UK Data Archive Study Number 4379 - Scottish Health Survey, 1998.
P1731
SCOTTISH HEALTH SURVEY 1998
INTERVIEWER PROJECT INSTRUCTIONS
Issue 1: March 1998 Contents:
1. Background and aims 1
2. The survey 2
3. The research team 3
4. Summary of survey design 4 4.1 The interviewer visit 4 4.2 The nurse visit 4
5. Survey materials 6
6. Notifying the police 7
7. Your sample 7 7.1 The sample design 7 7.2 Rules for interviewing children 7 7.2.1 ‘Thank you’ presents for children and young people 8 7.3 Address Record Form 9 7.4 Address List 15 7.5 Interviewer Sample Sheet 16
8. Introducing the survey 17 8.1 Advance Letter and Survey Leaflets 17 8.2 Doorstep introduction 17 8.3 Introducing the height and weight measurements 19 8.4 Introducing the nurse's visit 19
9. Liaising with your nurse partner 22 9.1 Making appointments for the nurse visit 22 9.2 Accompanying the nurse 23 9.3 Appointment times for different blood type samples 23 9.4 The Nurse Record Form (NRF) 24 9.5 Making out Nurse Record Forms for additional households 27
10. The Questionnaire 28 10.1 Introductory questions 28 10.2 The grid 29 10.3 Joint or concurrent interviewing 30 10.4 Allocating individuals to interviewing sessions 30 10.5 The individual questionnaire 31 10.6 The structure of the questionnaire 32 10.7 Introductory questions 32 10.8 General health, CVD, asthma 32 10.9 Accidents 36 10.10 Activity and exercise - adults 36 10.11 Activity and exercise - children 36 10.12 Eating habits 37 10.13 Smoking 38 10.14 Drinking behaviour 39 10.15 Dental health 41 10.16 Employment classification module 42 10.17 Other classification questions 43 10.18 Parental history 43 10.19 General Household details 43 10.20 Presentation of self-completion booklets 44 10.21 Measurements 45 10.22 The National Health Service Central Register 46
11. Opening up additional households 46
12. Backing up data on disk and returning work to Brentwood 47
Contact names and telephone numbers 48
Appendix A: Protocol for taking height measurement 49
Appendix B: Protocol for taking weight measurement 57 1. BACKGROUND AND AIMS
"The Scottish Health Survey" has been commissioned by the Scottish Office Department of Health. It is the second survey of its kind (the first was carried out in 1994/5) and is likely to be repeated at three- yearly intervals in the future. The survey's objective is to monitor trends in the population's health over time. It is very similar to the Health Survey for England which began in 1991 and is repeated every year.
In 1991, the Scottish Office published "Health Education in Scotland - A National Policy Statement", which set out key health targets in a number of areas. The aim in setting these targets is to increase people's life expectancy and to improve the quality of their lives. "Health Education in Scotland" recognised that a health strategy for improving life quality involved a variety of approaches, designed not only to reduce the amount of ill-health (through high quality health services, healthier lifestyles and improved physical and social environments) but also to alleviate its effects.
Before the first Scottish Health Survey, little systematic information had been available about the state of the population's health, or about the factors that affect it. There were statistics on the number and causes of deaths. Other statistics (such as hospital admissions) have been derived from people's contacts with the National Health Service, but these statistics are concerned only with very limited aspects of health. For example, they are likely to record the particular condition treated rather than the overall health of the patient. While information is also available from other sources, such as surveys, it tends to deal with specific problems, not with health overall. And even the wider-ranging surveys fail to provide measures of change over time.
The statistics derived from the Scottish Health Survey are therefore the first to provide a picture of the health of the Scottish population as a whole, or of the way it may be changing. It has not previously been possible to say with any certainty whether people are getting generally healthier or less healthy, or whether their lifestyles are developing in ways that are likely to improve or damage their health.
But good information is vitally needed for formulating health policies aimed not only at curing ill-health but also at preventing it. Prevention is, from every point of view, better than cure. Good information is also essential for monitoring progress towards meeting health improvement targets. Consequently, the Scottish Department of Health decided that a major health survey should be carried out in order to monitor the country's state of health so that trends over time could be noted and appropriate policies planned.
The Scottish Health Survey is that survey. It plays a key role in ensuring that health planning is based on reliable information. As well as monitoring the effectiveness of the government's policies and the extent to which its targets are achieved, the survey will be used to help plan NHS services to meet the health needs of the population.
The 1998 survey differs from its predecessor in that children aged 2 to 15 and adults aged 65 to 74 are included in addition to adults aged 16 to 64 years. A number of new questions have been added, covering asthma, eating habits and drinking among other topics, and some new measurements are being taking. However, the main purpose of the 1998 survey is to repeat the questions and measurements from the 1995 survey in order to update the old survey’s information and allow trends in people’s health and health-related behaviour to be measured.
1 2. THE SURVEY
The Scottish Health Survey is a large survey, involving interviews with approximately 9,000 adults and 4,000 children. Fieldwork is continuous throughout the year between April 1998 and March 1999.
Like the 1995 survey, the new survey is being carried out by the Joint Health Surveys Unit, set up in 1993 jointly by SCPR and the Department of Epidemiology and Public Health, University College London (UCL) Medical School.
This survey again focuses on cardiovascular disease. Cardiovascular disease (including heart attacks and strokes) is the largest single cause of death in Scotland. Even when it does not kill, it brings ill- health and disability to thousands of people every year. Coronary heart disease caused more than a quarter of all deaths in 1991, while strokes were responsible for more than one in ten.
Cardiovascular disease is thus an issue of great importance. It is also an issue that lends itself to study in a survey because there are a number of measurable indicators of cardiovascular conditions, and specific factors that put people at increased risk. Action can be taken to reduce risk levels.
The 1995 survey set a against which future trends in cardiovascular health can be measured. Specific aims include:
- estimating the proportion of adults in Scotland who have particular cardiovascular conditions
- estimating the prevalence of certain risk factors associated with these conditions, and looking at the extent to which combinations of risk factors are found
- examining the variation in risk factors between population sub-groups
This will help to:
- inform policy on preventive and curative health
- monitor change overall and among certain groups
- monitor progress towards the health targets relating to cardiovascular disease set in "Health Education for Scotland".
The 1998 survey is also concerned with asthma and other breathing problems. The Scottish Office is particularly interested in collecting information on this subject as there is some concern about rates of asthma, especially among young children.
Information about the survey, its objectives and design have been circulated to all Area Health Boards Research Ethics Committees. These are the bodies that approve the ethical aspects of medical research. Committee members represent medical, professional and patient interests. They have been asked to confirm that they are happy with the ethical aspects of this study. All the health boards in Scotland have given their approval for this study.
2 3. THE RESEARCH TEAM
4. SUMMARY OF SURVEY DESIGN
The 1998 Scottish Health Survey is a survey of people aged between 2 and 74 living in private residential accommodation in Scotland. A sample of over 14000 address has been selected from the Postcode Address File (PAF).
There are two parts to the survey, an interviewer-administered questionnaire using CAPI (Stage 1), and a visit by a nurse to carry out measurements and take a blood sample (Stage 2). Co-operation is entirely voluntary at each stage. Someone may agree to take part at Stage 1 but decide not to continue to Stage 2. However, we know from previous surveys in Scotland and England that people can generally be persuaded to co-operate with all the survey procedures.
Each interviewer covers one sample point (23 addresses) while each nurse covers two. It is important that interviewers and nurses work as a team so that the two interviewers who work with the same nurse make the best use of her time in the appointments they arrange.
An advance letter will be sent to each address explaining briefly the survey and its purpose. Two other information leaflets to be given out by the interviewer and the nurse provide the respondent with greater detail.
One person aged between 16 and 74 and up to two children aged between 2 and 15 will be randomly selected at each address for inclusion in the study. Fuller details of the sample and associated documents are given in Section 7.
4.1 THE INTERVIEWER VISIT
For each selected adult in the study, there is a CAPI administered questionnaire which asks about: problems connected with cardiovascular disease (such as chest pain, wheezing, etc); asthma; exercise; eating habits; smoking and drinking; accidents; dental health; household, social and demographic information. At the end of the interview, there is a short self-completion questionnaire, which collects information on well-being, exposure to passive smoking, drinking experiences, incontinence and, for women, contraceptives use and hormone replacement therapy. For children aged 2 to 15 there are similar questions covering most of these topics with the precise questions differing according to the age of the child. Interviews of adults and children are carried out at the same time. Children aged 13 to 15 may be interviewed directly while in the case of those aged between 2 and 12 the questions are directed at a parent, though the child should still be present during the interview. (The rules for interviewing children are given in Section 7.2). The interview should take around 60 minutes to complete for one adult or about 90 minutes for a household containing an adult and two children. This questionnaire and how it should be administered is discussed in more detail in Section 10.
Towards the end of the interview, each person's height and weight are measured. We estimate that this will take around 5 minutes per respondent. If a respondent would like a record of their height and weight measurements, the interviewer prepares a Measurement Record Card.
At the end of the interview, the second stage of the survey is introduced. The second stage involves a visit by a nurse to ask a few more questions and carry out some more measurements. The interviewer arranges an appointment for the nurse to visit a few days later.
3 4.2 THE NURSE VISIT
The second stage of the survey is carried out by a qualified nurse. After carrying out the interview, the interviewer makes an appointment for the nurse to visit the respondents. The nurse will then call on the respondents in their home in order to ask a few questions about any prescribed medicines that are being taken and to carry out more measurements: waist, hip, lung function, blood pressure, (mid-upper arm circumference (children aged 2-15 only) and demi-span (those aged between 65 and 74 years only). If the respondents wish to be given the results of these measurements, the nurse enters this information onto their Measurement Record Cards.
The nurse will then take a sample of saliva (spit) and ask for written permission to take a small blood sample (normally 15ml). The saliva and blood samples are sent for analysis by the Newcastle Royal Infirmary.
Within 5 sample points each month, nurses will be taking a small amount of extra blood (6ml) from respondents so that some extra tests on vitamins and fatty acids can be carried out. If you are working in one of these points, you will need to adopt slightly different procedures when making appointments for nurses. This is explained in section 9.
With the respondent's permission the results of the blood test, lung function and blood pressure will be sent to their GP. The respondent can also receive their blood test results, if they so wish.
Details of how to explain the purpose of the nurse visit are given in Section 8.4.
4 5. SURVEY MATERIALS
The following is a list of documents and equipment you will need for this survey. Before starting work, check that you have received the following supplies.
Document Number Colour
Sample related documents Interviewer Sample Sheet 1 pale yellow Adult list sheet 1 white ARFs (pre-labelled) 23 blue cover ARFs for additional dwelling units 10 orange cover Interviewer response form A 1 pink
Nurse related documents Nurse Record Form 33 lilac cover Appointment Diary 1 white Appointment letter 10 white Appointment Record Card 33 white
Interview documents Advance letter 8 Scottish Office paper Survey Leaflet (stage 1) 29 green card Stage 2 Leaflet (nurse) 3 pale yellow card Self-completion booklet, 18+ 21 grey cover Self-completion booklet, 16-17 3 cream cover Self-completion booklet, 13-15 5 lilac cover Self-completion booklet, 8-12 5 pale yellow cover Show cards for respondents 1 set white card Interviewer coding cards set of 3 white card Cigarette coding booklet 1 pink cover Measurement Record Card 30 blue card NHS central register consent form 30 grey
Other documents Admin. Notes 1 white Jump number card for CAPI 1 white card Police notification letter 4 Brentwood headed paper Suggestion sheet 1 white Project instructions 1 white SCPR leaflets 25
Disks BackUp Disk 1
Equipment Stadiometer to measure height Frankfort Plane Card 1 Scales to measure weight
Presents for children pens 7 surprise packs 7
5 6. NOTIFYING THE POLICE
You, as the interviewer, are responsible for notifying the police in your area about the work both you and your nurse partner will be undertaking on this survey. You will be given a special form for this purpose. You will need to obtain all the relevant details from your nurse partner (eg make and registration number of car) so that you can complete this form. Before you start any work hand this form in at the police station in your area together with a copy of the advance letter, Stage 1 leaflet and Stage 2 leaflet.
7. YOUR SAMPLE
7.1 THE SAMPLE DESIGN
The sample for this survey has been drawn from the publicly available Postcode Address File. 14,352 addresses have been selected for the whole year. These will be clustered into 312 postcode sectors. 26 postcode sectors will be covered each month. Each sector will contain two sample points consisting of 23 addresses each. These two sample points will be covered by different interviewers but the same nurse. The sample has been designed such that each quarter's sample is fully representative of the population of Scotland.
The first task of the interviewer will be to identify how many dwelling units there are at a selected address. If there are two or three separate units, you may need to include all of these in your sample. If there are four or more separate units, you will be required to carry out a random selection of either one or three of these units. This is described fully in section 7.3.
The interviewer then lists all persons in household on the ARF in descending order of age (there are separate lists for elderly adults aged 75 or over, adults aged 16 to 74, children aged 2 to 15 and young children aged 0 to 1). Following instructions on the ARF the interviewer then selects for interview:
1) one adult aged between 16 and 74, plus: 2) up to two children aged 2 to 15
The rules governing interviews of children are given below.
7.2 RULES FOR INTERVIEWING CHILDREN
For all children under 16 you must get permission from the child's parent(s) before you interview the child. If a child is not living with his/her natural or adoptive parent, permission should be obtained from the person(s) in the household who is in loco parentis for that child on a permanent/long-term basis. For example, a foster parent or a grandparent who is bringing the child up instead of the parents could give permission. Such a person should never be used as a substitute if the natural or adoptive parent is a member of the child's household. Always give preference to the natural/adoptive parent and, wherever possible, to the mother.
If the parent(s) are temporarily away from home and will be throughout your fieldwork period (for example, abroad on business or on an extended holiday without the children) and have left them in the care of a close relative, then if that relative feels they can give permission for a child of 13-15 to be interviewed, this is acceptable. This is not practicable in the case of younger children, as the person concerned needs to know a lot about the health history of the child. A non-relative must never be taken as the person in loco parentis in this type of situation.
The parent or "guardian" of a 13-15 year old must be present at the time you carry out the interview. They need not necessarily be in the same room but they must be at home and be aware that you are 6 carrying out the interview. This protects both the child and yourself.
If there is any disagreement between parents, or between parent and child, in respect of willingness to co-operate in the survey, you should respect the wishes of the non-co-operating person. Obviously, you may not always know if both parents agree or disagree as you may not see them together. But if the disagreement is brought to your attention, then the above rule applies.
2 to 7 year olds You should interview the parent or guardian about the child. As you will be measuring the height and weight of the child, the child has to be present in the home at the time of the interview. Ideally they should be present during the interview as they may be able to provide information about themselves that their parent either does not know or has forgotten. 8 to 12 year olds Again interview the parent or guardian. Children of this age are asked to complete a self-completion booklet. So make sure that the child is present during the interview and that their parents are happy with the self-completion questionnaire. 13-15 year olds Interview in their own right (after obtaining parental permission). These children will also be given a self-completion booklet. 16 to 17 year olds It is not necessary to obtain formal parental agreement to interview these young people. It is however courteous to let the parents know that you wish to interview them. This age group is also given a self-completion questionnaire.
Should a parent wish to know the content of the survey, explain briefly what the survey covers.
What should you do if there is a child in the household who is away from home for the whole of your fieldwork period? For example, children away at boarding school (who do not come home at weekends), on an extended visit/holiday away from home, or ill in hospital.
Child aged 13-15: Code as unproductive.
