Main Exams

To insure maximum accuracy and legibility for persons performing data entry, please adhere to the following guidelines:

1. Use a red or blue pen, or any other pen which will stand out from the page (pencil or black ball-point pen unacceptable).
2. Make sure all numerals are unmistakably clear.
3. Do not leave any blanks on exam form. If measurements are not taken, please enter 9’s in blanks, and document the reason. Your comments are helpful at any point of the exam where data is not recorded in the standard manner.
4. If you make an error, please cross it out entirely, write the correct information in the margin, and initial the change. Do not superimpose numerals one on top of the other.
5. Make sure both sides of the page are filled out, as the new exam form uses two-sided pages.
6. For more information on anthropometric measurements, refer to the following manual which is available in the clinic:

4. WEIGHT MEASUREMENT

1. Ask participant to wear FHS gown for measurement if he/she brought heavy gown from home. Have participant remove slippers or shoes.
2. Prior to asking participant to step onto scale, lift the counter poise and position it at zero.
3. Ask participant to step onto scale, facing measurement beam.
4. Instruct participant to stand in the middle of the scale platform with head erect and eyes looking straight ahead. Weight should be equally distributed on both feet, and participant should not touch or support him/herself.
5. With participant standing still in the proper position, lift the counterweight (larger weight), and slide it to the right until the beam approaches balance.
6. Adjust the top poise until the beam is evenly balanced.
7. Have participant step off scale. Read weight with eyes level to the point of measurement.
8. Record the weight to the nearest pound; round up if ≥ 0.5, round down if < 0.5.
9. Calibrate scale daily.

5. STANDING HEIGHT MEASUREMENT

1. Participant should be barefoot or wearing thin socks so positioning of the body can be seen. Ask participant to stand erect with his/her back to vertical mounted metal ruler (stadiometer).
2. Heels should be together and against the vertical ruler, both feet flat on the floor, with weight distributed evenly across both feet. Check to make sure both feet are back against the wall.
3. Participant faces straight ahead with his/her head positioned in the Frankfort horizontal plane (see next page). The lower margin of the bony orbit (the socket containing the eye) should be on the same horizontal plane as the most forward point in the supratragal notch (the notch just above the anterior cartilaginous projections of the external ear.)
4. Ask participant to let arms hang freely by the sides of the trunk, palms facing the thighs. Ask participant to inhale deeply and maintain a fully erect position.
5. Bring the carpenter square down snugly but not tightly on top of participant’s head. Use an extension board for proper measurement of severely kyphotic subjects.
6. Record measurement to the nearest 1/4 inch, rounding down.

1. Locate and mark posterior tip of the acromial process (point of the shoulder) on the right arm.
2. Have participant flex right elbow 90 degrees.
3. Mark olecranon (point of the elbow) and then straighten and relax arm.
4. Measure with cloth tape the distance between the acromial process and the olecranon (see figure 1, next page).
5. Make a pen mark on the back of the right upper arm halfway between the tip of the acromial process and the olecranon.
6. Have the participant place right arm at his/her side.
7. Check caliper on measuring block at 10 mm.
8. Firmly grasp a fold of skin between thumb and first two forefingers in your left hand, 1 cm above the mark of the midpoint of the upper arm. Gently lift fold away from the muscle and then release fold.
9. Repeat, gently lifting fold 2 or 3 times to make sure no muscle is grasped.
10. Again, firmly grasp a fold of skin, gently lifting fold away from the muscle.
11. Place the contact surface of the caliper at the level of the mark (see figure 2, next page).
12. Keep a firm grip on the skinfold with the left hand during the entire measurement.
13. Release the calipers, count silently 1-2-3 (approximately 2 seconds) and take the reading.
14. Take the reading to the millimeter, rounding down, before the needle drifts. Hold the pinch until after the measurement is completed.

Adapted from Atherosclerosis Risk in Communities Study (ARIC) Protocol Manual 2. Cohort Component Procedures. Version 2.0 1/88, pp. A46–A47.

Figure 1

Marked midpoint for triceps skinfold site

Figure 2

Measurement of triceps skinfold.

