ULSAM-70

Investigations 70 years

Questionnaire

General and medical background

Group A
Family history


1. Does/did your father have diabetes?  Z112
   1X. If yes, at what age did he contract it?  Z416
2. Does/did your mother have diabetes?  Z113
   2X. If yes, at what age did she contract it?  Z417
3. How many brothers and sisters do you have/have you had?  Z418
4. How many of them have/had diabetes?  Z419
5. At what ages did they contract diabetes? (statistics not presented)
6. How many children have you got/had?  Z420
7. How many of them have/had diabetes?  Z421
8. At what ages did they contract diabetes? (statistics not presented)
9. Is your father still alive?  Z116
10. Does/did he have heart problems in the form of pain (angina)?  Z117
11. Did your father have a heart infarction (blood clot in the heart)?  Z118
12. Did your father die from a heart infarction (blood clot in the heart, heart attack)?  Z119
13. Has your father had a cerebral haemorrhage or blood clot on the brain?  Z120
14. Did your father die from a cerebral haemorrhage or blood clot on the brain?  Z121
15. Is your mother still alive?  Z122
16. Does/did your mother have heart problems in the form of pain (angina)?  Z123
17. Has your mother had a heart infarction (blood clot in the heart)?  Z124
18. Did your mother die from a heart infarction (blood clot in the heart, heart attack)?  Z125
19. Has your mother had a cerebral haemorrhage or blood clot on the brain?  Z126
20. Did your mother die from a cerebral haemorrhage or blood clot on the brain?  Z127
21. Does/did your father have high blood pressure?  Z128
22. Does/did your mother have high blood pressure?  Z129
23. Do you have a brother with high blood pressure?  Z130
24. Do you have a sister with high blood pressure?  Z131
25. Has any brother of yours had a heart infarction (blood clot in the heart)?  Z132
26. Has any sister of yours had a heart infarction (blood clot in the heart)?  Z133
27. Has any brother of yours had a cerebral haemorrhage or clot on the brain?  Z134
28. Has any sister of yours had a cerebral haemorrhage or clot on the brain?  Z135
29. Did your father die of cancer?  Z136
30. Did your mother die of cancer?  Z137
31. Has any brother or sister of yours died of cancer?  Z138

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Group B
Cardiovascular Symptoms

32. Have you ever had pains in the chest?  Z139
33. Have you ever experienced pressure or a feeling of pressure across the chest?  Z140
34. Have you ever experienced pains in the chest when walking uphill?  Z141
35. Have you ever experienced pains in the chest when walking at a normal pace on level ground?  Z143
36. Have you ever had pressure or a feeling of pressure in the chest when walking at normal pace on level ground?  Z144
37. Do you ever get pains in the chest when walking outdoors?  Z145
38. Have you ever had severe chest pains which have lasted 30 minutes or more?  Z147
39. Have you ever been in hospital because of a heart infarction (clot in the heart)?  Z148
40. Have you ever been told by a doctor that you've got angina?  Z149
41. Do you take nitro-glycerine tablets?  Z150
42. Do you take digitalis medicine (e. g. Lanacrist, Digitrin, Digitoxin)?  Z151
43. Do you usually get pains in one or both calves when you walk?  Z152
44. Does climbing two flights of stairs or the equivalent at the same speed as others of your age leave you out of breath?  Z153
45. Have you ever been told, when having your blood pressure taken, that you've got high blood pressure?  Z154
46. Do you take tablets for high blood pressure?  Z155
47. Do you regularly take diuretics?  Z156

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Group C
Skeletomuscular Symptoms

48. Do you ever get pain or other problems in the:
    a. upper back  Z422
    b. lower back  Z423


49. How long have you had pain or discomfort in the:
    a. upper back  Z424
    b. lower back  Z425


50. How often do you get pain or discomfort in the:
    a. upper back  Z426
    b. lower back  Z427


51. Have the pains or discomfort progressively worsened in the last year in the:
    a. upper back  Z428
    b. lower back  Z428