Child aged 2-12: Carry out the CAPI interview for this child with one of his/her parents. Obviously you will not be able to measure the child's height or weight. You can however get estimated information.
These are the only occasions when children might not be present for the interview. Even though you are asking a parent about the health of a child aged between 2-12, you must have the child close-by during the interview so that you do not lose height, weight and self-completions. You must ensure that appointments for interviews are made for times when the child(ren) will be available and not at school, visiting a friend or likely to be in bed. This must be stressed to parents when setting up appointments for your interview and the nurse interview.
In households where you have three people to interview you will want to interview all of them on the same visit to a household wherever possible. If it is not possible to see them at the same time, then you will need to arrange separate appointments. Try to see everyone in a household within the shortest possible period of time. As well as being easier for you, this will be a big help to your nurse partner as it will be easier for you to arrange a single nurse appointment.
8 7.2.1 ‘Thank you’ presents for children and young people
Given the large demand we are making on the household, particularly in ‘child’ households, we feel it is appropriate to make a small present to each of the children and young people helping with the survey. You will be given a selection of small ‘lucky bags’ that contain stickers and puzzles to complete for younger children, and a selection of pens for older children. As a rough guideline, you may find it appropriate to use the bags with 2 to 9 year olds and the pens with 10 to 15 year olds.
It is up to you to decide at what point in the interview to give the ‘present’; make sure it is clear that all children will be given a ‘present’, whether or not they agree to all the measurements. In some cases you may also feel you should give a ‘present’ to a sibling not selected for the survey. This is fine. The pens are intended for older children - not for adults. It will occasionally be tactful to give an older young person (eg. someone aged 16/17) a present as well as his/her younger siblings. We have only a limited number of presents, so please do not be over-generous; each child should receive a pen or a lucky bag - not both.
7.3 ADDRESS RECORD FORM
You will receive a blue ARF for each of the 23 addresses in your assignment. You must cover each of these ARFs, and attempt an interview at all relevant addresses.
Address label & Serial number
The Address Label at the top left of the ARF gives, in addition to the full address, a six-digit serial number. This is the serial number for Household No. 1. It is made up of the following components:
* Point no. (3 digits) - this is the sampling point number of your area * Address no. (2 digits) - from 01 to 23 * Household no. (1 digit) - this is the household number. This will always be 1 on pre-labelled ARFs. For additional households, this will be 2 or 3. * Check Letter
Make sure that you always copy this serial number accurately onto all documents relating to that household.
Other information contained on the address label is as follows:
* Month of the assignment, e.g. APR for April. (You can ignore the letter which follows the month - this is for office use only) * BT - "Blood type" This will be either "S" (Standard tests) or "V" (Vitamin/Fatty Acid tests). All ARFs in an assignment will be of the same blood type. This only affects you when you come to make appointments for the nurse (Section 9). * MOI number - the "Multiple Output Indicator" This will be a 2 digit number indicating the number of distinct dwelling units expected within an address, as recorded by the Post Office. In most cases, this will be 01, indicating just one unit at that address. However, in some areas, such as Glasgow where there are a lot of tenement block addresses, there may be a lot of addresses with MOIs greater than 1. Note that this number may not always be accurate. * GR: Grid reference This is provided in case it helpful in locating the address. It is likely to be most useful with rural sample points. * Eg name 9 An example name taken from the Electoral Register, where one was given. This is provided to help you locate an address. If the location is uncertain, perhaps because the address name is unclear or has changed, referring to the name of a current or former resident may help to establish which address is the sample one. In some cases, mentioning the name on the doorstep may help you to gain the confidence of a residence while you explain the purpose of the survey.
Please note: the name is only provided to help you locate the as an aid to locating the address and introducing the survey, as described above. However, it is the address we have selected, not the person. When you make contact at an address, you must still make a random selection from the 16-74 year old residents and treat the named person, if present, the same way as other residents. If the named person has moved, you should not try to find their new address. You should make the selection from the existing residents at that address.
Here is an example address label:
Point number Month of issue Blood type
Check letter
Point: 666 APR A Address number Add/HH: 01 1 A BT: S
Household number 17 Arndale Crescent Monifieth DUNDEE DD5 4AD MOI: 1 GR: 34516 10116 Eg name: Mr. D. Smith
Example name from Electoral Register Multiple Output Indicator (number of separate dwelling units Grid reference expected at the address)
As a further aid to locating your addresses you are provided with a list of all the addresses in your assignment which shows the previous and next addresses which are listed in the Postal Address File (see Section 7.4).
You will also receive a pale yellow Interviewer Sample Sheet which lists all the addresses in your assignment (see Section 7.5).
Household Selection label
The label on the top right of the ARF is the selection matrix for use where there are two or more dwelling units at the address. This will be one of two types, depending on the MOI number on the Address label (see above):
* A Type A label will have three rows of selection digits, and will be present if the MOI is equal to one; * A Type B label will have one row of selection digits, and will be present if the MOI is greater than one. 10 Where you come across a multi -unit address the Household Selection label will be used to:
· (if Type A) select three dwelling units out of a number between four and twelve. · (if Type B) select one dwelling unit out of a number between two and twelve
Examples of the two types of Household Selection labels are shown below:
HOUSEHOLD SELECTION - TYPE A HOUSEHOLD SELECTION - TYPE B Point : 666 Add/HH: 01 1 A Point: 666 Add/HH: 02 1 L DU: 4 5 6 7 8 9 10 11 12 DU: 2 3 4 5 6 7 8 9 10 11 12 ------SEL: 1 3 1 4 1 3 1 6 4 SEL: 1 2 2 3 5 1 2 6 7 1 11 3 4 3 5 2 6 5 7 7 4 5 6 7 6 9 9 10 11 DU CHKs: HH2=B HH3=C
Adult/Children Selection label
The second label on the right of the ARF is the selection matrix for use where there are two or more adults aged 16 to 74 or three or more children aged 2 to 15.
An example Adult/Children Selection label is shown below.
ADULT/CHILDREN SELECTION Point : 666 Add/HH: 01 1 A PERS: 2 3 4 5 6 7 8 9 10 11 12 ------SEL: 1 3 4 3 2 1 7 9 2 5 11 1 2 5 4 7 6 2 10 8 1
Rest of front page
Enter the following:
· Main contact name. The full name of the main person you have spoken to at the household. This may be the selected adult but need not be; it could be another adult who provided household details or a parent who was not selected for interview. You will need to enter the name of this person in the Admin Block after the interviews.
· Telephone number. The full telephone number, including area code. You will need to enter this in the Admin Block at the end of the interview.
· Your interviewer name and interviewer number. · Calls record. Complete in the usual way. Note all personal visits, even if there was no reply. You will need to enter the total number of calls you have made in the Admin Block.
11 Questions 1-8
Please ensure that you follow the routing instructions here very carefully
The procedure in this section is designed to minimise the number of cases in which second and third dwelling units will need to be selected. If you come across a multi-unit address, in many cases you will only need to select one unit at random. In some cases, however, you will need to make a selection of two or three.
If you come across an address with more than one unit, then you will need to follow the instructions on the ARF carefully. The number of selections you make will depend on a) the number of units found at the address, and b) the selection label type - A or B.
Q2 You should ring codes 09 and 10 only on instruction by the Office. Use code 08 only if none of codes 01-07 apply and you are confident that it is a true ‘deadwood’ address. Otherwise, query with the office what you should do.
If one of these codes applies, there is nothing else for you to complete on the ARF - hence the instruction END. Open the Household Questionnaire for this serial number on the computer, and go straight to the Admin Block.
Q3 Record the number of occupied dwelling units at the address. Note that this number may not necessarily be the same as the MOI printed on the label. Do not worry if there is a mismatch. The ARF will take you through the necessary procedures to allow for this.
A brief resume of the household definition is provided in the box as a reminder. If you circle outcome code 21 or 22, you are asked to go to Q27. Give a full description of why you were unable to make contact or received a refusal to provide any information. Include any information that might be useful should we decide to ask another interviewer to make another attempt at getting co-operation.
Q4 This summary sorts addresses into those requiring a household selection process (codes C and D) from those where all households are eligible for inclusion in the survey (codes A and B). Make sure you follow the skip instructions carefully.
Q5 If there are 4-12 dwelling units at your address, list all of them in the grid in the order indicated. Please note that it is only OCCUPIED dwelling units that are eligible for selection. An empty flat in a block of flats would not be eligible for selection.
Then use the selection label on the front of the ARF to select which dwelling unit(s) to include in the survey. If this is a Type A address (MOI=1) you will be selecting three dwelling units. If this is a Type B address (MOI>1) you will be selecting just one dwelling unit. Go along the first row (marked ‘DU’) until you reach the number of dwelling units at your address and look below for the number(s) of the dwelling unit(s) to include. Ring the appropriate code(s) in the column headed ‘SELECTION CODE’. Then go to Q8 and repeat the location detail(s) for the selected dwelling unit(s).
You will only occasionally come across an address with 13+ dwelling units. If you do, list the dwelling units on a separate sheet of paper in the order indicated at Q5. Then use the appropriate look-up chart at the back of the ARF to select the appropriate dwelling unit(s) for interview (Chart A if it is a Type A address, Type B if it is a Type B address). For example:
· If it is a Type A dwelling unit and there are 19 units you will select units 13, 18 and 7 (see Look-up Chart A) 12 · If it is a Type B dwelling unit and there are 27 units you will select unit 17 (Look-up Chart B).
If you are unsure about how to list households at a multi-unit address or how to make a selection, call your supervisor or the office before going ahead.
Q8 Note the difference between the Household Serial Number in the left-hand column and the Selection Code to be entered in the right-hand column. The latter comes from the grid you completed at Q5 and is only used for helping you to make a correct household selection. The pre- numbered Household Serial Number is the number (together with the Check Letter) that should be used on all documents relating to this household. It is vital that you do not confuse these numbers.
Having made your selection, you should prepare ARFs for each household. The household listed first at Q8 is Household Number 1. Use the main (blue) ARF for this household. Note the location of this household in the ‘NOTES’ box provided at the bottom of the front page. This is both to remind you of which one it is and to help anyone who subsequently wishes to contact this household.
Make out an (orange) ARF B for the second and third households listed at Q8. Also write the location details of the household in the box provided below the selection label. An example of a completed ARF page A3 for a Type A address is provided at the back of these instructions (page 59). In this example the basement flat becomes Household Number 1 (use the ARF for this household), the ground floor right flat is Household Number 2 (make out an ARF B for this household; give it HH No. 2), and the first floor back right flat is Household Number 3 (make out another ARF B for this household; give it HH No. 3).
The remaining questions (Q9-Q32) appear on both the ARF and ARF B.
Questions 9-21
These questions are used to list all the people living in the household and to select an adult aged 16 to 74 and up to two children aged 2-15 for interview. You should collect this information from a responsible adult in the household. This will usually be a parent in the case of a household which includes some children. It should not be a child even if that person is an adult by age - always try to collect this information from a more senior member of the household unless this person suggests that the young adult should give the information on their behalf.
You must only interview the adult and child(ren) who have been randomly selected, no-one else can be used in their place. Do not collect proxy information if the respondent is unavailable or too ill/senile etc. In the case of young children (aged 2-12) you will need to collect information from a parent but the child will need to be present.
Q9 Enter the numbers of people in each age group in the household. The total of these four numbers is the total number of people in the household. The box below this question gives the rules for which people to INCLUDE or EXCLUDE as members of the household.
If you are unable to collect this information ring the appropriate code (23, 24 or 25), and go to Q27.
Q11 Enter the first name and age of each person aged 75 or over in descending order of age, starting with the oldest. As these people are not eligible for interview we only need their first name to allow us to refer to them easily later on. 13 · If you are not given a first name an initial will do, or a description (eg. ‘Grandma’). · If you are not able to get an exact age an estimate will do (mark this with an “E”). If the person you are talking to if unsure whether the person is aged 75 or is younger, try to find out for sure before accepting an estimate - if this information is wrong it will lead you to select the wrong adult for interview.
Q13 Complete the grid at this question if there are 1-12 adults aged between 16 and 74 living in the household. Enter each eligible adult in descending order of age, starting with the oldest, giving their first names and ages. Follow the instructions at Q14 and identify the Selected Adult using the Adult/Children selection label. Place a tick against this person in the right hand column of the grid.
Q15 In the rare cases where there are 13+ adults aged 16-74 in the household, list them on an Adult/Children List Sheet adult in descending order of age, starting with the oldest, giving their first names and ages. Follow the instructions and identify the Selected Adult. Place a tick against this person on the sheet. Attach the completed sheet to page A5 of the ARF.
Q17 Complete the grid at this question if there are 1-12 children aged between 2 and 15 living in the household. Enter each eligible child in descending order of age, starting with the oldest, giving their first names and ages. Follow the instructions at Q18 and identify the selected child(ren), referring to the Adult/Children Selection label if there are more than two eligible children to select from. Place a tick against the selected child(ren) in the fourth column of the grid.
Indicate Child A and (if applicable) Child B in the final column of the grid. If two children have been selected ‘Child A’ is the older one and ‘Child B’ is the younger one. If there is only one eligible child then this is ‘Child A’.
Q19 In the rare cases where there are 13+ children aged 2-15 in the household, list them on an Adult/Children List Sheet adult in descending order of age, starting with the oldest, giving their first names and ages. Follow the instructions and identify the two selected children, marking the older one as ‘Child A’ and the younger one as ‘Child B’ on this sheet. Attach the completed sheet to page A6 of the ARF.
Q21 Complete the listing of all people living in the household by listing children aged under two, again in descending order of age. Any child who has not yet reached his/her first birthday should be shown as age 0.
Questions 22-27
Q22 Code ‘AA’ if the household questionnaire is completed (which means that you have collected the details of all the people in the household and so have been able to identify which person or persons is eligible for interview.
If you use any of codes 30-39 (no contact and other reasons why no household interview was obtained) you are asked to go to Q27 to provide full details why.
If you find a household where all the household members are ineligible, (eg. where they are all aged 75 or over) please write in an outcome code ‘33’ between the codes 32 and 34, and circle it.
(Please note that if you come across a household like this, when you enter the household questionnaire ('SHS98HH') on the computer for that household, you should put in the first 10 14 digits of the address as normal at Adrfield, then at First press
Q23 You should complete a row here for all the eligible respondents (i.e. for the selected adult, Child A and Child B). The outcome code will be given to you by the program during the Admin Block, at Iout. The individual outcome codes are summarised at the bottom of page A11 of the ARF, for your reference.
Q24 The outcome code summary is given to you during the program’s Admin Block at PrOut.
Q25 Record full details of the persons eligible for interview at this question whether or not you actually managed to interview them. Those eligible people who were interviewed go in GRID ONE. Those people who have not been interviewed go in GRID TWO. The TITLE, INITIALS and SURNAME details you enter in GRID ONE will later be entered in the program’s Admin Block and be used to generate GP and respondent letters and will be copied onto the NRF. It is vital that all these details are correct.
Q26 Where a nurse visit has not been agreed for a Selected Adult, Child A or Child B (as noted at GRID ONE), give full reasons why here.
Observation sheet
Complete Qs 28-31 for all addresses, other than those classified as deadwood at Q2 (i.e. outcome codes 01-10). Complete from observation of the area in which the address is located.
Copy the information to the Admin Block when you have finished with the household
Q28 Ring a code to indicate the type of properties in the immediate area of the address. If the address was on an estate, it would be the type of estate; if in a street, the type of property in that street.
Q29 Ring a code to indicate the type of building lived in by the household. For example, if your address is a whole house, but you find that it is occupied by households occupying different flats, then each household would be code 05.