Figure 3

Measurement of skinfold thickness with caliper.

1. Have the participant place right hand in middle of his/her back to help define the medial border of the right scapula.
2. Locate the medial border of the right scapula with the fingers of your left hand.
3. Move your fingers down the full length of the medial border of the scapula until the inferior angle is located.
4. Have subject relax arm at his/her side.
5. Make a pen mark 1 cm below the inferior angle of the right scapula on the diagonal line extending slightly downward and outward from the medial border (see figure 1, next page).
6. Grasp the skinfold 1 cm above the mark with your left hand. The skinfold is grasped and lifted up along the diagonal line extending slightly downward from the medial border. Gently lift fold away from the muscle and then release fold.
7. Repeat, gently lifting fold 2 or 3 times to make sure no muscle is grasped.
8. Again, firmly grasp a fold of skin, gently lifting fold away from the muscle.
9. Place the contact surface of caliper at the level of the mark (see figure 2, next page).
10. Keep a firm grip on the skinfold with left hand during entire measurement.
11. Release caliper, count silently 1-2-3 (approximately 2 seconds) and take the reading.
12. Take the reading to the millimeter, rounding down, before the needle drifts. Hold the pinch until after the measurement is completed.

Adapted from Atherosclerosis Risk in Communities Study (ARIC) Protocol Manual 2. Cohort Component Procedures. Version 2.0 1/88, p. A48–A49.

Figure 1

Landmarks for subscapular and triceps skinfolds.

Figure 2

Measurement of subscapular skinfold.

1. With cloth tape, measure 3 centimeters to the right of umbilicus (navel) and 1 cm inferior to it (see figure 1, next page). Mark the spot. If a scar is present, measure 3 cm to the left of umbilicus and 1 cm inferior to it. If the left side is used, please note on the exam form.
2. At the marked spot, firmly grasp a fold of skin between thumb and first two forefingers in your left hand. Gently lift fold away from the muscle and then release fold. Raise a horizontal skinfold.
3. Repeat, gently lifting fold 2 or 3 times to make sure no muscle is grasped.
4. Place the contact surface of the caliper at the level of the mark (see figure 2, next page).
5. Keep a firm grip on the skinfold with the left hand during the entire measurement.
6. Release the calipers, count silently 1-2-3 (approximately 2 seconds) and take the reading.
7. Take the reading to the millimeter, rounding down before the needle drifts. Hold the pinch until after the measurement is completed.

Figure 1

Location of abdominal skinfold site.

Figure 2

Measurement of abdominal skinfold.

10. IMPORTANT POINTS FOR ACCURATE GIRTH MEASUREMENTS

(right arm, waist, hip and proximal thigh girths)

1. Carefully locate the correct site to be measured.
2. Keep the measuring tape snug so it does not slide, but do not indent the skin.
3. Make sure tape is horizontal for the entire circumference of the body part.

11. RIGHT ARM GIRTH (circumference)

1. Locate and mark posterior tip of the acromial process on the right arm (see figure 1, next page).
2. Have participant flex right elbow 90 degrees.
3. Mark olecranon (point of the elbow) and then straighten and relax arm.
4. Measure with cloth tape the distance between the acromial process and the olecranon.
5. Make a pen mark on the back of the right upper arm halfway between the tip of the acromial process and the olecranon.
6. Have the subject place right arm at his/her side.
7. Measure arm circumference at midpoint of upper arm (see figure 2, next page). Record measurement to the nearest 1/4 inch, rounding down.

Figure 1

Location of the midpoint of the upper arm.

Figure 2

Measurement of arm circumference.

12. WAIST GIRTH (circumference)

1. Participant stands erect, arms hanging loosely at sides, weight equally distributed on both feet, head facing straight ahead.
2. Apply anthropometric tape at the level of the umbilicus, underneath the gown (see figure on following page).
3. Apply tape snugly but not tightly.
4. Make sure the tape is horizontal and not twisted, checking from both the front and back.
5. Read measurement at mid-respiration with participant breathing normally.
6. Record measurement to the nearest 1/4 inch, rounding down.

