." Obesity is considered to be "abnormal nutrition." 11. External ear: Record if the ears are pierced. Check "Operative scar" only for mastoid operation scars. Check and write under "other" additional findings which are significant cosmetically and/or which might impair hearing. 12. Auditory canal: Check "Completely occluded" if there is not sufficient tympanic membrane visible to characterize the membrane under "Drum" (below), and check as "Partially occluded" all other cases in which there is obstruction of or protrusion into the auditory canal. For all positive responses check the cause of the obstruction; write cause under "Other" for causes other than cerumen. 13. Drum: Check "Not visible" only if "Completely occluded" is checked above. Check as many structured responses as apply in the description of the membrane, e.g., dull, bulging, and fluid may be checked under R ear. However, do not check two responses for one code number. If the membrane is perforated, check either "With discharge" or "Without discharge." Check "Other" and write in a description if the structured responses need to be supplemented. 14. Nares: Check "Acute" or "Chronic" if the naris is obstructed (use physical appearance plus history to judge if obstruction is acute or chronic). Check as many responses under "Other significant findings" as are necessary to describe the nares. Nasal Polyps--These are soft, smooth, pale, movable tumors usually multiple. 15. Neck: Check "Adenopathy," "Tracheal deviation," or "Other (describe)" to describe significant clinical findings (except thyroid) in the neck. 16. Chest: In the structured response chart check the columns corresponding to the observed abnormalities at the levels of the lobes over which the findings are observed. (If needed, see diagrams present in the MEC for normal distribution of pulmonary segments and lobes.) Other auscultatory findings, and findings on inspection, percussion, or palpation should be checked and written in under "Other chest findings." 17. Heart: a. PMI: Check whether the PMI is "Felt" or "Not felt." If felt, check the number of the closest interspace and check the relationship to the mid-clavicular line. b. Thrills: Check whether a thrill is "Absent" or "Present." If present, check systolic and/or diastolic to time the thrill, and check either base or apex to locate the maximum intensity of a given thrill. For multiple thrills, record only the most intense one. c. Heart sounds: Check the structured response which best describes the first heart sound and the one which best describes the second heart sound. d. Murmurs: Check "None" if no murmurs are heard. If a murmur or murmurs are heard, place checks under the appropriate period--systolic and/or diastolic--to indicate the timing when categorizing by type and location of the murmur(s) or the component(s) of murmur(s) within each period--systolic and diastolic. When typing systolic murmurs, check "Organic" if any systolic murmur or systolic component of a murmur is thought secondary to a cardiovascular lesion; and check "Functional" if no systolic murmur or systolic component of a murmur is thought secondary to a cardiovascular lesion. Check "Don't know" only if a reasonable clinical judgment cannot be made. Follow the same guidelines for typing diastolic murmurs. Note that "Functional," "Organic," and "Don't know" are to be considered mutually exclusive responses within each period (systole, diastole). In locating and grading a murmur, record the grade of the murmur by checking the grade as judged at its point of maximum intensity in the appropriate period column to the right of the structured location response which best approximates the location of its point of maximum intensity. Unless there are both systolic and diastolic components to a murmur, check only one grade-location response for each murmur; for multiple murmurs make multiple responses. However, there should be only one response at a given location within a given period.) To locate the origin of each murmur or component thought secondary to a cardiovascular lesion ("Organic" will have been checked), check in the appropriate period column (systolic, diastolic, or both) to the right of the location of the cardiovascular lesion thought to be the origin of the murmur; e.g., for pulmonic stenosis check to the right of 254 in the box numbered 1. Make multiple responses for multiple murmurs of "Organic" origin. Check "Other" if the location of other than 251-256 and check "Don't know" if the murmur is thought to be organic but a reasonable clinical judgment of the origin cannot be made. e. Other cardiac and cardiovascular findings: If there are significant cardiac or cardiovascular findings for which there are no other appropriate responses in either the heart or arterial evaluation sections, check "Yes" and then check the structured or open ended (under "Other") response which applies. Check "No" if this space is not needed to describe cardiac or cardiovascular findings. 