Q30 Ring a code to indicate the type of accommodation lived in by the household.
Q31 Ring a code to indicate the ethnic mix of the immediate area of the address.
7.4 ADDRESS LIST
In addition to the ARFs, you will be given a paper list of all the sampled addresses in the sample point. This will also show the previous and next addresses to the sampled address, from the Postal Address File. This information is for you to use if you have any problems in locating an address. It will also help you to decide if you need to interview at multiple households at an address. The basic principle is that if a household has a separate listing on the PAF file, then it has a chance of being sampled for the survey, and so should not be treated as an additional household.
For example, say the sampled address is: 15 Kirk Road and the listing shows the previous and next addresses as: 15 13 Kirk Road and 17 Kirk Road
When you get to 15 Kirk Road, you find that it is actually two flats, 15a Kirk Road and 15b Kirk Road. You can see from the listing that there is only one entry for 15 Kirk Road and so: · if it is a Type A address (MOI=1), you will need to interview at both 15a and 15b · if it is a Type B address (MOI>1), you will need to select one household from the three at which to interview, using the Household Selection label.
If, on the other hand, the sampled address had been: 15a Kirk Road and the listing shows the previous and next addresses as: 13 Kirk Road and 15b Kirk Road this would confirm that you only need to interview at 15a (15b was listed separately on the PAF and therefore had a chance of being selected in its own right.
7.5 INTERVIEWER SAMPLE SHEET
This document will accompany your set of 23 ARFs. Your supervisor’s name and telephone number will be entered on the sheet. It will also tell you if you are to be supervised in that survey month.
Complete this document as you work through your addresses and keep it as your own record of what you have done. You will then be in a better position to answer any queries relating to work you sent to the nurse or have returned to the office.
16 8. INTRODUCING THE SURVEY
The response rate achieved on the Scottish Health Survey in 1994-5 was very good, and we expect a good response again. People are interested in health and are concerned about it. This is a high profile survey on a topical issue.
8.1 ADVANCE LETTER AND SURVEY LEAFLETS
A letter describing the purpose of the survey has been sent to all addresses a few days before the start of each month's fieldwork. You have been given copies of the advance letter to use as a reminder.
You have also been given a leaflet (Stage 1 leaflet) which gives further details about the survey. This should be given to everyone you interview. You will usually hand this out when you are in the house and have selected the adult to be interviewed. It should only be given out on the doorstep if you feel it will help to obtain a particular person's co-operation. Read it carefully. It will help you answer some of the questions people might have.
At your briefing you will have been given a copy of another leaflet which the nurse will hand out (Stage 2 leaflet). You may find this useful when answering questions. You can tell respondents that the nurse will be giving it to them when she or he calls.
8.2 DOORSTEP INTRODUCTION
The general rule is keep your initial introduction short, simple, clear and to the immediate point.
Show your identity card
Say who you are
Say who you work for Say that you are carrying out a "very important Government survey about health."
The way the survey is introduced is vital to obtaining co-operation. Keep your explanation as short as possible, saying as little as you can get away with. This is the way in which interviewers who get the highest response tackle their doorstep introductions.
Only elaborate if you need to, introducing one new idea at a time. Do not give a full explanation right away - you will not have learned what is most likely to convince that particular person to take part.
Concentrate on obtaining the interview. Do not mention measurements and the nurse visit. The letter sent in advance to sampled addresses refers only to an interview. It does not mention measurements or a subsequent nurse visit. We do not want to risk losing an interview because a person is worried about being weighed or measured, or about seeing a nurse. These are decisions they can make later. The interview itself is very important, and we want this even if we do not get any measurements for a person. Our experience in the past is that people are usually very happy to proceed from one stage of the survey to the next, but respondents may be put off if they are told about all the stages at the beginning.
Introduce the height and weight measurements when the interview has been completed. Introduce the nurse visit after those measurements have been carried out. Your initial task is to get the respondent involved so that they feel happy to continue through to the end. Occasionally you may feel that mentioning the measurements is likely to encourage a particular respondent to respond. In which case, 17 you may of course do so.
Do not turn up with your stadiometer and scales. Leave your car somewhere where you can retrieve these. You will not require these until the end of the interview and they look very off-putting.
What you might mention when introducing the survey
* It is a national (Government) survey (on behalf of the Scottish Office Department of Health)
* It is a very important survey
* It is the largest Scottish national survey to look at the health of the general population
* It provides the government with accurate and up-to-date information on the health of the population
* It gives the Government information on health trends, and monitors how well the health targets set by the Government are achieved
* It is used to help plan NHS services
* It is used to help plan private medical services
* The information is available to all political parties
* The information will be needed by whichever government is in office
* Results will be published and reported in the national press
* To get an accurate picture, we must talk to all the sorts of people who make up the population - the healthy and the unhealthy, those who use the NHS and those who use private medicine, and those who like the current government's policies and those who do not
* Young people might think that health services are not for them now - but they will want them in the future and it is the future that is now being planned
* Each person selected to take part in the survey is vital to the success of the survey. Their address has been selected - not the one next door. No one else can be substituted for them.
* No-one outside the research team will know who has been interviewed, or will be able to identify an individual's results
* The government only gets a statistical summary of everyone's answers
18 8.3 INTRODUCING HEIGHT AND WEIGHT MEASUREMENTS
The relationship between general build and health is of great interest to the Scottish Office. Any changes in these measures will reflect the changes in the population's diet and lifestyle. This survey will provide the only reliable source of data on the changes that are taking place.
Explain that it will only take a very short time to do and that they will not be asked to undress.
8.4 INTRODUCING THE NURSE'S VISIT
Our target is to interview and measure everyone selected. The measurements carried out by the nurse are an integral part of the survey data and without them the interview data, although very useful, cannot be fully utilised.
Convincing interview respondents of the importance of the second stage of this survey is therefore an essential part of your work and should be taken as seriously as getting an interview in the first place.
At the end of the questionnaire, you will be giving an introduction to this second stage of the survey. Use this wording to start with. But sometimes you will need to provide further information in order to convince people of the importance of this stage. They may want to know more about what is involved. Some may be nervous of seeing a nurse and you will need to allay any fears.
Try to convince everyone that seeing a nurse is a vital part of the study and that it is non-threatening.
If the person is reluctant, use the arguments given in the box below to try to get them to change their mind:-
Stress that by making an appointment with the nurse the person is not committing themselves to helping with all, or any, of the measurements.
Explain that the nurse is the best person to describe what his/her visit will be about. They can always change their mind after hearing more about it.
The nurse will be asking for separate permission to carry out each of the various measurements.
No pressure will be put on the respondent to give blood. A blood sample is only taken if the respondent gives written permission at the time. It is the last thing the nurse will do.
Respondents and their GPs, if the respondent wishes, will be given their blood pressure and lung function readings and the results of the blood tests. If you feel that their knowing this will help you get an appointment for the nurse, please explain this. However, be careful to avoid calling the nurse visit a "health check" - it is not. One of the most common reasons for respondents refusing to see the nurse is "I don't need a health check - I have just had one". Avoid getting yourself into this situation. You are asking the respondent to help with a survey.
19 As with the doorstep introduction, say as little as possible in order to gain co-operation.
General points to make when introducing the nurse visit
* it is an integral part of the survey - the information the nurse collects will make the survey even more valuable
* the nurse is fully trained (Grade E or above). They have all had extensive experience, working in hospitals, health centres etc and have also been especially trained for this survey
* if the respondent wants, they will be given the results of the measurements carried out by the nurse, including the results of their blood test. If they like, this information will also be sent to their GP. This means that by seeing the nurse they will get much of the information they would receive if they paid for a private health check - in particular blood pressure and cholesterol levels
* we will not be testing for HIV, or any other viruses
* the amount of blood the nurse will take (usually 15ml) is tiny compared to the pint that blood donors give
* they are not committing themselves in advance to agreeing to everything the nurse wants to do. The nurse will ask separately for permission to do each test - so the respondent can decide at the time if they do not want to help with a particular one. The nurse has to obtain written permission from a respondent before a blood sample can be taken
* the equipment for taking blood is known as the Vacutainer system. It is safe and efficient. Fresh equipment is used for every sample
* several thousand people have already given blood samples on the Scottish Health Survey.
* your local medical ethics committee has been consulted and has given their approval to the survey
Summary of nurse tasks and how to describe them to respondents
The various types of measurements the nurse will ask permission to carry out are listed below. When describing the nurse visit to respondents do not go through all of these. For example, when asked about blood samples, mention the things people might already know about - for example a haemoglobin test to detect anaemia.
You have a copy of the Nurse Leaflet (Stage 2) which the nurse will be giving to all the people s/he visits. This describes the purpose of each measurement. Read it carefully so that you can use the information it contains.
Arm circumference - gives information about the distribution of fat around the (aged 2-15 only) body (and can indicate nutritional status)
20 Waist and hip - the waist to hip ratio is a measure of the distribution of fat (aged 16-74) over the body
Blood pressure - both systolic and diastolic pressures will be taken, together (aged 5 and over) with a pulse reading.
Demi-span - an alternative to height for elderly people who may not be (aged 65-74) able to stand completely straight.
Saliva sample - children dribble into a tube through a wide bore straw. Adults chew (aged 4 and over) on a dental roll. The saliva is tested for cotinine. Cotinine is a derivative of nicotine and shows recent exposure to tobacco smoke, either because the individual is a smoker or because they have been exposed to other people's tobacco smoke.
Blood sample - three small tubes of blood will be taken using the safe and efficient (aged 16 and over) vacutainer method. The blood will be tested for the following:
Haemoglobin - - this is the red pigment in the blood which carries oxygen. If you have a low level of haemoglobin you are anaemic. Anaemia may be caused by a shortage of iron
Ferritin - - this gives a measure of the level of iron in the body
Fibrinogen - - this is a protein necessary for blood clotting, and high levels are associated with a higher risk of heart disease
Cholesterol - - this is a type of fat found in the blood
Gamma GT - - the level of this in the blood gives an indication of the health of the liver
C-reactive protein - - the level of C-reactive protein in the blood gives information on inflammatory activity in the body, and it is also associated with risk of heart disease
Additional blood In these areas, one extra tube of blood will be taken for the sample - following additional tests (In selected areas only)
Vitamins A,C,E -vitamins are important for good health, and it is & carotenoids thought that they might offer protection against certain diseases
Fatty acids - this reflects the type of fat eaten in the diet
The blood will not be tested for any viruses, such as HIV (the AIDS test).
21 9. LIAISING WITH YOUR NURSE PARTNER
It is vital that you and your nurse partner establish a good working relationship. Wherever possible we will arrange for you to attend the same briefing day. If this is not possible, you should arrange to meet up as soon as possible. The success of the survey depends on a good working relationship between the interviewer and the nurse. It is the interviewer's task to initiate this. You must contact and meet with your nurse partner before you start work. Respondents often want more information about the nurse. You may want to describe the nurse, so an elderly or concerned respondent knows who to expect.
It is important to note that each nurse will be working with another interviewer as well as with you. You will need to keep in regular contact with the nurse so that your knowledge of when she is free for appointments is kept up-to-date.
Things you need to know about your nurse partner include: · Make and registration number of her/his vehicle.
· Days and times of availability for the month ahead.
· Does s/he work as a nurse in a hospital/clinic/in the community, as well as being a survey nurse?
· Does s/he wear a uniform (the nurse makes her/his own decision about this)?
· How well do they know the area you are both working in?
9.1 MAKING APPOINTMENTS FOR THE NURSE VISIT
It is the interviewer’s responsibility to make appointments for the nurse. We have found in the past that this approach is most effective in ensuring a continuation of response from the interviewer to the nurse. There are no exceptions to this rule. It is the interviewer’s responsibility to ensure that effective appointments are made in all cases.
To make effective appointments for the nurse, you will need to be in close contact with your nurse partner so that you know when s/he is available to visit. You have both been given an Appointment Diary covering the relevant survey period. Go through this together before you start work. Note carefully the days and times on which the nurse is available to make a visit. If you get this wrong, you will not only probably lose the respondent but you will irritate your nurse. You will need to liaise frequently in order to update this information.
You will need to be aware that your nurse will usually be working with another interviewer at the same time. To avoid double-booking the nurse agree periods of the week in which s/he will be available for appointments with your respondents. This approach has been followed successfully on other surveys. However, it is important to appreciate that this will only work well if you (and the other interviewer working in your area) keep in regular contact with the nurse.
Ideally you will provide the nurse with an even spread of work and minimise the number of visits s/he has to make to the area. But of course this might not always be possible.
Try to arrange for everyone in a household to be seen one after the other. Allow a minimum of 30 minutes for each person aged 8+ and 15 minutes for persons aged 2-7 to be seen by the nurse, plus 20 minutes per household for sorting out equipment etc. You will know how long a nurse will need to get from one address to another if you are making appointments on the same day. For the Vitamin
22 sample points, you will need to arrange adult appointments for the early morning wherever possible (see Section 9.3).
When you have made an appointment for a household, give the respondents a completed Appointment Record card. Remember always to fill in the household serial number, in case any respondent has to telephone the office with a problem. If you have made appointments for individual people remember to write their name on the Appointment Record Card. Note carefully the dates and times of each person's nurse appointment in your Appointment Diary and be sure to pass this information on to the nurse.
Point out to all respondents the notes at the bottom of the Appointment Record Card. These tell respondents that we would like them not to eat, drink, smoke or take part in vigorous exercise for half an hour before their appointment, and ask them to try to wear light clothing. Children under 16 are asked to wear something sleeveless if possible, as the nurse will be measuring their arm. Adults aged 16 or over are asked not to wear tight clothing, as the nurse will be measuring waist and hip. Light clothing makes it much easier to get accurate measurements.
Make sure your nurse is given good warning of all appointments you have made. Telephone appointments through to your nurse the same day or immediately the next day. A very important part of your job is keeping the nurse fully informed about the outcomes of your attempts to interview people and to arrange for the follow-up nurse visit.
Send the nurse the completed Nurse Record Form for a household as soon as you have finished work there (see Section 9..4). Do not wait until you have a few NRFs, send them immediately. Also if you send a batch of NRFs together (more than 3), split them between envelopes or make sure you weigh them because they become too heavy for standard postal rates and this delays delivery to the nurse. If you have set up nurse appointments before you have completed all interviewing in the household, telephone through the interim appointments. You should telephone the nurse regularly to tell her/him what s/he should be expecting from you. This is especially important if you have made a nurse appointment for someone within the next day or two, to give the nurse time to prepare her/his work.
In this survey, unlike the one in 1995, nurses will be using CAPI for the nurse schedule. However, they will still collect the details of whom to interview at each address from you.
9.2 ACCOMPANYING THE NURSE
You may come across a situation where you feel that the nurse might not get a response, or might have other problems with the respondent, unless you accompanied them. If you feel this is the case, obtain clearance from your Area Manager to accompany the nurse.
9.3 APPOINTMENT TIMES FOR DIFFERENT BLOOD TYPE SAMPLES
When you are able to make appointments for the nurse will depend on the "blood type" of your assignment. There are two "blood types", and these are indicated on the ARF address labels as below:
Standard sample - labels will contain the marker "BT: S" (meaning "Blood type: Standard) Vitamin sample - labels will contain the marker "BT: V" (meaning "Blood type: Vitamins").
All addresses issued in any one assignment will be of the same blood type. Most of you will be working on "Standard" assignments. Six sampling points per month will be allocated as "Vitamin" assignments.