Adapted from Atherosclerosis Risk in Communities Study (ARIC) Protocol Manual 2. Cohort Component Procedures. Version 2.0 1/88, p. A50.

13. HIP GIRTH (circumference)

1. Participant stands erect, arms hanging loosely at sides, weight equally distributed on both feet, head facing straight ahead.
2. Apply anthropometric tape at the level of the maximal protrusion of the gluteal muscles, underneath the gown but over the underwear (see figure on following page).
3. Apply tape snugly but not tightly.
4. Make sure the tape is horizontal and not twisted, checking from both the front and back.
5. Record measurement to the nearest 1/4 inch, rounding down.

Adapted from Atherosclerosis Risk in Communities Study (ARIC) Protocol Manual 2. Cohort Component Procedures. Version 2.0 1/88, p. A51.

14. PROXIMAL THIGH GIRTH (circumference)

1. Participant stands erect, arms hanging loosely at sides, weight equally distributed on both feet, head facing straight ahead. Legs should be far enough apart that thighs do not touch each other.
2. Apply anthropometric tape immediately below the gluteal furrow (buttock) (see figures, next page).
3. Apply tape snugly but not tightly.
4. Make sure the tape is horizontal and not twisted, checking from both the front and back.
5. Record measurement to the nearest 1/4 inch, rounding down.

Figure 1

Posterior view of locations for thigh circumferences.

Figure 2

Measurement of proximal thigh circumference.

Figure 3

Anterior view of locations for thigh circumferences.

16. ECG PRECORDIAL LEAD PLACEMENT (see diagram, next page)

• Point V1: The first intercostal space is palpated just below the clavicle. Count down and identify the fourth intercostal space just below the fourth rib. Point V1 is just to the right of the sternum in the fourth intercostal space.
• Point V2: Should be at the same level as Point V1 and immediately to the left of the sternum.
• Point V4: Lies in the midclavicular line in the fifth interspace. (In a male or a small breasted female, this is usually close to the nipple.)
• Point V3: Lies at the midpoint of an imaginary straight line connecting V2 and V4. Use a flexible, graduated straight edge to mark the point midway between V2 and V4.
• Point V6: Lies in the middle axillary line in the fifth intercostal space.
• Point V5: Lies in the anterior axillary line in the fifth intercostal space, midway between V4 and V6.

  NOTE: Place electrodes on chest wall, not on top of breast.

See Body Composition data set

PURPOSE

(For the participant) Bioelectrical impedance assessment (BIA) is a method for determining the amount of lean and fat tissue there is in the body. These measurements will be used to investigate health risks associated with obesity.

(For the medical technician) Electrodes placed on the body are attached to the BIA machine. A very slight charge is run through the body (one cannot feel this). Fat and lean tissue conduct the charge differently and give us resistance and reactance values which are then used to calculate the percentages of lean and fat in the body.

1. For best results:
   1. Use electrodes only once.
   2. Legs should be far enough apart that thighs do not touch each other. If participant is obese, it may be necessary to use a towel to separate thighs.
   3. Hands and arms should be far enough apart that they do not touch the torso.
   4. No body part should be in contact with any external metal (although jewelry and pins in bones will not affect the results).
   5. The subject’s skin should be clean, dry and warm (not hot or cold) to the touch.
      1. If skin is oily, clean with an alcohol swab before attaching the electrodes.
      2. If skin is extremely dry, apply a small amount of ECG or conductive paste before attaching the electrodes.
   6. Prior to attachment, cut the electrodes in half, bisecting the foil tab.
2. Electrode placement:
   1. Bioelectrical Impedance Assessment (BIA) measurements will be made with the electrode halves in two sets of sites (four sites altogether), in order to allow estimation of total body and trunk body composition. These two sites are:
      1. Wrist/metacarpal prominence (MCP) and ankle/metatarsal prominence (MTP)
      2. Iliac crest/thigh and sternal notch/mid neck, respectively, according to the method of Baumgartner et. al. (see diagram on page 29).
   2. Each pair of electrode halves should face each other on the cut side and be parallel. The tab side of the electrode should face toward the BIA machine.
   3. Three measures are made at each site, without moving the electrodes between measurements.
3. To read the Impedance Data:
   1. Turn on power switch.
   2. Place the x1/x10 switch in the x1 position.
   3. Place the Resistance/Reactance switch in the Resistance position. Record the Resistance value which appears on the Impedance meter.
   4. Place the Resistance/Reactance switch in the Reactance position. Record the Reactance value which appears on the Impedance meter.
   5. Immediately after taking the Resistance and Reactance values, turn off the power switch to conserve the system’s batteries.