18. Arterial evaluation: Check the structured response ("Normal," "Sclerotic," "Tortuous," or "Sclerotic and Tortuous") which best characterizes each artery listed, and check the structured response ("Normal," "Bounding," "Diminished," or "Absent") which best characterizes each pulse listed. If the dorsalis pedis pulse is absent and the posterior tibial pulse is present, check "Absent" for dorsalis pedis and write in "posterior tibial" after "Other" and check its character. If the dorsalis pedis and posterior tubial pulses are both absent, check "Absent" for dorsalis pedis and write in "popliteal" after "Other" and check the character of the popliteal pulse. 19. Joints: To record findings in joints, locate the box for the finding to be recorded (i.e., tender, swelling, deformity, limitation, Heberden's nodes, pain on motion, other) & the joint involved. Within the box check right, left, or both to indicate the location of involvement for shoulder, elbow, wrist, ankle, feet, knees, & hips and check the total number of digits involved on each side for the MP and DIP joints. Check the total number of digits involved on the right and on the left for each finding (note this is the total number of digits involved and not the digit involved). a. Back: Check the described deformities if observed; check the location of any tenderness or limitation of motion. If there is pain with motion, check the location at the right of the motion which elicits the pain--"diffuse" should be checked if all three locations (cervical, thoracic, low back) are involved, but do not check thoracic or low back in these instances. "Uncertain" should be checked if pain occurs but the site cannot be specified. The severity of pain in flexion and extension of the neck is graded 0-none, 1-doubtful, 2-minimal, 3-moderate, and 4-maximum. If there is limitation of motion on flexion of the lumbar spine, check box M4c(368) and describe as limitation of flexion, lumbar spine. b. Straight leg raising: For the SLR test, check negative or positive for both the right and the left. Also, for "Increase with dorsiflexion," check either "Yes" or "No" for both the right and left. 20. Other systems: Record here system findings which cannot be noted in other parts of the form, eg., Reticuloendothelial--marked inguinal and axillary adenopathy plus cervical adenopathy, pallor, and petechiae previously noted. But if only petechiae & cervical adenopathy were observed, they would have previously been recorded and need not be recorded here. 21. Blood pressure: Record the systolic and the diastolic blood pressures to the nearest even digit for both the recumbent and the sitting positions and note the time to the nearest minute of the determination. 22. Summary of diagnostic impressions On the last page of the physical examination recording form under the heading "Summary of Diagnostic Impressions" findings should be summarized. Diagnostic impressions may be on the basis of physical exam, history, X-ray, laboratory findings, etc. Certainly not all findings should be listed,but those deemed significant in relation to disease or certain condition states should be listed. However, in order to facilitate data processing all entries under other categories should be listed and given ICD codes. It is preferable to summarize findings by condition such as "osteoarthritis" rather than by listing symptoms or signs. After completing the examination, indicate whether the examinee is "normal" or "abnormal." If abnormal, summarize findings according to the directions briefly outlined above. Cardiovascular (including venous disease), musculoskeletal, and respiratory findings should be listed in their appropriate sections with other findings below. Following each such listing, indicate the seeming severity of each, checking whether it appears to be either minimal, 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 of the two should be selected. Then indicate the certainty of the diagnosis using a scale ranging from 0 to 9 according to the following criteria: 0-not at all certain 2-little bit certain 4-somewhat certain 6-fairly certain 8-very certain 9-extremely certain The range is continuous and any number representing a degree of certainty between two of the listed scale numbers may be selected. When selected, the number should be written in the appropriate space. Each condition should finally be coded according to Eighth Revision International Classification of Diseases, Adapted for Use in the United States, which has been modified for use in HANES. A complete listing of these HANES modified codes are kept in each caravan. Since the vast majority of examinees with findings will have one or more of a small number