How this will affect when you can make appointments for the nurse is explained below:
23 Standard sample (BT:S):
Most of you will be working with "Standard" assignments. This means that the nurse will be taking three tubes of blood for the standard blood tests described on page 203-), and there will be no restrictions in when you can make appointments for the nurse (aside from the nurse's own availability).
Vitamin Sample (BT:V):
This means that in addition to the standard blood tests, adult respondents (16-74) will also have their blood tested for vitamins A,C,E, carotenoids and fatty acids. This will require the nurse to take one extra tube of blood. This only applies only to adult respondents (even after blood taking in children is started, sometime in the summer of 1998).
For these respondents, it is important that you attempt to make morning appointments for the nurse (as early as possible). The levels of vitamins/fatty acids in the respondent's blood is affected by what the respondent has eaten in the period before the nurse's visit. Ideally, we would like the nurse to visit respondents even before they have had breakfast.
For respondents who work every day during the week, you may find it easier to make morning appointments at weekends. Otherwise, try to spread your appointments throughout the week as far as possible.
It should be possible for a high proportion of Vitamin sample appointments to be scheduled for the early morning. However, in households where two children are to be measured you may find that there is insufficient time available in a morning appointment for the nurse to measure both the adult and the two children. If this is the case, it may be best to arrange separate appointments for the adults and children. Remember that the vitamin blood samples are not required for children and so the time of day for their appointments is less critical. Any time when a parent will be present will do.
In these "BT:V" sampling points, never make more than two consecutive appointments. Because the vitamins/fatty acids in the blood are unstable, the nurse will need to take blood to a local hospital within four hours for the blood to be spun and frozen. This means that, ideally, the nurse can make two visits, and then drive to the hospital and get both tubes processed. If you make more than two appointments for the nurse on any one morning, the nurse may not be able to get the blood taken from the first respondent to the hospital in time.
9.4 THE NURSE RECORD FORM (NRF)
The nurse has a list of the addresses in the point being covered. S/he needs to know the outcome of your visits to each address (including any at which no interview can be attempted because they are vacant, etc). If there is more than one household at an address s/he needs to know the number of households and the outcome for each of these. If an appointment has been made, s/he needs full details.
This information is communicated via the Nurse Record Form (NRF). The Nurse Record Form (NRF) is the nurse's equivalent of your ARF, and is used for households where you have made an appointment for the nurse to visit.
It is your responsibility to prepare one of these for each address/household in your sample. Your sample pack contains a set of NRFs, together with a sheet of address labels for household no. 1.
As soon as you have finished your work at a productive household where at least one person agreed to see the nurse, make out the NRF and send it to the nurse (even if you have already told him or her by telephone of appointments you have made).
24 Completing the NRF
It is your responsibility to complete the sections on page 1 and 2 of the NRF. Pages 3 and 4 are for the nurse to complete. The screen ‘NRF’ in the program’s Admin Block provides instructions on which details to enter.
· Enter your name/number and that of the nurse at the top of the first page. · Affix the label in the space provided (if Household Number 1) or, if Household Number 2 or 3, copy the full details into the ‘ADDRESS LABEL’ box. · Enter the telephone number. If there is more than one household at the address, describe the location of the household covered by that NRF. · Write in any relevant HOUSEHOLD LOCATION DETAILS or USEFUL TIPS for the nurse in the boxes provided on the right. These might cover how to find the address, if this is difficult, or any information of relevance about the residents (eg the occupant is a very nervous, elderly lady; the dog sounds vicious but is quite safe, etc). Because nurses are new to CAPI, it would also be helpful if you could pass on ‘laptop tips’, eg whether or not you were permitted to use the mains electricity, and where might be a good place to ‘plug in’, or inquisitive children/pets who might interfere with the machine.
25 Completing Part A
1. Complete the Interviewer Outcome Summary box:
If you have arranged at least one appointment for the nurse, ring code A, and complete Part A. If there are no appointments, ring code B and forward the NRF to the nurse.
2. Enter the date on which you conducted the household interview at that household. It is very important that you write this date down correctly and clearly as the nurse will be entering it into the computer, and the computer will use this date to calculate the respondent’s age. As the questions asked and the measurements taken depend on the respondent’s age, it is obviously important that this information is correct.
3. Complete the grids at Questions 3 (details of the selected adult) and 4 (details of the selected children, if any) on page 2. Complete the NRF from the screen as you go along, following the instructions. When you complete the Admin Block check your entries on the NRF.
Ensure that full names are entered for all individuals, including the parents of Child A and Child B, not just the first names.
For the selected adult:
* enter their full name and title (eg Mr. David Smith) * circle a code to indicate their sex (1= male, 2=female) * their age at the date of the Household interview * ring code 1 if that person agreed to see the nurse * ring code 2 if you interviewed that person but they refused to see the nurse * ring code 3 if that person was not interviewed * enter the appointment date and time
For each eligible child (aged 2-15) that you enter at Question 4:
* enter the Person Number of each "parent" (living in the household) * For each "parent" ring code 1 if they are the natural or adoptive parent or code 2 if they are someone who has legal parental responsibility for the child (see Section 11.2). That you enter this information correctly is VITAL. The nurse will use this information in obtaining consents to measure children and it is only these people who legally have the right to give consent. * Please also write in, beside the parent details of each child who is to be seen by the nurse, the name of the parent who will be present during the nurse interview with that child. From July onwards there will be a space provided on the NRF for you to write this information in; until then please write in “______(parent’s name) will be present”. * Remember that you need to enter these details even if the child has refused a nurse visit or was not interviewed, as it is possible that the situation might change such that a nurse visit may become possible.
Examples of completed pages 1 and 2 of the NRF are provided on pages 60 and 61 at the back of this document (not a very satisfactory household, but it has been filled in to show a variety of outcomes).
In some instances, you will make a nurse appointment for the same day, or the day following, your visit and so you are likely to have to tell the nurse about this appointment in advance of sending her/him the NRF. If this is the case, fill in the appropriate details on the NRF and telephone the nurse to inform them of the appointment. Read out the information about the respondent/s from the NRF, and give her/him the date of the household interview. The nurse has a form called the Interim Appointment 26 Record, it is a copy of the page on the NRF with Q3 and 4 on. The nurse will fill in the respondent's information onto the Interim Appointment Record sheet, including the person number/s of the adult/s who claim legal parental responsibility for any children who are to be seen by the nurse. The nurse will use this until s/he receives the NRF from you. Always make sure you get the nurse to read back the name to you so that you are both sure the information has been transferred correctly. The nurse will check the details on the NRF against the Interim Appointment Record when it arrives.
9.5 MAKING OUT NURSE RECORD FORMS FOR ADDITONAL HOUSEHOLDS
If you carry out an interview at a second or third household, you will need to make out the first two pages of a Nurse Record Form and send it to the nurse.
First enter your name and that of the nurse at the top of the first page then fill in the details in the box in the left hand corner. All you need do is copy the information from the original (blue) ARF
- the serial number (the same as the blue ARF except the last digit, which will always be 2 or 3) - the survey month (i.e. the month you were issued the sample) - the full address - the Blood type "BT". This will either be "S" or "V" depending on the sample type of your assignment. Additional households are of the same type as first households.
27 10 THE QUESTIONNAIRE
10.1 INTRODUCTORY QUESTIONS
AdrField
This is a very important check to ensure that you have selected the right serial number for that household and to make sure that you are not interviewing at an incorrect address. This check will only work if you check with the respondent that you are at the address that is typed on the ARF address label. When the respondent confirms the address, key in the first 10 digits from the first line of the address from the label on the ARF.
Please note the first 10 digits include anything printed at the beginning of the first line of the address, including spaces, any words or letters in brackets, and the brackets themselves. For example, if the first line of the address printed on the label is “(Scott) 4 Argyll Avenue”, the first 10 digits will be “(Scott) 4 ” rather than “4 Argyll A”.
Please remember that if you are entering information for a household where no one is eligible for interview (eg. because everyone in the household is aged 75 or over), you should put in the first 10 digits of the address as normal at Adrfield, then at First press
If you have selected the correct serial number and you choose to continue at First, the computer will pass you to IntDate. If the address and serial number do not match, you will be given a warning. If you have chosen the wrong serial number for that address, exit via Admin. and select the correct serial number. Do not continue.
Please note that once you have entered them, the address details are not stored with the questionnaire in the computer, so the respondent does not need to worry about confidentiality.
IntDate
Whenever you are asked to enter a date, always enter the month in words (using the first 3 letters). For example: 3 Jan 98. This greatly reduces the likelihood of dates being entered incorrectly (- if you enter the month as a number it is easy to get the date number and the month number the wrong way round).
This date must be correct as the computer uses it to calculate the respondent’s age - and this determines which questions you will be routed to for that respondent.+
28 10.2 THE GRID
The Household Questionnaire collects the basic information about the composition of the household. You should enter the names of all the people in the household in descending order of age, starting with the oldest. Start with people aged 75 years and over, then list those aged 16-74, children aged 2-15 and finally children aged 0-1. As you already have this information on the ARF you do not need to ask for it again, just copy from the ARF.
Although it will be easier for you to enter people in age order, the order in which you will have listed them on the ARF, this is not crucial to the program. If you find that you have missed someone out you can add them in at the bottom of the grid. If you find that there are any other people in the household who were not listed on the ARF you should go back to the ARF and revise the lists so that they appear in correct age order. If the missing people are adults aged 16-74 or children aged 2-15 you should also make fresh selections of people for interview.
SizeConf asks you to confirm the number of people in the household. You should always read this question out loud to make sure that the list of people you have collected is complete. If the number is wrong you can go back to the grid to correct it (be sure to also correct the ARF).
At Name you only need to enter the first name of each person (the name they are normally known by). If you are not given a name, initials or a description (eg. ‘Grandma’) would suffice. Do not enter a person’s surname - this is collected later.
Sex and AgeOf are asked for all people in the household. Children who are less than one year old should be recorded as 0 years old.
Select asks you to indicate whether or not the person has been selected for interview (from the ARF). Further questions are only asked for selected people:
· DoB: This need not be collected from the selected person him/herself as you will check the date of birth with him/her at the start of the individual questionnaire. If the DoB is not known (or the age has been estimated) you can enter “don’t know” and pick up the correct details in the individual questionnaire. Both the date of birth and the age are collected as a double check. If the two answers do not correspond, the program will trigger an error message.
· Marital: asked for the selected adult only. The aim is to obtain the legal marital status, irrespective of any de facto arrangement such as a couple living together (we will know about this from the household grid). The only qualification to this aim is that you should not probe the answer “separated”. Should a respondent query the term, explain that it covers any person whose spouse is living elsewhere because of estrangement (whether the separation is legal or not).
· Par1, Par2: This question must always be read out. Do not make assumptions. This is a very important question as it helps us to establish the person, or people, who have legal responsibility for the child in the household. The nurse has to seek the consent of these people to measure the child - no one else has the right to give such consent. You will be passing this information to the nurse on the NRF. Make sure you complete these questions correctly.
Do not attempt to define legal parental responsibility. This is not necessarily the same as acting in loco parentis. It is up to the person concerned to say whether or not they have this legal right. If they are doubtful, then encourage them to say "No". The responsibility must be on a permanent basis.
If there is no person who is the parent or has legal parental responsibility (eg for a schoolchild who
29 is boarding with a family or living with their adult brother or sister), enter code 97 at both Par1 and Par2. If there is only one "parent" in the household, enter code 97 "Not a household member" at Par2.
10.3 JOINT OR CONCURRENT INTERVIEWING
This survey differs from many of the surveys that SCPR carries out in that more than one person in the household may be interviewed. Ideally, we would want you to carry out the interviews with the different people in the household one after the other. However, this would be time consuming, and could put respondents off who might not want to sit around waiting while other household members are interviewed. Carrying out a joint or concurrent interview may prove the best way of obtaining co- operation.
Therefore, in order to make the survey as "respondent-friendly" as possible, we feel that, where appropriate, you should carry out joint interviews. The CAPI program allows three selected people to be interviewed at the same time (in the same session). Alternatively you can interview two people or one person at a time. You allocate the respondents to sessions at the end of the Household Questionnaire.
Remember where there are two or three people to interview you do not have to do all of them at the same time. The computer allows you to say "no one else" once you have allocated the required number of people to a session. (Once you have said "no one else", it will stop asking you for names).
Once you have set up a session in the Household Questionnaire, an Individual Questionnaire is created for that session. You get into the Individual Questionnaire by pressing
DO NOT go back to the Household Questionnaire and add more people to a previous session. Instead set up a new session.
Remember that we want you to collect information about children aged 12 or under from their parent or guardian - not from other household members so if a parent or guardian is the eligible adult it will make sense to carry out a joint or concurrent interview for that adult and the child. (See Section 7.2 for the rules governing interviewing with children).
Be sensitive in your choice of people to be interviewed together. Make sure that everyone is happy with the situation. Remember cross-generational interviews might be difficult. Avoid, if possible, interviewing a teenager with an over-bearing parent. We want people to tell us the truth about themselves and they may be reluctant to disclose some information about themselves in front of all or some household members. Be prepared to adjust your approach if necessary, for example if it becomes appropriate to ask certain adult questions out of a child’s earshot.
10.4 ALLOCATING INDIVIDUALS TO INTERVIEWING SESSIONS
When you get to the end of the Household Questionnaire, you can either exit via admin, or allocate individuals to sessions. To do the latter, you should press <1> +
When you have allocated all the respondents you wish to allocate to a session (a maximum of three), enter ‘97’ to signal to the computer that there are to be no more respondents in that session.
The next time you press
Once you have started the interview proper, you cannot go back and change the allocation of individuals to sessions for that session.
To allocate individuals to a second or subsequent session, enter the Household Questionnaire (via Ctrl+Enter), press
10.5 THE INDIVIDUAL QUESTIONNARE
Once you have completed the Household Questionnaire, try to conduct an individual interview with the selected adult (aged 16+) and up to two children (aged 2-15)
These interviews should be conducted with the respondent in person, except for children aged 2-12. Questions for these children should be addressed to a parent, although the child should be present. If there is no parent in the household, they should be addressed to the person acting in loco parentis.
The rules for seeking permission to interview children are set out in Section 7.2.
If someone drops out of the Individual Questionnaire before you complete it use the following rules:
* they drop out before you complete the general health, CVD, asthma and physical activity modules treat them as unproductive and give them the appropriate outcome code (a refusal normally)
* they complete at least the general health, CVD, asthma and physical activity modules code them as partially productive (outcome code 52).
At the end of the physical activity section you can abort (or suspend) the interview for a particular individual. If you chose suspend/abort here, the respondent will be asked no more questions. If you are able to go back later and collect the rest of the information from the respondent, go back into that interview session, go to the ‘Suspend/abort’ question and change to code 1 continue. If the respondent drops out after this break point, code all remaining questions in the questionnaire as refusal (CTRL + R) from then on.
31 10.6 THE STRUCTURE OF THE QUESTIONNAIRE
The individual questionnaire is divided into a number of modules, preceded by ‘Jump to’ questions:
Jump to question Module/block
0 General health module 1 Cardiovascular disease (CVD) 2 Asthma 3 Accidents 4 Child physical activity 5 Adult physical activity 6 Eating habits 7 Smoking 8 Drinking 9 Dental health 10 Economic activity 11 Education 12 Parental history 13 General household 14 Self-completion booklets 15 Measurements 16 Consents
10.7 INTRODUCTORY QUESTIONS
AdResp
If the respondent is aged 2-12 you are asked to say which respondent will be answering on their behalf. This should be a parent or, if there is no parent in the household, the person who is acting in loco parentis.
10.8 GENERAL HEALTH, CVD AND ASTHMA
This section starts with a question asking for the date of birth, the following questions cover general health.