18. PROCEDURE TO DETERMINE MAXIMAL INFLATION LEVEL

For each participant, determine the maximal inflation level, or the pressure to which the cuff is to be inflated for systolic blood pressure measurement. This assures that the cuff pressure at the start of the reading exceeds the systolic blood pressure and thus allows the first Korotkoff sound to be heard.

1. Attach the cuff tubing to the sphygmomanometer.
2. Palpate the radial pulse.
3. Inflate the cuff rapidly until the radial pulse is no longer felt (palpated systolic) by inflating rapidly to 70 mmHg, then inflating by 10 mmHg increments.
4. Deflate the cuff quickly and completely.

19. NURSE’S SEATED BLOOD PRESSURE

1. Equipment:
   1. One standard Litman stethoscope tubing and earpieces with bell: Classic II 3M
   2. One standard mercury column sphygmomanometer: Baumanometer
   3. BP cuffs in three sizes:
      • 1 large adult cuff
      • 1 pediatric cuff
      • 1 regular adult cuff
2. Application of the blood pressure cuff:
   1. With participant seated, place the appropriate cuff around the upper left arm. The midpoint of the length of the bladder should lie over the brachial artery, and the mid-height of the cuff should be at heart level.
   2. Place the lower edge of the cuff, with its tubing connections, about 1 inch above the natural crease across the inner aspect of the elbow.
   3. Wrap the cuff snugly about the arm, with the palm of the participant’s hand turned upward.
   4. If the subject has had a left-sided mastectomy, the right arm may be used for blood pressure measurement.
3. Guidelines for accurate blood pressure readings:
   1. The participant should be in a seated position for at least 5 minutes before the blood pressure is measured.
   2. All readings are made to the nearest even digit.
   3. Any reading which appears to fall exactly between marking on the mercury column should be read to the next higher marking, i.e. 2, 4, 6, 8, or 0.
   4. All readings are made at the top of the meniscus, the rounded surface of the mercury column.
   5. When the pressure is released quickly from a high level, a vacuum is formed above the mercury and the meniscus is distorted. Allow a few moments for it to reappear before reading the manometer.
4. Blood pressure readings:
   1. Following any previous inflation, wait at least 30 seconds after the cuff has completely deflated.
   2. By closing the thumb valve and squeezing the bulb, inflate the cuff at a rapid but smooth, continuous rate to the maximal inflation level (30mmHg above palpated systolic pressure).
   3. The examiner’s eyes should be level with the mid-range of the manometer scale and focused at the level to which the pressure will be raised.
   4. Open the thumb valve slightly. Allow the cuff to deflate, maintaining a constant rate of deflation at approximately 2 mmHg per second.
   5. Using the bell of the stethoscope, listen throughout the entire range of deflation, from the maximum pressure past the systolic reading (the pressure where the first regular sound is heard), until 10 mmHg below the level of the diastolic reading (that is, 10 mmHg below the level at which the last regular sound is heard.)
   6. Deflate the cuff fully by opening the thumb valve.
   7. Remove stethoscope. Neatly enter systolic and diastolic readings in the spaces provided on the form.

Please refer to the Ankle-Arm Blood Pressure data set for most current data.

Test not done at this exam.

1. Background and purpose:

   Previous work has shown that orthostasis appears to be an independent risk factor for subsequent mortality in older adults. Work by Sparrow and colleagues has suggested that postural changes in blood pressure predict the incidence of sustained blood pressure elevation as well as myocardial infarction events. Postural changes in heart rate and blood pressure have also been proposed as markers of cardiovascular reactivity, an area of current interest in the study of determinants of blood pressure elevation and cardiovascular morbidity, about which very little is known in older adults.