52. Have you been to the doctor because of this back pain?  Z430
53. Have you been to a doctor because of any other kind of joint problem?  Z431
54. Have you ever had any of the following X-rayed?
    a. upper back  Z432
    b. lower back  Z433
    c. right shoulder  Z434
    d. left shoulder  Z435
    e. right wrist  Z436
    f. left wrist  Z437
    g. right hip  Z438
    h. left hip  Z439


55. Have you ever broken any of the following?
    a. upper back  Z440
    b. lower back  Z441
    c. right shoulder  Z442
    d. left shoulder  Z443
    e. right wrist  Z444
    f. left wrist  Z445
    g. right hip  Z446
    h. left hip  Z447
    
56. Walking ability:
    a. can walk without support  Z448
    b. need help (e.g. stick or walking frame)  Z449
    c. need someone to support me  Z450
    d. need a wheelchair  Z451


57. Do you feel unsteady when you walk?  Z452
58. Do you get black dots in front of the eyes when you get up?  Z453
59. Do you have a poor sense of feeling in your legs?  Z454
60. Is the strength in any of the following reduced?
    a. right arm  Z455
    b. left arm  Z456
    c. right leg  Z457
    d. left leg  Z458


61. How many times in the last year have you had a fall?  Z459
62. Are you taking or have you ever taken cortisone tablets?  Z460
63. Do you take any of the following types of pharmaceuticals?
    a. sleeping pills  Z461
    b. tranquillisers  Z462
    c. other medication for nervous problems  Z463
    d. vitamin D  Z464
    e. calcium tablets  Z465


64. Has your mother broken any of the following since the age of 40?
    a. hip  Z466
    b. wrist  Z467
    c. vertebrae  Z468


65. Has your father broken any of the following since the age of 40?
    a. hip  Z469
    b. wrist  Z470
    c. vertebrae  Z471
    

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Group D
Smoking Habits and Alcohol

66. Have you ever smoked on a daily basis for at least 6 months?  Z157
67. Do you smoke?  Z158
68. Do you inhale?  Z159
69. Have you been smoking for longer than one year?  Z160
70. Have you been smoking for longer than 5 years?  Z161
71. Have you been smoking for longer than 10 years?  Z162
72. Have you radically reduced your consumption in the past 6 months?  Z163
73. Have you given up smoking in the last year?  Z164
74. Did you give up smoking between one and 5 years ago?  Z165
    
75. Did you give up smoking more than 5 years ago?  Z166
76. Do you smoke cigarettes every day?  Z167
77. Do you smoke more than 10 cigarettes a day?  Z168
78. Do you smoke more than 20 cigarettes a day?  Z169
79. Do you smoke more than 30 cigarettes a day?  Z170
80. Do you smoke more than 40 cigarettes a day?  Z171
81. Do you smoke one cigar or 2 cigarillos a day?  Z172
82. Do you smoke 2-3 cigars or 4-6 cigarillos a day?  Z173
83. Do you smoke at least 3 cigars or at least 6 cigarillos a day?  Z174
84. Do you smoke a pipe?  Z175
85. Do you smoke less than one packet of pipe tobacco a week?  Z176
86. Do you smoke more than one packet of pipe tobacco a week?  Z177
87. Do you use 'snus' (Swedish wet snuff)?  Z480
88. How many tins of 'snus' do you consume a week?  Z481
89. How long (years) have you regularly drunk:

a. high alcohol beer   Z482
b. medium alcohol beer   Z483
c. wine   Z484
d. spirits   Z485

90. How often do you drink high alcohol beer, wine or spirits?  Z486
91. How much light beer/cider (no. of bottles (33 cl)) do you usually drink per week?  Z487
92. How much medium alcohol beer (no. of bottles (33 cl)) do you usually drink per week?  Z488
93. How much high alcohol beer (no. of bottles (33 cl)) do you usually drink per week?  Z489
94. How much wine (no. of glasses (1.5 dl)) do you usually drink per week?  Z490
95. How much spirits (no. of cl) do you usually drink per week?  Z491

