Women s Health Study Matrix of Variables Collected
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1 Women s Health Study Matrix of Variables Collected 1. Demography DOB SS# Marital status Gender Race Profession Education NHS participant Income Employment status Phone number Contacts 2. Anthropometry Height Weight Weight fluctuations (age 18-30) Weight fluctuations (past 6 yrs) Waist/Hip Unintended weight loss (past 6 years) 3. Cigarette Habit Nicotine dependence Personal Details Passive smoking 4. Reproductive Hx Menarche Menopause Pregnancy Hx Breast feeding Hx DES use 1
2 5. Participant s Own Birth/ Infancy Hx 6. OC Use 7. HRT Use Herbal HRT 7a. SERMS use 8. Diet Full Diet QQ Alcohol D D Standard vitamins (BC, A, E, multi) D D Folic acid D Zinc D Chromium D Mineral supplements D D 9. Total Cholesterol (mg/dl) 10. HDL Cholesterol 11. Blood Pressure (mmhg) 12. Exercise Measures Current time in recreational activities Flights of stairs Walking pace At young age (frequency) 13. Screening Procedures Eye/ Mam 14. Drugs Aspirin NSAIDs New NSAIDs (Cox-2 inhibitors) Acetaminophen Anticoagulants Corticosteroids 2
3 Fertility (CLOMID) Insulin Oral/diabetes Cholesterol (specific name) Antihypertensives (specific name) Antibiotics (see #19 Other ) Being treated with C Being treated with HPT All other meds use (provide specific names) Meds/1 year ago/stopped (provide specific names) Statins Parkinsons meds/ specific name Depression meds/ specific name 15. List of Illnesses (see attached) 16. Family Medical Hx MI CA DIA MD MI CA DIA MI CA DIA HPT Parents DOB/DOD 17. Compliance Reason for non-compliance (NC= not coded) NC NC NC NC NC NC NC NC NC NC NC NC 18. Potential Side Effects Symptoms of gastric upset Symptoms of peptic ulcer Nausea Constipation Diarrhea Skin discoloration Blood in urine 3
4 Easy bruising Nose bleed Skin rash Fatigue Drowsiness Headache 19. Other Cosmetic/ reconstructive surgery Hair dyes history = Hx colors = C Hx C Memory loss Motives for joining study Frequency of colds Frequency of infections Antibiotic use Activities of daily living How s your health? Job satisfaction/ employment conditions Feelings about life Close to others? SF-12 Series Active or Placebo *Legend: E = Enrollment questionnaire D = Diet questionnaire R = Run-in questionnaire 6-120: Follow-up questionnaire, months after randomization HH: Final endpoints questionnaire at end of trial RF: Final risk-factor questionnaire at end of trial 4
5 WHS ILLNESS (#15 List of Illnesses) E R HH RF ALS Angina Asthma Atrial Fibrillation Bradycardia CA Colon CA Non-melanoma Skin CA Lung CA Melanoma CA Breast CA Other CABG Carotid Artery Surgery Cataract Chronic Lung Disease Cholesterol Elevated Coag. Disorder Colon Polyp Congestive Heart Failure CTD Series Diabetes Depression Dry Eye Syndrome Series DVT Fibrocystic Breast Disease Fluid Retention Fractures Gallbladder Removed Gallstones GI Bleed Gout Hemorrhoid 1
6 WHS ILLNESS (#15 List of Illnesses) E R HH RF Hypertension Intermittent Claudication Kidney Disease (not stones) Kidney Failure Left Ventricular Hyper. Leg Swelling Liver Disease Lupus Macular Degeneration MI Migraines Details MS Osteoporosis Parkinson s Disease PE Periodontal Peripheral Artery Surgery PTCA Restless legs Shingles (Varicella-zoster) Stroke TIA Unstable angina/acute coronary syndrome Ulcer Urinary Incontinence Ventricular Tachycardia 2
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