of common conditions, the more probable conditions with the appropriate code numbers are listed below: Modified ICDA Codes for Use in HANES I. Infective and Parasitic Disease (000-136) 011.X Pulmonary Tuberculosis 044.X Polio, Late Effects of 111.0 Tinea Versicolor II. Neoplasms (140-239) See specific Neoplasms as classified 214.X Lipoma 227.0 Hemangioma of Skin III. Endocrine, Nutritional and Metabolic Diseases (240-279) 240.X Simple Goiter 241.X Nontoxic Nodular Goiter 242.X Hyperthyroidosis (Hyperthyroidism) with or without Goiter 243.X Cretinism 244.X Hypothyroidism (acquired) 250.X Diabetes Mellitus 274.X Gout 277.X Obesity not specified as of Endocrine Origin IV. Diseases of Blood and Blood Forming Organs (280-289) 280.X Iron Deficiency Anemias 282.X Hereditary Hemolytic Anemias including Sickle Cell Disease 287.X Purpura and other Hemorrhagic Conditions V. Mental Disorders (290-315) 295.X Schizophrenia 296.X Affective Psychoses 300.X Neuroses 303.X Alcoholism 309.X Mental Disorders not specified as Psychotic; associated with Physical Conditions; includes Brain Syndrome 309.2 Due to Brain Trauma 309.3 Due to Circulatory Disturbance 309.6 Due to Senile or Presenile Brain Disease VI. Diseases of the Nervous System and Sense Organs (320-389) 324.X Meningitis or Encephaslitis, late effects of 342.X Paralysis Agitans (Parkinson's Syndrome) 343.X Cerebral Spastic Infantile Paralysis 344.X Other Cerebral Paralysis 344.1 Hemiplegia 345.X Epilepsy 346.X Migraine 350.X Facial Paralysis 353.X Neuralgia or Neuritis of Sciatic Nerve 360.X Conjunctivitis and Conjunctival Infection 367.X Retinitis 373.X Strabismus 374.X Cataract 375.X Glaucoma 377.0 Vascular Lesions of Retina 377.1 Degeneration of Retina 379.X Blindness 380.X Otitis External 381.X Otitis Media without Mastoiditis 382.X Otitis Media with Mastoiditis VII. Diseases of Circulatory System (390-458) 394.X Disease of Mitral Valve 395.X Disease of Aortic Valve 401.X Essential Benign Hypertension 402.X Hypertensive Heart Disease 403.X Hypertensive Renal Disease 412.X Chronic Ischemic Heart Disease 413.X Angina Pectoris 427.0 Congestive Heart Failure 427.3 Heart Block 427.4 Atrial Fibrillation or Flutter 427.9 Other and Unspecified Disorders of Heart Rhythm (Other than PAT, AT, VF, Heart Block) 429.0 Cardiac Enlargement and Hypertrophy 436.X Stroke 440.X Arteriosclerosis 443.0 Raynaud's Syndrome 443.9 Intermittent Claudication, PVD, not otherwise specified 451.X Phlebitis and Thrombophlebitis 454.0 Varicose Veins, with Ulcer 454.1 Varicose Veins, with Stasis Dermatitis without Ulcer 454.9 Varicose Veins other, without Ulcer VIII. Disease of Respiratory System (460-519) 460.X Cold 461.X Acute Sinusitis 462.X Acute Pharyngitis 463.X Acute Tonsillitis 464.X Acute Laryngitis and Tracheitis 465.X URI of unspecified or multiple site 466.X Acute Bronchitis 491.X Chronic Bronchitis 492.X Emphysema 493.X Asthma 500.X Hypertrophy of Tonsils and Adenoids 504.X Deviated Nasal Septum 505.X Nasal Polyp 507.X Hay Fever 507.1b Allergic Rhinitis IX. Disease of Digestive System (520-577) 529.1 Geographic Tongue 533.X Peptic Ulcer, site unspecified 550.X Inguinal Hernia not obstructed 551.0 Femoral Hernia not obstructed 551.1 Umbilical Hernia not obstructed 551.3 Diaphragmatic Hernia, not obstructed 564.1 Irritable Colon 571.X Cirrhosis of Liver 573.0 Hepatitis, not otherwise specified 574.1 Cholelithiasis with Cholecystitis or Cholangitis (chronic) 574.9 Cholelithiasis without Cholecystitis or Cholangitis 575.X Cholecystitis, without mention of Calculus X. Diseases of the Genitourinary System (580-629) 590.0 Chronic Pyelonephritis XI. Complications of Pregnancy, Childbirth and the Puerperium (630-678) XII. Diseases of the Skin and Subcutaneous Tissue (680-709) 680.X Boil and Carbuncle 684.X Impetigo 690.X Seborrheic Dermatitis 691.X Atopic Dermatitis, Infantile Eczema, Neurodermatitis 692.X Contact Dermatitis 695.2 Erythema Nodusum 696.X Psoriasis 706.1 Acne Vulgaris 708.9 Hives 709.9 Intertrigo, Vitiligo XIII. Diseases of the Musculoskeletal System and Connective Tissue (710-738) 712.X Rheumatoid Arthritis 713.0 Osteoarthritis 714.0 Traumatic Arthritis 715.X Arthritis, unspecified 717.9 Fibrositis, Myalgia, Myositis 718.X Rheumatism, unspecified 725.0 Displaced Cervical Intervertebral Disc 725.1 Displaced Lumbar & Lumbosacral Intervertebral Disc 728.0 Pain in Neck 728.7 Low Back Pain 730.X Bunion 731.X Synovitis or Bursitis 735.0 Scoliosis 735.1 Kephosis 736.X Flat Foot XIV. Congenital Anomalies (740-759) 752.1 Undescended Testicle 756.4 Pectus Excavatum 757.4 Congenital Clubnail Miscellaneous 780.3 Abnormal Involuntary Movements (Atheosis, Tremor) 780.4 Disturbance of Coordination (Ataxia, Muscular Incoordination) 989.X Insect Bites b This is an artificial code not included in the ICDA codes.
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