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Group E
Stress Symptoms

96. Do you have difficulty in getting to sleep at night?  Z178
97. Do you often wake in the small hours and are unable to get back to sleep?  Z179
98. Do you take sleeping pills more than 3 times a week?  Z180
99. Have you ever taken sleeping pills regularly for a long period?  Z181
100. Have you in the past 5 years had any period of stress (by which we mean that you have felt tense, irritable or anguished) because of problems or conflicts at work or at home?  Z186
101. Have you been living under continuous stress (felt tense, irritable or anguished) during the past year because of problems or conflicts at work or at home, etc.?  Z187
102. Have you lived under continuous stress (felt tense, irritable or anguished) for the past 5 years because of problems or conflicts at work or at home, etc.?  Z188

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Group F
Physical Activity

103. Do you spend most of your time reading, watching TV, going to the cinema or doing other, mostly sedentary, activities?  Z199
104. Do you often go walking or cycling for pleasure?  Z200
105. Do you do any active sport or heavy gardening for at least 3 hours every week?  Z202
106. Do you regularly perform hard physical training or competitive sport?  Z203

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Group G
Broncho Pulmonary Symptoms

107. Have you had tuberculosis?  Z204
108. Have you ever had pneumonia?  Z205
109. Do you go for check ups for any lung complaint?  Z206
110. Have you had asthma since the age of 20?  Z207
111. Have you been troubled by a cough recently?  Z208
112. Have you been troubled by hoarseness recently?  Z209
113. Do you regularly every year have more than one period of respiratory problems in the form of a cough with expectoration?  Z210
114. Have you, at any time of your life, been troubled by a lengthy and persistent cough (by this we mean a more or less daily cough lasting several (at least 3) consecutive months for several (at least 2) consecutive years)?  Z211
115. Do you usually cough up phlegm in the mornings?  Z212
116. Have you recently observed traces of blood in the phlegm?  Z213
117. Have you got a cough at the moment?  Z214
118. Have you had a feverish cold in the past 3 weeks?  Z215
119. Do you get out of breath when you climb stairs or walk uphill?  Z216
120. Do you usually get out of breath when walking on level ground?  Z217

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Group H
Gastro-Intestinal Symptoms

121. Have your bowel habits changed in the past month?  Z218
122. Have you had periods of diarrhoea in the past year (more than 3 loose bowel movements per day)?  Z219
123. Do you take laxatives?  Z220
124. Have you observed blood in your stools recently?  Z221
125. Have you had surgery for stomach ulcers?  Z222
126. Have you had your gallbladder removed?  Z223
127. Do you often get pains or drawing sensations in the pit of your stomach?  Z224
128. Are you often troubled by indigestion and burping?  Z225
129. Have you had pains anywhere in the stomach on a number of occasions in the past year?  Z226
130. Are your bowel movements irregular (alternating constipation and loose bowels)?  Z227

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Group I
Urinary Tract Symptoms

131. Have you had dark or bloody urine at any time in the past year?  Z228
132. Do you have difficulty in starting to pass water?  Z229
133. Has the stream of urine become thin and weak?  Z230
134. Have you ever had inflammation of the bladder?  Z231
135. Have you ever had an inflammation of the kidneys with blood in the urine (even in childhood)?  Z232
136. Have you ever had inflammation of the renal pelvis?  Z233
137. Have you had antibiotics or the like for a urinary tract infection?  Z234
138. Have you ever had albumin in your urine?  Z235
139. Have you ever had an attack of kidney stones?  Z236
140. Have you had several such attacks?  Z237
141. Have you had your kidneys X-rayed?  Z238

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Group J
Medical History

142. Have you had pains in the wrists or finger joints in the past year?  Z239
143. Are you troubled by pains in the joints?  Z240
144. Have you ever had gout?  Z241
145. Have you had anaemia in the past 5 years?  Z242
146. Has your appetite worsened?  Z243
147. Have you lost weight in the past year?  Z244
148. Have you gained more than 10 kg in weight since you were 30?  Z245
149. Have you had a cerebral haemorrhage or a blood clot on the brain?  Z246
150. Have you had cancer?  Z247
151. Have you ever taken painkillers for a lengthy period?  Z250
152. Do you feel entirely healthy?  Z252
153. Have you ever had, or been told that you've got, sugar in your urine?  Z253
154. Do you have diabetes?  Z254
155. Have you been treated for goitre?  Z255
156. Do you feel the cold easily (by this we mean not only the hands and feet)?  Z256
157. Have you ever spent time in hospital?  Z257

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