2. Equipment:
   1. One standard Litman stethoscope tubing and earpieces with bell: Classic II 3M
   2. One standard mercury column sphygmomanometer: Baumanometer
   3. Large wall clock with second hand
   4. BP cuffs in three sizes:
      • 1 large adult cuff
      • 1 pediatric cuff
      • 1 regular adult cuff
3. Application of the blood pressure cuff:
   1. With participant on the examination table, place the appropriate cuff around the upper left arm. The midpoint of the length of the bladder should lie over the brachial artery, and the mid-height of the cuff should be at heart level.
   2. Place the lower edge of the cuff, with its tubing connections, about 1 inch above the natural crease across the inner aspect of the elbow.
   3. Wrap the cuff snugly about the arm, with the palm of the participant’s hand turned upward.
   4. If the subject has had a left-sided mastectomy, the right arm may be used for blood pressure measurement.
4. Guidelines for accurate blood pressure readings:
   1. All readings are made to the nearest even digit.
   2. Any reading which appears to fall exactly between markings on the mercury column should be read to the next higher marking, i.e. 2, 4, 6, 8, or 0.
   3. All readings are made at the top of the meniscus, the rounded surface of the mercury column.
   4. When the pressure is released quickly from a high level, a vacuum is formed above the mercury and the meniscus is distorted. Allow a few moments for it to reappear before reading the manometer.
5. Heart rate measurement:
   1. Palpate the radial pulse with the palm of the hand turned upward for exactly 30 seconds.
   2. Record the number of beats per 30 seconds.
6. Blood pressure readings:
   1. Following any previous inflation, wait at least 30 seconds after the cuff has completely deflated.
   2. By closing the thumb valve and squeezing the bulb, inflate the cuff at a rapid but smooth, continuous rate to the maximal inflation level (30 mmHg above palpated systolic pressure).
   3. The examiner’s eyes should be level with the mid-range of the manometer scale and focused at the level to which the pressure will be raised.
   4. Open the thumb valve slightly. Allow the cuff to deflate, maintaining a constant rate of deflation at approximately 2 mmHg per second.
   5. Listen throughout the entire range of deflation, from the maximum pressure past the systolic reading (the pressure where the first regular sound is heard), until 10 mmHg below the level of the diastolic reading (that is, 10 mmHg below the level at which the last regular sound is heard.)
   6. Deflate the cuff fully by opening the thumb valve.
   7. Remove stethoscope. Neatly enter systolic and diastolic readings in the spaces provided on the form.
7. Supine heart rate and blood pressure measurement procedures:
   1. Place the participant in the full supine position for 5 minutes.
   2. Measure the heart rate. Neatly record it on the study form.
   3. Obtain blood pressure measurement. Neatly record it on form.
   4. Measure second heart rate 1 minute 30 seconds after obtaining first blood pressure measurement.
   5. Measure second supine blood pressure measurement 2 minute after the first BP measurement.
8. Standing heart rate and blood pressure measurement:
   1. Assist participant to standing position. If participant cannot stand without support, assist him/her to an upright seated position.
   2. Arrange cuff tubing to prevent it from pulling.
   3. Ask participant not to talk other than to express any discomfort.
   4. Hold the participant’s left arm so that it rests slightly below the heart level. Support it by holding it against your side and with the hand holding the stethoscope in place.
   5. To prevent the blood pressure cuff from sliding, participant’s arms are kept flexed at the elbow and relaxed, with hands clasped loosely and resting against the abdomen.
   6. Measure heart rate after participant has been standing for 30 seconds.
   7. Measure the 1 minute standing blood pressure.
   8. Measure second heart rate after 1 minute 30 seconds have elapsed since standing.
   9. Take second blood pressure measurement after 2 minutes have elapsed since standing.
9. Participant safety measures for orthostatic bp measurement:
   1. Prior to assisting participant to standing position, notify participant that if s/he feels dizzy to lean backwards against the examination table and ask for assistance. This is the time of highest risk of orthostatic symptoms.
   2. To enhance participant safety, stay close by and observe participant’s alertness, to verify visually that s/he tolerates upright position well.
   3. When there appear to be any symptoms of dizziness or fainting, or when in the judgement of the examiner, the participant is unstable, seat the participant and obtain remaining measurements in the sitting position.
   4. If the participant continues to feel dizzy or is fainting, support participant under his/her arms and place him/her on the table.
   5. Notify clinic physician that assistance is required and immediately return to the participant.
   6. Elevate and support participant’s feet in a 20 degree angle from the floor.
   7. Obtain heart rate and blood pressure measurements.
   8. After the clinic physician has attended to the participant’s safety and comfort, log the incident on the study form. This will provide a record of the occurrence, and indicate the participant’s position (standing/sitting) when the measurements were obtained.