OwnDoB, OwnAge
The date of birth of each respondent is a vital piece of information. For example, we are using it to make a link with the National Health Service central register, if the respondent agrees. Although you have already entered it in the Household Questionnaire, it may have been provided by someone else. Always ask for it again and check their age. Do not copy it from the Household Questionnaire.
If you enter a date of birth which is different to that given in the household grid, you will be given a warning. Make absolutely sure that you now have the right date of birth and suppress the warning. Do not go back to change the household grid - you will not be able to change the date of birth in the household grid. As long as it is correct in the Individual Questionnaire, the computer will update the Household Questionnaire with that date.
If someone does not know their date of birth or refuses to tell you, use the following rules:
i) if you obtained a DoB in the Household Grid, use this one and enter a note (
Sometimes an individual interview may take place later than the household interview. Very occasionally this may mean that a respondent has a birthday between completion of the household grid and the Individual Questionnaire.
ELIGIBILITY to take part in an interview is determined by age at household grid. Even if a child aged one at household grid reaches age two by the time you come to individual interviews, they are still outside the scope of survey and cannot be interviewed.
Once sampled for the survey by the household grid, it is the age at the time of the Household Questionnaire that determines the questions and self-completion document that you administer and what measurements the nurse should take. If a child has been sampled and has crossed an age threshold between completion of the Household Questionnaire and the Individual Questionnaire, the Individual Questionnaire routing will treat the child as their age at the time of the Household Questionnaire. You simply follow the routing as directed by the program. If a child aged 12 at the household grid has become 13 by the time you carry out the Individual Questionnaire, you should still ask the parent to answer on behalf of the child, and CAPI will direct you to do this.
IllsM, More, LimitAct
Use probes to obtain fuller details of an illness, disability or infirmity. For example, someone may say, "I had an operation to sort out my feet." This does not tell us what was wrong with "my feet". Probe, "Can you explain a bit more?" etc. Only enter information about one condition at the first IllsM then use the "Anything else" probe in order to record any other problems and to ensure that all long-standing illnesses are recorded. There is a maximum of six IllsM slots. When you have finished entering all the conditions, a further question will ask if any illness limits the respondent in any way.
Chest pain, phlegm, breathlessness and wheezing
When administering these questions, make no attempt to help the respondent by interpreting the questions. For example, you should not say what you think is meant by pain or discomfort in the chest. These questions are intended to stand entirely on their own and for the respondent to use their own interpretation.
If a serious doubt arises about the correct interpretation of a particular answer, it should be recorded in such a way as to exclude the suspected condition eg Uphill "Do you get it when you walk uphill or hurry?" "Well, maybe, but I can't really remember." This answer should be coded as "No". However, please note that Chest is an exception to this (see below).
Chest Record any instance of pain. For example, an answer such as "No, except for indigestion" should be coded "Yes". The questions that follow are designed to filter out any chest pains that are not related to cardiovascular disease.
33 Uphill The answer must be interpreted strictly. We only want to know about pain when walking uphill or hurrying - not when doing any other activity. Pain experienced only when going up stairs should be recorded as "No".
WalkDo If the respondent says they take a tablet (eg GTN, nitroglycerin, trinitrin) or mouthspray (for the heart and not for the wheeze), code 1 (ie they stop walking).
PainAway If the pain goes away after taking a tablet, or mouthspray then code 1 (ie the pain goes away after stopping and taking medicines).
ShowPain Please be as precise as possible, using the diagram as a guide. Be careful about which side is left and which is right. The numbers on the diagram match the numbers that need to be coded here.
SevPain Do not give the respondent any guidance about what is meant by a severe pain across the front of the chest.
DocWhat If the doctor said the pain was "nothing to worry about" then enter code 4.
ECGEver An ECG measures the electric current generated by the heart muscle. Electrodes are connected to the left side of the front of the chest, and to the wrists and ankles. The subject does not feel any sensations during the test, and is asked to relax and lie still.
The electrodes are attached to an ECG machine, which is the size of a video-recorder, usually on a trolley. This records the rhythm of the heart. The test only takes about 20 minutes. It is important to distinguish this test from the 24 hour Ambulatory Holter-Monitor test which is used to investigate transient types of heart rhythm abnormalities.
Flegm If the respondent does not know what phlegm is, give the following description: "Phlegm is a thick substance which is coughed up from deep in the chest"
Phlegm from the chest or throat must be distinguished from pure nasal discharge - exclude phlegm from the nose, but include phlegm swallowed. Phlegm with first smoke or on first going out of doors should be coded "Yes".
Stress the word "usually" - and note that the reference period is winter. Usually refers to most mornings in most winters.
If the respondent works nights, then you can use the words "on getting up" rather than "first thing in the morning".
SoBUp-SoLev If respondent answers "sometimes" to any of the breathlessness questions, code SoLev "Yes".
LegPain Stress "...pain or discomfort...which comes on when you walk". We are only interested in picking up cardiovascular-related leg-pain (i.e. claudication), not conditions such as rheumatism, scaiatica.
34 Cardiovascular conditions: diagnosis and treatment
This is a very important section and obtains information on experience of cardiovascular diseases (CVD) or other conditions which may be related to CVD. They are not however explicitly referred to as cardiovascular diseases as this could lead people to exclude conditions which they do not realise belong to this category. CVD1-CVD8 These questions ask about various heart conditions. At the back of your Showcard set is a card which gives some of the common names for some of these illnesses.
CVDOth Other heart trouble must be described in detail at this question, so that it can be coded later in the office by the survey doctor. Please get as much information as you can.
DocTold2/DocTold3 etc. At these questions we are trying to find out whether the condition was medically diagnosed. If the respondent had the condition diagnosed when still a small child, then it might be the respondent's parents who were informed of the diagnosis rather than the actual respondent. This should still be coded "Yes".
PastYr2/PastYr3 etc. Refers to the actual condition or event, not to after effects. Angina and other heart trouble is counted as continuing during the previous 12 months if the person has had the symptoms or if they have continued to have treatment for the condition.
DocBp Medical diagnosis is important to prevent incorrect self-diagnosis. We are interested in diagnosis by proper medical personnel - this will include nurses as well as doctors.
StopMed If the respondent has stopped taking medication on several occasions, take the last occasion. It is known that many people do not take medicines that are prescribed for them. First, be sure who decided that the respondent should stop (a medical advisor or the respondent) and then code why.
Use of services
This section is to find out about the use of various health services, particularly by those with CVD complaints. It is not designed to investigate need for services.
DocTalk/DocTalkN Exclude talking to a doctor at a hospital. Hospital visits are covered later.
Talking to a doctor can mean seeing him/her (at home, at the surgery etc) or speaking to him/her on the telephone. Enter details only if the respondent actually talked to the doctor - but exclude social chats with a doctor who happens to be a friend or relative.
Include talking to a doctor at a district health authority clinic (eg a family planning clinic) or talking to a doctor while abroad.
OutPat/OutPatN This asks about any visit to a hospital, where the respondent did not stay overnight. Include any visits to any hospitals or clinics (eg for psychiatric treatment, for minor operations, to a private hospital or clinic, or abroad).
35 InPat/InPatN An in-patient stay must be for at least one night.
BPMeas-Diastol There are a few questions about having blood pressure measured. As part of the new GP contract patients should be offered the opportunity to have their blood pressure regularly checked. These questions are to find out whether people have been having such checks and what feedback they received. We are only interested in blood pressure measurements taken by a doctor or nurse. We do not want to know if people had their blood pressure taken by eg a fitness assessor at the sports centre, a machine at the chemist, a physiotherapist, a dietician, or any self-testing. It is only medical testing in which we are interested.
NormBP Doctors may use a variety of euphemisms to describe high blood pressure, so code as "higher than normal" anything such as slightly raised, moderately raised, a little high etc.
CHMeas This asks about cholesterol, in a similar way to blood pressure.
HNotAsk In an initial pilot of the questionnaire, interviewers reported that respondents sometimes felt the questionnaire was not of relevance to them as their particular health conditions were not covered. Clearly, we cannot ask about everything in 1 hour, and the Scottish Office has needed to limit what it can ask about. However, we have added this question to let respondents tell us about any other conditions that have not been covered. This is not merely to satisfy respondents but may be used to code other illnesses. Therefore please record full details.
10.9 ACCIDENTS
DrAcc Include all accidents which resulted in the respondent seeing a doctor/nurse or other health professional, or where they needed to take time off work (or school). Telephone-only consultations with doctors or other health professionals do not count.
Accidents happening outside the UK do count, if they saw a doctor/nurse.
10.10 ACTIVITY AND EXERCISE - ADULTS
ActivA Note the distinction between `hillwalking' at Code 11, and `Other walking of 1 mile or more' at Code 12.
ActivB/ActivC The cards list examples of `heavy' housework, gardening and DIY. If necessary, please stress that we are only interested in heavy housework/gardening/DIY of the kinds listed on the card, and not just any housework/gardening/DIY.
10.11 ACTIVITY AND EXERCISE - CHILDREN
This module aims to get a general picture of the child’s level of physical activity.
Note that the time period referred to in the child physical activity module is the LAST WEEK. This means the seven days prior to the interview.
36 For children who are at school, activities that are done as part of school lessons should NOT be counted at any of these questions. Activities done on school premises, but not as part of school lessons (eg. after school clubs, things done during lunch break) SHOULD be included.
For pre-school children, activities done at any nursery or playgroup the child attends SHOULD be included. DWESp/DWEAct/DSitWE
At these questions we are asking for the time spent per day on Saturday/Sunday of the last week. If the child only did an activity on the Saturday or the Sunday (but not both), then the question asks about time spent on the relevant day only.
WkSpor/WkActH/WkSitH
At these questions, enter the amount of time spent doing the activity on EACH weekday. Take an average if the amount of time varied from day to day.
10.12 EATING HABITS
The eating habits module has been substantially changed in 1998, and is based on the Dietary Instrument for Nutrition Education (DINE) questionnaire, which was designed by the Imperial Cancer Research Fund’s General Practice Research Group. It will allow us to allocate a ‘fat score’ to each respondent, and to assess fibre intake.
Diet is an important risk factor in cardiovascular disease. For instance, high fat intake can increase levels of cholesterol in the blood, which increases the chance of getting heart disease. In this survey we do not ask detailed questions about what people actually eat. Instead we are trying to focus on a few indicators of "healthy" versus "less healthy" eating habits to get a general overview.
As far as possible avoid mentioning the risks of eating less healthily in case it biases the replies. If asked about the purpose of the section, say that there is a lot of discussion about the effect of diet on health, and that we are interested to see what effect this discussion is having on people's eating habits.
In many of the questions in this section we ask about what the respondent usually eats. By this we mean the type of food the respondent most often eats. If, for example, the respondent says that they eat two types of bread, check if they eat one type more frequently.
UsBread This is a "code one only question". The definition of bread is wide - it includes rolls, pittas, bagels, nans, chapattis etc as well as standard bread. We are interested in the type of bread normally eaten.
In analysis we are going to look at wholemeal bread as this is particularly high in fibre. There may be confusion about different types of brown bread - not all brown bread (such as granary or wheatmeal) is wholemeal. So if the respondent says that they eat brown bread check whether this is wholemeal brown bread or not. If the respondent is confident that it is wholemeal code 3, if not - use code 2.
If the respondent mentions Hi-bran bread, code 4 and specify.
For respondents who eat different kinds of bread (nans, pittas, parathas, chapattis etc), find out what kind of flour is used to make the bread and code 1 to 3 as appropriate.
Generally, you should use code 5 only as a last resort, and if you do use it please specify in detail.
37 Spr In your Showcard pack you have a card (Coding List 1) which lists the brand names of many butters and margarines. You can use this to code the respondent's answer if it is not immediately obvious. They may say "Anchor Butter" which could immediately be coded as 1. However if they say St. Ivel Gold, you may need to check Coding List 1 to see that this would be code 2.
If the respondent gives you a brand name that is not on the list, read out the precodes and ask which type it is. If it is not obvious which type it is - enter DK <[>, and make a note of the name.
Milk This asks about the type of milk that the respondent usually uses (ie uses most often). Here is a guide to milk bottles:
Gold top = Channel Island, Jersey Code 1 Red or silver top = Whole milk Code 1 Red and silver striped top = Semi-skimmed Code 2 Blue and silver striped top = Skimmed Code 3
For powdered milks and whiteners that are added straight to tea or coffee you should probe as to whether the powder is skimmed, semi-skimmed or whole and code as if liquid milk. If the powdered milk is made up into liquid milk, probe to see if it is made up with water or milk. If water, code according to the type of powder it is. If it is made up with milk, code it according to the type of milk it is made up with.
Cereal Ask this as an open question. For the purposes of the survey we are defining high fibre cereal as cereals with more than 6.5% fibre content (eg 6.5g/100g). Coding List 2 gives a code list for products. Refer to this as necessary in order to code. All the brands listed on the card (and own name versions of those brands) are high fibre and so are coded 1. However, there may be some high fibre brands that are not on the list in which case code 2. Generally, any cereal with the words bran, oat or wheat in the name will be high fibre (except for instant porridge eg Ready Brek).
Pulses Pulses include things such as baked beans, lentils, split peas, kidney beans, butter beans, chick peas, mung beans - but NOT green beans such as broad beans, runner beans, french beans, string beans or green peas. Include any pulses eaten in soups, such as lentil soup.
RawVeg Respondents may say that it is difficult to provide an average for this as their consumption varies seasonally. However, you should encourage respondents to try to give an approximate average for the whole year.
10.13 SMOKING
All those aged 18 and over are routed to this section. 16-17 year olds complete questions about smoking and drinking in a self-completion questionnaire which you will administer later.
Smoking is an important risk factor in cardiovascular disease - and the section on smoking will enable us to examine the relationship between smoking patterns, cardiovascular symptoms and use of services. The data collected here will allow us to discover what proportion of the population is exposed to this risk factor, and how it relates to other risk factors such as heavy drinking, lack of exercise or high blood pressure.
It will also allow us to monitor over time whether smoking habits change. 38 Avoid reminding respondents of the health risks of smoking in case it biases their replies.
We are interested in looking at ordinary tobacco which is smoked. Ignore any references to snuff, chewing tobacco or herbal tobacco. Include hand rolled cigarettes.
SmokEver By ever smoked, we mean even just once in their life.
DlySmoke/RolDly We ask here about daily consumption. Note that if a respondent smokes roll-ups and can only tell you how many ounces/grams of tobacco they smoke a day, code `97' as in the instructions on screen. This will route you to RolDly, and GramRol or OuncRol which will ask for the amount of tobacco smoked in a day (in either grams or ounces). Please be as accurate as possible, as this information will be used in the office to code back to cigarette number.
NumSmok If the ex-smoker cut down gradually over time, find out the number they used to smoke at peak consumption.
PregRec "Pregnant in the last year" - this means any stage of pregnancy at any time in the last year.
10.14 DRINKING BEHAVIOUR
The information collected here will be used to look at the relationship between drinking habits and health. We are only interested in alcoholic drinks - not in non-alcoholic or low alcohol drinks. Make sure that the respondent is aware of this. This is why we exclude canned shandy (which is very low in alcohol). However, shandy bought in a pub or made at home from beer and lemonade does have a reasonable alcohol content and so is included.
If a respondent aged between 18 and 74 does not drink at all, the programme will instruct you at PagEx to cross out the drinking experiences questions in his/her self-completion booklet before you hand it over (NB. the questions are on page 4 of the booklet). Please note that you must put a line through the text of the questions only, making sure that it does not go through any of the tick boxes (see page 62 at the back of this document for illustration). This is because the scanning machine will read any mark inside a box as a tick for that answer.
8-17 year olds
As with smoking, 8-17 year olds (and 18-19 year-olds at your discretion) are asked about drinking in their self-completion booklet which is presented near the end of the interview.
NBeer, NBeerQ etc
This is the first of a series of questions, each set asking about a different group of drinks, and how often they are drunk. You will ask first how much normal strength beer, stout, cider or shandy is drunk in the last 12 months and then how much was drunk on a drinking day. These questions are repeated for each type of drink. Then, for each type of drink, you will also ask the respondent about their drinking in the previous seven days.
The reason for the addition of these questions is the revised Government advice on safe drinking levels. The advice used to be based on a maximum number of units of alcohol in a week. However, this ‘safe’ limit was supposed to be spread over the week rather than all consumed in one or two sessions, so the advice was changed to recommended maximum daily consumption. We therefore need to ask 39 respondents about their heaviest drinking day in the last week to get an idea of the frequency with which these ‘safe’ daily levels are exceeded. We need to keep the old questions as well, both for trend data and for an estimate of usual drinking behaviour.
We are asking respondents to answer separately about ‘normal strength’ beer/stout/cider, and ‘strong’ beer/stout/cider. ‘Strong’ has been defined as at least 6% alcohol by volume, and some examples are given as part of the question (eg Tennants Extra, Carlsberg Special Brew, Diamond White cider). Some respondents will not know whether they drank strong or normal beer/stout/cider. In such cases, assume that it was normal strength.
For each group of drinks read out the full description. We are interested in the frequency of drinking all types of drink in a category - so if someone says that they drink gin once a month and vodka three or four times a week, ask them to tell you how often they drink any kind of spirit. If the respondent says that the amount they drink on any one day varies greatly, ask them to think of the amount they would drink most often.
Again, the amount refers to the whole group of drinks, not to a particular drink within a group.
For beer/stout/cider/shandy, the amount is coded in half pints, so any answers given in pints will need to be multiplied by two before entering eg 3 pints of shandy = 6 half pints. With beer you also have the option to code in small cans, large cans or bottles if the respondent answers in this way. If the respondent tends to drink cans/bottles and halves in a usual drinking occasion, then enter both on the questionnaire. If the respondent drinks large 2 litre bottles, instruct him/her to convert the amounts into half pints.
If a respondent drinks bottled beer CAPI will ask for the brand name. Where possible, try and get specific names and ask for the size of the bottle. For example, ‘Carlsberg Special Brew 550ml’.
Spirits are recorded in singles - so if the answer is given in doubles multiply it by two before entering. A nip or a tot should be treated as singles. Miniature bottles contain two singles, a normal bottle contains 27 singles, half a bottle contains 14 singles. If someone gives a different measure, eg "I have a couple of spoonfuls of brandy in my coffee" then ascertain the size of spoon and use
For wine the answer is in glasses:
A carafe or 70cl standard bottle = 6 glasses Half a bottle = 3 glasses 1/3 or ¼ bottle = 2 glasses Litre bottle = 8 glasses Half a litre bottle = 4 glasses 1/3 of a litre bottle = 3 glasses ¼ of a litre bottle = 2 glasses
Sherry is usually drunk in small glasses, but if it is drunk in schooners this counts as two glasses. One bottle of fortified wine is 14 small glasses.
For the first time in 1998, we are asking separately about ‘alcopops’, eg alcoholic lemonade. In previous years, you were instructed to include these under ‘beer’, but they now make up such a large section of the drinks market that we must treat them as a separate category.
40 AlcOtA
There are some drinks that people like to think are non-alcoholic such as Ginger Wine or Peppermint cordial. These should be included, if mentioned, under AlcOt.
WhichDay
If a drinking session continued beyond midnight, code the day on which it started.
10.15 DENTAL HEALTH MODULE
FalseT - Dentist A few questions about the respondent's teeth. If the respondent has false teeth only, they will get filtered out of the remainder of this section.
Note that capped teeth should not be counted as false teeth.
‘Total protection toothpaste’ counts as a fluoride toothpaste.
At the question where children are asked when they first went to the dentist, the following guidelines may help:
Age Likely activity Less than one 2-3 years mother and toddler 3-4 years playgroup 4-5 years nursery 5+ years primary school
41 10.16 EMPLOYMENT CLASSIFICATION MODULE
Activ
Code FIRST that applies on the list.
"Going to school or college full-time (including on vacation)": those on vacation should be counted as in full time education if they are planning to return at the next opportunity (ie are not taking a year out). If return depends on exam results, assume that they get the results and code them as "going to school or college full time".
"In paid employment or self-employed" includes any paid employment - no matter how few hours. Include things like babysitting, a paper round, Saturday jobs, casual work. It also includes:
- Anyone paid a wage or salary by an employer while attending an educational establishment
- Wives or husbands working unpaid in their spouse's business as long as they work for 15 hours a week or more
- Anyone working in a friend or relative's business as long as they receive an amount of money in remuneration, or a share of the profits
- People working for employers last week as part of a Government Scheme.
- Anyone absent from work due to holiday, maternity leave, lay-off etc provided they have a job to return to - with the same employer.
"Intending to look for work but prevented by temporary sickness or injury": do not use this code if sickness or injury has lasted over 28 days - if so, code as "Doing something else".
"Permanently unable to work because of long-term sickness or disability": Do not use this code for women over 59. Instead use "Retired", "Looking after the home and family", or "Doing something else" as appropriate.
"Retired": this only applies to people who retired from full-time employment at around retirement age or who were permanently sick prior to reaching retirement age.
CIEIncEarn
We want to collect details of the Chief Income Earner in the household if this person is different from the respondent.
42 10.17 OTHER CLASSIFICATION QUESTIONS
TopQual
Qualifications are asked about in two questions. This question asks about academic qualifications. The next question will deal with vocational qualifications.
Make sure that the respondent has properly looked at the show card and told you the highest academic qualification they have.
TopVocat
Unlike TopQual, this is a code all that apply question.
10.18 PARENTAL HISTORY
We need to collect information about the respondent's natural parents - not adopted or step parents.
The questions ask first about mother and then father. If the respondent's parent is in the household we check if that is the respondent's natural parent. If so we do not need to ask any questions about him/her.
When natural parents are not living in the household, we ask whether the natural parent is still alive. If the parent is still alive, we ask their age. If the natural parent is dead, we ask for age at death and whether they died of a cardiovascular disease. Only code one cause of death - the main cause. If the only known cause is "old age", code don't know. If the only known cause is "heart failure", then code don't know, but also write it in.
If exact age at death is not known, then accept an estimate.
10.19 GENERAL HOUSEHOLD DETAILS
There are then a few questions about the household and the accommodation they live in.
BedRooms Every dwelling must have at least one bedroom, ie a room where a person sleeps. A bedsit will have one bedroom. Count as bedrooms those rooms the respondent considers to be bedrooms.
CentHeat Central heating includes any system where two or more rooms are heated from a central source, such as a boiler, a back-boiler to an open fire, or the electricity supply. This definition includes a system where the boiler or back-boiler heats one room and also supplies the power to heat another room.
Where the accommodation has only one room, treat it as having central heating if that room is heated from a central source along with other rooms in the building.
Central heating does not include appliances that are plugged into the mains, such as electric fan heaters. Electric storage heaters are, however, included. Also include under-floor heating and hot air ducts.
43 Car "Normally available" includes vehicles used solely for driving to and from work and vehicles on long- term hire. It excludes vehicles used solely in the course of work and those hired from time to time.
IncSup Income support is a benefit for those who are out of work. If someone is getting help with their mortgage interest payments via the DSS, this will be part of income support.
FamCred Family Credit is paid to families with low earnings with at least one dependent child and with at least one earner working 16 hours a week or more.
HouseBen Housing benefit does not include Council Tax rebate or benefit.
10.20 PRESENTATION OF SELF-COMPLETION BOOKLETS
The self-completion booklets are as follows:
Title Colour Contents
Adult (18+) Grey General health, problem drinking, contraceptives, HRT, incontinence 16-17 Cream Smoking, drinking, general health, contraceptives, incontinence 13-15 Lilac Smoking, drinking, general health, incontinence 8 -12 Pale yellow Smoking, drinking
Make sure that you enter the serial number correctly on all self-completion booklets. Check your entry on the booklet against the display on screen SCIntro.
Please note that the Person numbers for the self-completion booklets should be completed as follows:
Person Number Adult 01 Child A (only or older selected child) 02 Child B (younger selected child) 03
Remember that for non-drinkers aged between 18 and 74, you should have crossed out the text of the drinking experiences questions, taking care that the line does not go through any of the tick boxes.
Explain how to complete the booklet. Wait for the respondent to finish and take it back at the end. If you are asked for assistance, give it. The level of assistance required and how it was given are to be coded at SC3Acc.
Smoking and drinking
It can be difficult to get people to tell the truth about smoking and drinking, and this is especially true for younger people particularly if you are interviewing with all the family there. Therefore, some of the questions on smoking and drinking from the interview have been put into self-completion format. The 16-17 year olds are asked a series of questions similar to those asked in the CAPI program of adults. This booklet can also be given to 18/19 year olds if you feel better quality information would be collected by so doing.
The section on drinking has a grid which is probably the most complex part of the self-completion. You can help the respondent out if they are having difficulty, but take care to preserve the anonymity of 44 the respondent's information. We want to ensure that the self-completion booklet is confidential for the respondent. To help you do this, we are providing some envelopes for you to hand over with the booklet in cases where you feel it would be helpful to stress the confidentiality by asking the respondent to return the booklet in an envelope. This may apply if it is important to indicate to an adult that a child’s booklet is confidential (although if the adult does not consent to the child completing the booklet you would not offer it in the first place).
10.21 MEASUREMENTS
Detailed protocols of how to take height and weight measurements are appended to these instructions. It is vital that you learn to administer these protocols properly and systematically. You are responsible for providing the official statistics on the populations' height and weight. If you have any problems in either administering the protocols or with the equipment, contact one of the SCPR team immediately.
In this section we describe who is eligible, the type of site required to take the measurements and how to complete this section of the questionnaire.
You should be able to measure the height and weight of most of the respondents. However, in some cases it may not be possible or appropriate to do so. Do not force a respondent to be measured if it is clear that the measurement will be far from reliable, but whenever you think a reasonable measurement can be taken do so. You are asked to record the reliability of your measurement at RelHiteB and RelWaitB. Examples of people who should not be measured are:
* Respondents who are chairbound should not have their height and weight taken.
* If after discussion with a respondent it becomes clear that they are too unsteady on their feet for these measurements, do not attempt to take them.
* If the respondent finds it painful to stand or stand straight, do not attempt to measure height.
* Pregnant women are not eligible for weight as this is clearly affected by their condition.
It is strongly preferable to measure height and weight on a floor which is level and not carpeted. If all the household is carpeted, choose a floor with the thinnest and hardest carpet (usually the kitchen or bathroom).
Read the preamble at the question called Intro. If further explanation is required, say that although many people know their height and weight, these measurements are not usually up to date or are not known with the precision required for the survey. The reason for wanting to know accurate heights and weights is in order to relate them to other health measures.
If the height or weight is refused or not attempted, the respondent is asked to estimate their height or weight. You are given a choice of whether to enter their estimate in metric or imperial measurements.
RelHiteB and RelWaitB You are asked here to code whether you experienced problems with the measurement and, if you did, to indicate whether you felt the end result was reliable or unreliable. As a rough guide if you think the measurement is likely to be more than:
2 cms (¾ inch) from the true figure for height 1 kg (2 lbs) from the true figure for weight code as unreliable. 45 Measurement Record Card
When you have taken the respondent's height and weight, offer the respondent a record of his/her measurements. Make out a Measurement Record Card (blue) and give it to the respondent. There is room on the Measurement Record Card to write height and weight in both metric and imperial units if the respondent wants both. The computer does the conversion for you.
10.22 THE NATIONAL HEALTH SERVICE CENTRAL REGISTER
NHSCR/NHSNo The National Health Service has a central register, and we would like to flag the names of respondents on this. There may also be other NHS registers which we would like to link up respondent's details with. As the survey is planned to continue for many years, it will be useful to be able to follow up what happens to respondents in the future. For example, looking ahead into the future, we can be informed when a respondent dies and of the cause of their death. This information, linked to the information obtained in the survey, could be extremely helpful to future medical researchers.
However, as this may seem off-putting to the respondent we have worded the question about flagging on the NHS register in a more general way.
We need the respondent’s written consent for flagging their names on the NHS central register. This is recorded on a special consent form. There are two sides to the form, one for adults aged 16-74 and one for children aged 2-15 (for whom the parent provides written consent). Use a separate form for each respondent. Enter all the sample details in the boxes at the top of the form and ring the appropriate person code (1=Selected adult, 2=Child A, 3=Child B). Make sure that people’s names are legible.
If the respondent refuses permission, please type in why they did so on the screen, as indicated.
Return the consent forms in envelopes together with the ARF for that household.
11. OPENING UP ADDITIONAL HOUSEHOLDS
If, upon contact at an address, you have needed to carry out a selection of two or three households, you will need to open the new serial numbers on your laptop.
Your address menu will only contain first households at any address (serial number sending in 1). To open up a second or third household, you will need to do the following:
1. Move your arrow keys to highlight the serial number of the first household at that address. For example, if you are wanting to open up a second household at address number 13 in point number 64, you would move your cursor to `064131'.
2. Press
3. At the Household menu which you are then taken to, move your arrow keys down to "HHOLD? [OPEN NEW HHOLD QUESTIONNAIRE]" 4. Enter the new HHOLD number as requested. This will either be 2 or 3.
5. You will then be asked for the check letter. Check letters for additional households will be found on the selection label of the blue ARF for the first household.
6. You may now begin an interview, or enter admin details for that household. 46 7. When you return to the address menu, you will see that an extra line has been opened up for that household.
12. BACKING UP DATA ON DISK AND RETURNING WORK TO BRENTWOOD
Backing up
In your own interests, you should take a back-up at the end of each day on which you have done some interviewing. This is a quick and simple procedure, which takes an extra security copy of your work. Always use the backup disk provided for this purpose (usually coloured blue).
To take a back-up, simply select your current assignment from the Project Menu, select `B' for `Backup Data' from the Action Menu, and follow the instructions on screen.
47 CONTACT NAMES AND TELEPHONE NUMBERS
AREA MANAGER
ASSISTANT AREA MANAGER
FIELD DEPARTMENT
SCPR RESEARCHERS
Interviewer to complete:
NURSE PARTNER:
INTERVIEWER SUPERVISOR:
48 APPENDIX A
PROTOCOL FOR TAKING HEIGHT MEASUREMENT
A. THE EQUIPMENT
You are provided with a portable stadiometer. It is a collapsible device with a sliding head plate, a base plate and three connecting rods marked with a measuring scale.
Please take great care of this equipment. It is delicate and expensive. Particular care needs to be taken when assembling and disassembling the stadiometer and when carrying or repacking it in the box provided.
- Do not bend the head or base plate - Do not bend the rods - Do not drop it and be careful not to knock the corners of the rods or base plate pin - Assemble and disassemble the stadiometer slowly and carefully
The stadiometer will be sent to you in a special cardboard box. Always store the stadiometer in the box when it is not in use and always pack the stadiometer carefully in the box whenever you are sending it on by courier. Inside the box with the stadiometer is a special bag that you should use for carrying the stadiometer around when you are out on assignment.