Adapted from CHS Operations Manual, 4.9. OP. October 7, 1989 pp. 103–109.

22. CARBON MONOXIDE ANALYSIS

1. Set-up:
   1. Keep the Analyzer set on Low range and read the needle indicator on the Red (bottom) scale. CO content is rarely large enough to necessitate switching to the High range and scale.
2. Purpose:
   1. CO analysis is performed to confirm or repudiate the patient’s account of his smoking/nonsmoking status as recorded during the physician’s interview.
   2. CO analysis is not particularly useful in assessing passive smoke exposure. Since the patient is confined to the non-smoking clinic environment for a number of hours, the excess CO s/he may have picked up has had enough time to be exchanged for O2.
3. Procedure:
   1. Ask participant to take deep breath of room air and exhale completely.
   2. Ask participant to take another deep breath and to hold it for 15 seconds.
   3. Time the 15 seconds and offer participant encouragement to continue holding his/her breath. 15 seconds allows time for diffusion in the lungs, i.e., gas exchange of CO for O2.
   4. Ask participant to exhale a small amount of air, to get rid of dead-space air which does not represent blood volumes of CO.
   5. Ask participant to exhale remainder of his/her lung volume into the collection bag provided. Make sure the bag is pinched off before participant removes the mouthpiece from his/her mouth, or air sample will be lost.
   6. Remove the mouthpiece and insert the bag into the CO filter. Turn the Ecolyzer to the ON position.
   7. Read and neatly record the CO content in ppm’s.
   8. Expected levels for non-smokers is 3–7 ppm, which is picked up from environmental pollution. Expected levels for smokers are naturally higher than non-smokers, but will depend upon number of cigarettes consumed and the time elapsed between smoking and testing.
   9. Use caution in testing participants who have recently consumed alcohol. High blood alcohol levels can damage the Ecolyzer. The CO filter must be changed after use by a participant who has consumed alcohol. This patient is easily identified by his/her extraordinarily high CO levels, generally 40 ppm or greater.
4. Quality Control:
   1. The Ecolyzer is calibrated daily according to the procedure outlined in the company’s manual. The manual gives no recommendations on changing the CO filter, so it is arbitrarily changed at the end of the month.
   2. It is also wise to perform another calibration check by testing the air sample of a non-smoking technician each week. This serves as a reference standard for the clinic’s ambient CO content.

23. COGNITIVE FUNCTION

Please refer to the MMSE data set for most current data.

Interview not done at this exam.

This interview below is given by the clinic personnel. The interviewer records the patient’s response on the form.

1. RATIONALE AND BACKGROUND

   The Center for Epidemiologic Studies Depression Scale (CES-D) was developed for use in epidemiologic research of depressive symptomatology in the general population. It was designed as a screening instrument to elicit symptoms associated with depression. It is intended to document the presence and severity of depressive symptoms but is not intended to make clinical diagnosis. It assesses the current state of the subject by focusing on symptomatology in the past week.

   The scale is given at each exam. The scale is not given if the patient is: sedated, aphasic, non-English speaking, comatose, or uncooperative.