The rods
There are three rods marked with a measuring scale divided into centimetres and then further subdivided into millimetres. (If you are not familiar with the metric system note that there are ten millimetres in a centimetre and that one hundred centimetres make a metre). The rods are made of aluminium and you must avoid putting any kind of pressure on them which could cause them to bend. Be very careful not to damage the corners of the rods as this will prevent them from fitting together properly and will lead to a loss of accuracy in the measurements.
The base plate
Be careful not to damage the corners of the base plate as this could lead to a loss of accuracy in the measurements.
Protruding from the base plate (see diagram on page 50) is a pin onto which you attach the rods in order to assemble the stadiometer. Damage to the corners of this pin may mean that the rods do not stand at the correct angle to the base plate when the stadiometer is assembled and the measurements could be affected.
The head plate
There are two parts to the head plate; the blade and the cuff. The blade is the part that rests on the respondent's head while the measurement is taken and the cuff is the part of the head plate that slips over the measurement rods and slides up and down the rods. The whole unit is made of plastic and will snap if subjected to excessive pressure. Grasp the head plate by the cuff whenever you are moving the headplate up or down the rods, this will prevent any unnecessary pressure being applied to the blade which may cause it to break.
49 STADIOMETER ASSEMBLY
t.:;;?/
'\.::::;;--- Baflbearing lock system
Base Plate Pin
Head Plate Cuff Arrowhead points to edge you must take reading from
Base plate
Head Plate Blade
50 Assembling the stadiometer
See the diagram on page 50
You will receive your stadiometer disassembled with the three rods banded together and the head plate attached to the pin so that the blade lies flat against the base plate. Do not remove the head plate from this pin.
Note that the pin on the base plate and the rods are numbered to guide you through the stages of assembly. (There is also a number on the side of the rods, this is the serial number of the stadiometer). The stages are as follows:-
1 Lie the base plate flat on the floor area where you are to conduct the measurements.
2 Take the rod marked number 2. Making sure the yellow measuring scale is on the right hand side of the rod as you look at the stadiometer face on, place rod 2 onto the base plate pin. It should fit snugly without you having to use force.
3 Take the rod marked number 3. Again make sure that the yellow measuring scale connects with the scale on rod 2 and that the numbers run on from one another. (If they do not, check that you have the correct rod). Put this rod onto rod number 2 in the same way you put rod 2 onto the base plate pin.
4 Take the remaining rod and put it onto rod 3.
Disassembling the stadiometer
Follow these rules:-
1 Before you begin to disassemble the stadiometer you must remember to lower the head plate to its lowest position, so that the blade is lying flat against the base plate
2 Remove one rod at a time
51 B. THE PROTOCOL - ADULTS (16+)
1. Ask the respondent to remove their shoes in order to obtain a measurement that is as accurate as possible.
2. Assemble the stadiometer and raise the headplate to allow sufficient room for the respondent to stand underneath it. Double check that you have assembled the stadiometer correctly.
3. The respondent should stand with their feet flat on the centre of the base plate, feet together and heels against the rod. The respondent's back should be as straight as possible, preferably against the rod but NOT leaning on it. They should have their arms hanging loosely by their sides. They should be facing forwards.
4. Move the respondent's head so that the Frankfort Plane is in a horizontal position (ie parallel to the floor). The Frankfort Plane is an imaginary line passing through the external ear canal and across the top of the lower bone of the eye socket, immediately under the eye (see diagram on page 55). This position is important if an accurate reading is to be obtained. An additional check is to ensure that the measuring arm rests on the crown of the head, ie the top back half.
To make sure that the Frankfort Plane is horizontal, you can use the Frankfort Plane Card to line up the bottom of the eye socket with the flap of skin on the ear. The Frankfort Plane is horizontal when the card is parallel to the stadiometer arm.
5. Instruct the respondent to keep their eyes focused on a point straight ahead, to breathe in deeply and to stretch to their fullest height. If after stretching up the respondent's head is no longer horizontal, repeat the procedure. It can be difficult to determine whether the stadiometer headplate is resting on the respondent's head. If so, ask the respondent to tell you when s/he feels it touching their head.
6. Ask the respondent to step forwards. If the measurement has been done correctly the respondent will be able to step off the stadiometer without ducking their head. Make sure that the head plate does not move when the respondent does this.
7. Look at the bottom edge of the head plate cuff. There is a green arrowhead pointing to the measuring scale. Take the reading from this point and record the respondent's height in centimetres and millimetres, that is in the form 123.4, at the question "Height." You may at this time record the respondent's height onto their Measurement Record Card and at the question "MbookHt" you will be asked to check that you have done so. At that point the computer will display the recorded height in both centimetres and in feet and inches. At RelHiteB you will be asked to code whether the measurement you obtained was reliable or unreliable.
8. Note that you should record the measurement to the nearest even millimetre. This means that if the reading should fall over an odd number but not quite to the full even number, then you should record to the even number anyway. Eg. for a reading 165.1 where the measurement is actually over the one millimetre mark but not quite up to the two, you would nevertheless record 165.2.
9. Push the head plate high enough to avoid someone hitting their head against it when getting ready to be measured.
52 C. THE PROTOCOL - CHILDREN (2-15)
The protocol for measuring children differs slightly to that for adults. You must get the co-operation of an adult household member. You will need their assistance in order to carry out the protocol, and children are much more likely to be co-operative themselves if another household member is involved in the measurement. If possible measure children last so that they can see what is going on before they are measured themselves.
Children’s bodies are much more elastic than those of adults. Unlike adults they will need your help in order to stretch to their fullest height. This is done by stretching them. This is essential in order to get an accurate measurement. It causes no pain and simply helps support the child while they stretch to their tallest height.
It is important that you practice theses measurement techniques on any young children among your family or friends. The more practice you get before going into the field the better your technique will be.
1. In addition to removing their shoes, children should remove their socks as well. This is not because socks affect the measurement. It is so that you can make sure that children don’t lift their heels off the base plate (see 3 below).
2. Assemble the stadiometer and raise the head plate to allow sufficient room for the child to stand underneath it. 3. The child should stand with their feet flat on the centre of the base plate, feet together and heels against the rod. The child’s back should be a straight as possible, preferably against the rod, and their arms hanging loosely by their sides. They should be facing forwards.
4. Place the measuring arm just above the child’s head.
5. Move the child’s head so that the Frankfort plane is in a horizontal position (see diagram on page 56). This position is as important when measuring children as it is when measuring adults if the measurements are to be accurate. To make sure that the Frankfort Plane is horizontal, you can use the Frankfort plane card to line up the bottom of the eye socket with the flap of skin on the ear. The Frankfort plane is horizontal when the card is parallel to the stadiometer arm.
6. Cup the child’s head in your hands, placing the heels of your palms on either side of the chin. Your fingers should come to rest just under the ears (see diagram on page 56).
7. Firmly but gently, apply upward pressure lifting the child’s head upwards towards the stadiometer headplate and thus stretching the child to their maximum height. Avoid jerky movements, perform the procedure smoothly and take care not to tilt the head at an angle; you must keep it in the Frankfort plane. Explain what you are doing and tell the child that you want them to stand up straight and tall but not to move their head or stand on their tip-toes.
8. Ask the household member who is helping you to lower the head plate down gently onto the child’s head. Make sure the headplate touches the skull and that it is not pressing down too hard.
9. Still holding the child’s head, relieve traction and allow the child to stand relaxed. If the measurement has been done properly the child should be about to step off the stadiometer without ducking their head. Make sure that the child does not knock the headplate as they step off.
53
10. Read the height value in metric units to the nearest millimetre and enter the reading into the computer at the question “Height”. At the question “MBookHt” you will be asked to check that you have entered the child’s height onto their measurement record Card. At that point the computer will display the recorded height both in centimetres and in feet and inches.
11. Push the head plate high enough to avoid any member of the household hitting their head against it when getting ready to be measured.
D. HEIGHT REFUSED, NOT ATTEMPTED OR ATTEMPTED BUT NOT OBTAINED
At HtResp you are asked to code whether the measurement was taken, refused, attempted but not obtained or not attempted. If for any reason you cannot get a height measurement, enter the appropriate code at this question and you will automatically be routed to the relevant follow up questions (ResNHi and NoHitM) which will allow you to say why no measurement was obtained.
E. ADDITIONAL POINTS
1. If the respondent cannot stand upright with their back against the stadiometer and have their heels against the rod (eg those with protruding bottoms) then give priority to standing upright.
2. If the respondent has a hair style which stands well above the top of their head, (or is wearing a turban), bring the headplate down until it touches the hair/turban. With some hairstyles you can compress the hair to touch the head. If you can not lower the headplate to touch the head, and think that this will lead to an unreliable measure, record this at question "HtAffM." If it is a hairstyle that can be altered, eg a bun, if possible ask the respondent to change/undo it.
3. If the respondent is tall, it can be difficult to line up the Frankfort Plane in the way described. When you think that the plane is horizontal, take one step back to check from a short distance that this is the case.
54 FRANK FORT PLANE CARD
...... ]' .r- ...... ~ .... ~ ...... 1 ••••••.•.••..... 4.· \-_____ bOl'izont ...... ~.. .f----lIo,.izont ss MEASURING CIDLDREN'S HEIGHT G) MAKE SURE HEAD horizontal IN FRANKFORT PLANE ~ APPLY GENTLE UPWARD PRESSURE <, I ., , I , 0:::: 'en ( 56 SUPPLEMENTARY INSTRUCTIONS FOR ALTERNATIVE MEASURING EQUIPMENT PROTOCOL FOR TAKING HEIGHT MEASUREMENT USING THE LEICESTER HEIGHT MEASURE A. THE EQUIPMENT Like the metal stadiometer also used for this survey, The Leicester height measure is a portable stadiometer which is collapsible and consists of a base plate, a head plate and some connecting rods marked with a measuring scale. The Leicester height measure differs from the metal stadiometer in that it is made of plastic and is constructed from four rods instead of three. Please take great care of this equipment. Being made of plastic it is relatively vulnerable to breakage or other damage. Particular care is needed when handling the head plate and base. The Leicester height measure is provided in a cardboard box. Always store the stadiometer in this box. How to pack the height measure Always pack the height measure before placing it in its box. First slot the four rods horizontally into the back of the base plate so that the thick ends connect with the base plate and the thin ends are free, with the metal measuring scale uppermost. There is space for two rods on each side of the base plate. Hold each pair of rods in position using an elastic band. Then secure the head plate to one pair of rods and the two stabilisers to the other pair, using elastic bands. Finally, place the secured equipment in the cardboard box. It should fit in neatly. Check that all parts are secured with elastic bands so that they are not free to move about when the box is carried. The rods There are four rods. Each is marked with two scales: · a black and white scale showing feet and inches. This must not be used. · a yellow scale metal scale showing centimetres. This must always be used. The metal strip has been individually calibrated for that equipment and so is more accurate than the scale which was pre-printed on the plastic rod. Be very careful not to bend or damage the rods or separate the yellow metal scale from the plastic rod. If you find that the equipment is damaged in any way contact the office to let them know. How to assemble the height measure 1. Place the base plate on the floor. Take the first rod (which has an arrow and a diagram marked at one end) into the base plate to that the scale can be read from the right side of the person when s/he is standing on the base plate. 2. Place the first stabilizer over the top of the first rod so that it points towards the wall, at the back of the stadiometer. 3. Attach the second rod (2 and 3 feet; ensure that the symbols at the end of rods match). 4. Attach the third rod (4 and 5 feet; ensure that the symbols match) 5. Attach the fourth rod (6 feet; ensure that the symbols match) 6. Place the head plate over the fourth rod and bring it down to a little above head height. 7. Place the second stabilizer over the top of the fourth rod, pointing towards the wall, above the head plate. To disassemble the stadiometer remove one piece at a time in the reverse order from that above (i.e. from 7 through to 1). B. THE PROTOCOL This is exactly the same as for the metal stadiometer (see above). 59 APPENDIX B PROTOCOL FOR TAKING WEIGHT MEASUREMENT A. THE EQUIPMENT The Soehnle scales are turned on by pressing the top of the scale (eg with your foot). There is no switch to turn the scales off, they turn off automatically. When you are storing the scales, or sending them through the post, please make sure that you remove the battery - to stop the scales turning themselves on. Batteries The scales take 1 x 9v rectangular MN1604 6LR61 batteries. It should not be necessary to have to replace the batteries, but if the display indicates .7.2.5, or another series of numbers separated by decimal points, it is indicating low output. Always ensure that you have some spare batteries with you in case this happens. If you need to change the battery, please buy one and claim for it. This type of battery is commonly available. The battery compartment is on the bottom of the scales. When you receive your scales you will need to reconnect the battery. Before going out to work, reconnect the battery and check that the scales work. If they do not, check that the battery is connected properly and try new batteries. If they still do not work, report the fault to your Area Manager. The reading is only in metric units, but as for height, the computer provides a conversion. If the respondent would like to know their weight in stones and pounds you will be able to tell them when the computer has done the calculation. IMPORTANT WARNING The scales have an inbuilt memory which stores the weight for 10 minutes. If during this time you weigh another object that differs in weight by less than 500 grams, the stored weight will be displayed and not the weight that is being measured. This means that if you make an error and need to weigh someone for a second time, you could be given the wrong reading. So if you get an identical reading for a second reading when you would not expect one, make sure that the memory has been cleared. Clear the memory from the last reading by weighing an object that is more than 500 grams lighter (ie a pile of books, your briefcase or even the stadiometer). You will then get the correct weight when you weigh the second time. B. THE PROTOCOL 1. Turn the display on by pressing firmly with your hand or foot on the top of the scales (the scales will turn themselves off after a short while). The readout should display 888.8 momentarily as a 57 check for the operation - if this is not displayed check the batteries, if this is not the cause you may need to report the problem to SCPR. While the scales read 888.8 do not attempt to weigh anyone. 2. Ask the respondent to remove shoes, heavy outer garments such as jackets and cardigans, heavy jewellery, loose change and keys. 3. Turn the scales on with your foot again. Wait for a beep and display of 0.0 before the respondent stands on the scales. 4. Ask the respondent to stand with their feet together in the centre and their heels against the back edge of the scales. Arms should be hanging loosely at their sides and head facing forward. Ensure that they keep looking ahead - it may be tempting for the respondent to look down at their weight reading. Ask them not to do this and assure them that you will tell them their weight afterwards if they want to know. The posture of the respondent is important. If they stand to one side, look down, or do not otherwise have their weight evenly spread, it can affect the reading. 5. The scales will take a short while to stabilize and will read 'C' until they have done so. If the respondent moves excessively while the scales are stabilizing you may get a false reading. If you think this is the case reweigh, but first ensure that you have erased the memory. 