2. PROCEDURE
   1. Each question is read to the subject who responds with one of four answers.
   2. Response alternatives should be printed on paper or cards which is/are placed in front of the patient for reference.
   3. Each category of response should be explained to the patient prior to the administering of the scale.
   4. If the patient is unable to read the response cards, the interviewer should read each response as well as the question referring to their feelings in the past week.
   5. Be sure that the patient understands that the questions refer to their feelings in the past week.
3. CES-D SCORING

   Patient responses are circled on the form; the score is the sum of 20 weighted responses and the final score is calculated by the computer. Score ranges from 0 to 60 by totaling all responses. Code “9 - refused or do not know” is not included in the score. Values for each question range from 0 to 3.

4. METHODS

   The CES-D Questionnaire consists of twenty questions. Since it is a scale for depression, it must be completed using responses by the participant, not a proxy.

   • SCRIPT: The next few questions are about your feelings during the past week. For each of the following statements, please tell me if you felt that way much of the time during the past week.
   • Hand card to participant and explain the categories to him/her.

     The following definitions should be given.

     Rarely or none of the time - Less than one full day

     Some or a little of the time - One to two days in the past week

     Occasionally or moderate amount of time - Three to four days in the past week or about half the time

     Most or all of the time - Five to seven days in the past week

• Read each item as it is written on the form, continuing with the response categories. For example:
  • SCRIPT: During the past week I was bothered by things that usually don’t bother me. Did you feel that way rarely or none of the time, some or a little of the time, occasionally or moderate amount of time, or most or all of the time.
  • Discontinue reading the responses when the participant provides a response before you are finished. On the next item, however, again begin to read the entire set of responses.
  • When a participant asks for an interpretation of a particular response, reread the definitions to him/her.
  • Code “9 - Refused or Do Not Know” is used when:
    • The question was asked, but the participant chooses not to answer. For example, response was: “I would rather not say,” or “Go on to the next question”
    • The question was asked, but the participant does not know, does not remember, or does not understand the form.
  • Check the response on the form.
  • When the participant refuses to respond to the statement, check “9 - refused or do not know”
  • When the participant asks about the meaning of any item or tries to qualify a statement, simply repeat the statement; for example:

    PARTICIPANT: What do you mean by bothered?

    INTERVIEWER: I was bothered by things that usually don’t bother me. Did you feel that way rarely or none of the time, some or a little of the time, occasionally or moderate amount of time, or most or all of the time during the past week.

  • When the participant still asks about the meaning or says s/he does not understand, check “9 refused or do not know. Do not try to interpret the statement for the participant.

Please refer to the PFT data set for most current data.

Offspring 5 Clinic Phlebotomy Protocol

1. Venipuncture to be performed on 5–7 fasting subjects between 8:15 am and 9:30 am five days a week.
2. Total of 10–13 tubes of blood are collected, the number depending upon whether or not the patient is a participant in special cortisol or cholesterol studies.
3. Phlebotomist should wear a clean lab coat and disposable protective gloves when collecting specimens.
4. Blood drawing takes place in an isolated room where the patient’s name and ID number are checked before applying labels to the tubes.
5. The participants are informed that blood is to be drawn and they are asked to lie down (the latter to standardize methodology and because platelet aggregation studies are done).
6. With sleeves rolled up to expose the antecubital fossa, a tourniquet is applied 3–4 inches above the venipuncture site.
7. After a suitable vein is found, the area is cleansed with a sterile alcohol prep and allowed to dry. A 21 guage needle, applied to a vacutainer holder, is used for venipuncture.
8. The tourniquet is released after the last tube is drawn. The needle is removed and a fresh gauze is placed of the venipuncture site. Pressure is applied to stop bleeding, and a bandaid is applied.
9. After the initial phlebotomy, persons without a history of diabetes mellitus, not taking insulin or oral hypoglycemic agents, and those without any other contraindications, are asked to consume a drink containing 75 gm glucose as part of a 2 hour glucose tolerance test.
10. A follow-up phlebotomy specimen (for glucose and insulin levels) is drawn (subject may be in sitting position) two hours after the last of the 75 gm oral glucose load was consumed.