6. The Soehnle scales have been calibrated in kilograms and 100 gram units (0.1 kg). Record the reading into the computer at the question "Weight" before the respondent steps off the scales. At question "MBookWt" you will be asked to check that you have entered the respondent's weight onto their Measurement Record Card. At that point the computer will display the measured weight in both kilos and in stones and pounds. WARNING The maximum weight registering accurately on the scales is 130kg (20½ stone). If you think the respondent exceeds this limit code them as "Weight not attempted" at "WtResp". The computer will display a question asking them for an estimate. Do not attempt to weigh them. Additional note Pregnant women do not have their weight measured. For women respondents aged 16-49, the computer displays a question asking them whether they are pregnant and then enforces the appropriate routing. 58 SHS 1998 Nurse Instructions P1731 THE SCOTTISH HEALTH SURVEY 1998 NURSE INSTRUCTIONS 1 CONTENTS PAGE 1. BACKGROUND AND AIMS 5 2. THE SURVEY 5 3. ABOUT SCPR AND UCL 6 4. THE SCPR/UCL TEAM 7 4.1. The Research Team 7 4.2. The Survey Doctor 7 4.3. The Fieldwork Team 7 5. SUMMARY OF SURVEY DESIGN 7 5.1. The sample 7 5.2. The interviewer visit 8 5.3. The nurse visit 8 6. SURVEY MATERIALS 9 7. NOTIFYING THE POLICE 10 8. LIAISING WITH YOUR INTERVIEWER PARTNER 10 8.1. Appointment Diary 11 8.2. What the interviewer has told respondents about your visit 11 8.3. Appointment Record Card 13 9. ACHIEVING A HIGH RESPONSE RATE 13 9.1. The importance of a high response rate 13 9.2. “You won’t want to test me…” 13 9.3. Health is interesting and important 13 9.4. Respondents are not patients 14 10. CONTACTING AND OBTAINING CO-OPERATION 14 10.1. Keep your introduction short 14 10.2. Being persuasive 15 10.3. Broken appointments 15 10.4. The number of calls you must make 16 11. INTRODUCING YOUR MEASUREMENT TASK 16 11.1. The introduction 16 11.2. The Stage 2 Leaflet 16 12. YOUR SAMPLE 16 12.1. Your sample 16 12.2. Serial numbers 17 12.3. Nurse Sample Sheet (NSS) 18 Example Nurse Sample Sheet 19 12.4. Nurse Record Form (NRF) 20 12.5. Additional Households 21 Example Nurse Record Form 22 12.6. Interim Appointment Record Form 24 Example Interim Appointment Record Form 25 2 13. OBTAINING CONSENT TO INTERVIEW AND TAKING BLOOD FROM MINORS 26 14. PREPARING FOR THE INTERVIEW 26 14.1. The Consent Booklet 26 14.2. The Nurse Schedule 28 14.3. At the Household 28 14.4. Getting into the Schedule 28 14.5. Household Information 28 14.6. General tips on how to use the program 29 15. THE INTERVIEW 29 15.1. Prescribed Medicines 29 15.2. Dietary Supplements 31 15.3. Nicotine Replacement Products 31 15.4. Gastrointestinal Illness 32 15.5. MEASURING UPPER ARM CIRCUMFERENCE (MUAC) 32 15.5.1. Purpose 32 15.5.2. Eligibility 32 15.5.3. Equipment 32 15.5.4. Procedure 32 15.6. RECORDING AMBIENT AIR TEMPERATURE 34 15.6.1. Purpose 34 15.6.2. Eligibility 34 15.6.3. Procedures 34 15.7. BLOOD PRESSURE MEASUREMENT AND HEART RATE READINGS 35 15.7.1. Purpose 35 15.7.2. Eligibility 35 15.7.3. Equipment 35 15.7.4. Preparing the respondent 35 15.7.5. Procedure 37 15.7.6. Error readings 38 15.7.7. Informing respondents of their blood pressure readings 38 15.7.8. Action to be taken by the nurse after the visit 40 15.8. MEASURING DEMI-SPAN 42 15.8.1. Purpose 42 15.8.2. Eligibility 42 15.8.3. Equipment 42 15.8.4. Preparing the Respondent 42 15.8.5. Procedure 43 15.9. MEASUREMENT OF WAIST AND HIP CIRCUMFERENCES 44 15.9.1. Purpose 44 15.9.2. Eligibility 44 15.9.3. Equipment 44 15.9.4. Preparing the respondent 44 15.9.5. Procedure 45 3 15.10. MEASUREMENT OF LUNG FUNCTION 48 15.10.1. Purpose 48 15.10.2. Eligibility 49 15.10.3. Equipment 49 15.10.4. Procedure 49 15.10.5. Cleaning procedure for the Escort spirometer 52 15.10.6. Important points to note 53 15.10.7. Fault finding guide 54 15.11. BLOOD SAMPLE COLLECTION 54 15.11.1. Purpose 54 15.11.2. Eligibility 54 15.11.3. Equipment 55 15.11.4. Preparing the respondent 56 15.11.5. Procedure 57 15.11.6. Fainting respondents 58 15.11.7. Disposal of needles and other materials 58 15.11.8. Needle stick injuries 58 15.11.9. Respondents who are HIV or Hepatitis B positive 58 15.12. SALIVA SAMPLE COLLECTION 59 15.12.1. Purpose 59 15.12.2. Eligibility 59 15.12.3. Equipment 59 15.12.4. Procedure 59 15.13. LABELLING AND SENDING BLOOD AND SALIVA SAMPLES TO THE ROYAL VICTORIA INFIRMARY LABORATORY IN NEWCASTLE 60 15.13.1. Labelling and Packaging the Saliva Tube 60 15.13.2. Labelling the blood tubes 60 15.13.3. Packaging the blood samples 61 15.13.4. Completing the Blood Despatch Note (DESPATCH 2) 61 15.14. DELIVERING BLOOD TO LOCAL PROCESSING LABORATORIES 62 15.14.1. Packaging and delivering the blood sample 62 15.14.2. Completing the Blood Delivery Note (DESPATCH 3) 63 15.15. FINISHING THE INTERVIEW 63 15.15.1. The admin block 63 15.15.2. Parallel blocks 63 15.15.3. Saving Work 64 16. COMPLETING THE NRF AND RETURNING WORK 65 16.1. Recording the Outcome of your Attempts to Interview and Measure 65 16.2. Returning Work to the Office 65 17. CONTACT NAMES AND TELEPHONE NUMBERS 67 4 1. BACKGROUND AND AIMS “The Scottish Health Survey” is the second of a series of surveys commissioned by the Scottish Office, Department of Health. The survey is planned to be repeated every 3 years. The survey’s objective is to monitor trends in the population’s health over time. It is very similar to the Health Survey for England which began in 1991 and is repeated every year. In 1991, the Scottish Office published “Health Education in Scotland - A National Policy Statement”, which set out key health targets in a number of areas. The aim in setting these targets is to increase people’s life expectancy and to improve the quality of their lives. “Health Education in Scotland” recognised that a health strategy for improving life quality should involve a variety of approaches, designed not only to reduce the amount of ill-health (through high quality health services, healthier lifestyles and improved physical and social environments) but also to alleviate its effects. Little systematic information has hitherto been available about the state of the population’s health, or about the factors that affect it. There are statistics on the number and causes of deaths. Other statistics (such as hospital admissions) are derived from people’s contacts with the National Health Service, but these statistics are concerned only with very limited aspects of health. For example, they are likely to record the particular condition treated rather than the overall health of the patient. While information is also available from other sources, such as surveys, it tends to deal with specific problems not with health overall. And even the wider-ranging surveys fail to provide measures of change over time. We therefore do not have a clear picture of the health of the Scottish population as a whole, or of the way it may be changing. It has not been possible to say with any certainty whether people are getting generally healthier or less healthy, or whether their lifestyles are developing in ways that are likely to improve or damage their health. But good information is vitally needed for formulating health policies aimed not only at curing ill- health but also at preventing it. Prevention is, from every point of view, better than cure. Good information is also essential for monitoring progress towards meeting health improvement targets. Consequently, the Scottish Office Department of Health decided that a major health survey should be carried out in order to monitor the country’s state of health so that trends over time could be noted and appropriate policies planned. The Scottish Health Survey is that survey. It thus plays a key role in ensuring that health planning is based on reliable information. As well as monitoring the effectiveness of the government’s policies and the extent to which its targets are achieved, the survey will be used to help plan NHS services to meet the health needs of the population. 2. THE SURVEY The Scottish Health Survey is a large survey, involving interviews with around 8,000 adults aged 16-64. This year we will also be interviewing children (aged 2-15) and older adults (aged 65-74). Fieldwork is continuous throughout the year. This is the second of a series of surveys, which are planned to be repeated every three years. As with the first survey, the second survey is being carried out by the Joint Health Surveys Unit, set up in 1993 jointly by Social and Community Planning Research (SCPR) and the Department of Epidemiology and Public Health, University College London (UCL) Medical School. 5 The survey will focus on different health issues each time it is carried out, with topics repeated at suitable intervals to monitor changes over time. The first major issue studied by the Scottish Health Survey was cardiovascular disease and this will be continued in the 1998 survey. Cardiovascular disease (including heart attacks and strokes) is the largest single cause of death in Scotland. Even when it does not kill, it brings ill-health and disability to thousands of people every year. Coronary heart disease caused more than a quarter of all deaths in 1991, while strokes were responsible for more than one in ten. Scotland has the highest mortality rate from coronary heart disease for men and the second highest for women in the world. Cardiovascular disease is thus an issue of great importance in Scotland. It is also an issue that lends itself to study in a survey because there are a number of measurable indicators of cardiovascular conditions, and specific factors that put people at risk. Action can be taken to reduce risk levels. The aim of the 1998 survey is to provide more data to measure trends in cardiovascular health. Specific aims include: - estimating the proportion of adults in Scotland who have particular cardiovascular conditions - estimating the prevalence of certain risk factors associated with these conditions, and looking at the extent to which combinations of risk factors are found - examining the variation in risk factors between population sub-groups. This will help to: - inform policy on preventive and curative health - monitor change overall and among certain groups - monitor progress towards the health targets relating to cardiovascular disease set in “Health Education for Scotland”. Information about the survey, its objectives and design have been circulated to all Area Health Boards’ Research Ethics Committees. These are the bodies that approve the ethical aspects of medical research. Committee members represent medical, professional and patient interests. They have been asked to confirm that they are happy with the ethical aspects of this study. All the Health Boards in Scotland have given their approval for the study. 3. ABOUT SCPR AND UCL SCPR is one of Britain’s leading social research institutes. It was founded in 1969 as an independent, non-profit making institute specialising in social surveys. Some of SCPR’s work is initiated by the institute itself and grant-funded by research councils or foundations. Other work is initiated by government departments, local authorities or quasi-governmental organisations to collect and interpret information on aspects of social, health and economic policy. SCPR has its own research, interviewing, coding and computing resources. The UCL Department of Epidemiology and Public Health is one of the UK’s leading academic departments of public health. It was awarded a star, equivalent to the top rating of 5, in the UFC (Universities Funding Council) research excellence assessment exercise. The main thrust of the 6 Department’s work has been in cardiovascular disease, diabetes and dental health. It has also conducted studies in mental health, neuro-epidemiology, cancer and chronic respiratory disease. Early in 1993 SCPR and the UCL Department of Epidemiology set up “The Joint Health Surveys Unit” in order that their joint expertise could be utilised in undertaking health surveys. 4. THE SCPR/UCL TEAM 4.1 The Research Team SCPR UCL 4.2 The Survey Doctor A Scotland-based Survey Doctor is available to provide nurses with medical support. He will be available to provide all medical back-up to nurses such as in the rare event that you find you may need medical assistance with one of the respondents (e.g. in cases of severely raised blood pressure or other medical emergencies). If you have any queries about the study itself such as protocols, measurements or blood taking you may contact X. Contact details for both are given on the last page of this document. 4.3 The Fieldwork Team Nurses will be supported by a local fieldwork team consisting of the Scottish Area Manager, a nurse supervisor and an interviewer supervisor. The nurse supervisor is the person you should consult if you have any queries about your equipment, how to use it in the field or any other problems you might have relating to carrying out the interview and measurements. The nurse supervisor will from time to time accompany you in the field. Your interviewer supervisor is there to help you obtain high levels of co-operation from members of the public. This supervisor will also accompany you in the field from time to time. The supervisors are there to help you do your job to the best of your ability - please consult them whenever you feel you need help. The names of your supervisors are listed in the separate Project Administration notes. A list of names and telephone numbers of people to contact if you have problems is given in Section 15; and key phone numbers are shown on the last page of this document. 5. SUMMARY OF THE STUDY DESIGN 5.1 The sample The Scottish Health Survey is a survey of people aged between 2 and 74 living in private residential accommodation in Scotland. The sample of over 14,000 addresses has been selected from the Postcode Address File (PAF). There are two parts to the survey: an interviewer-administered questionnaire using CAPI (Stage 1), and a visit by a nurse to carry out measurements and take a blood sample (Stage 2). Co-operation is entirely voluntary at each stage. Someone may agree to take part at Stage 1 but decide not to continue to Stage 2. (Response to the first Scottish Health Survey was very high at both stages, and we expect similar results this year.) 7 Each nurse will be assigned two sampling points (of 23 addresses each) and will work in a team with the two interviewers covering those points. There will be 52 sampling points issued every month. An advance letter will be sent to each address explaining briefly the survey and its purpose. Two other information leaflets to be given out by the interviewer and the nurse provide the respondent with greater detail. One person aged between 16 and 74 and up to two children aged between 2 and 15 will be randomly selected at each address for inclusion in the study. Fuller details of the sample and associated documents are given in Section 12. 5.2 The interviewer visit The interviewer’s first task at an address is to make contact and identify all the persons aged 2-74 in the household and select one adult and up to two children at random. The interviewer will then attempt an interview with each of the people selected. Interviews will be carried out using computerised questionnaires (referred to as CAPI - computer-assisted personal interviewing). All interviewers have their own laptop computer. The following topics are covered: General health Chest pain, phlegm, wheezing and breathlessness Cardiovascular disease - diagnosis and treatment Asthma Use of health services Accidents Activity and exercise Eating habits Smoking and drinking Dental Health Parental history General background information Towards the end of the interview, the respondent’s height and weight are measured. A record of these is given to the respondent on a Measurement Record Card. The second stage of the survey is then introduced - the visit by a nurse to ask a few more questions and to carry out some more measurements. The interviewer arranges an appointment for the nurse to visit a few days later. 5.3 The Nurse Visit The second stage of the survey is carried out by a qualified nurse. For the first time in 1998, nurses will also be using Computer-Aided Personal Interviewing (CAPI). The nurse calls on the respondents in their homes in order to ask a few questions about any prescribed medicines, diet supplements and food related illnesses. She then carries out more measurements: mid-upper arm circumference (for children aged 2-15), blood pressure (for those aged 5-74), demi-span (aged 65-74), waist and hip measurements (for adults aged 16-74), and lung function (ages 7-74). All respondents aged 4-74 are asked to provide a saliva sample. If the respondent wishes to be given the results of these measurements, the nurse enters the information onto their Measurement Record Card. Respondents aged 16-74 will be asked to provide a small blood sample (normally 15ml), subject to their written consent. The blood and saliva samples are sent to the laboratory attached to the Royal 8 Victoria Infirmary in Newcastle-upon-Tyne for analysis. Details of these analyses are given later in Section 5.4. With the respondent's permission, blood pressure, lung function and the results of the blood tests will be sent to his/her GP. This information will also be given to the respondent, if (s)he so wishes. Among a small sub-sample of respondents (about one in eight), additional blood will be taken to be analysed for vitamins. These respondents will be confined to 10 of the 52 sampling points every month. In these sampling points, the nurse will take an extra tube of blood (6ml) and deliver the blood to a local laboratory for immediate processing; the local laboratory will then pass the blood on to the Institute of Food Research in Norwich where it will be analysed. 6. SURVEY MATERIALS The following is a list of documents and equipment you will need for this survey. Before starting work, check that you have received the following supplies. Documents Nurse Sample Sheet green 2 per assignment Appointment Diary white 2 per assignment Broken Appointment Cards white card (A5) 5 per assignment Information leaflets (Stage 2) pale yellow card 30 per assignment Consent Booklets blue cover 53 per assignment Set of labels for blood/saliva sample tubes not green 5 sheets per assignment Drug coding booklet lilac cover 1 per nurse bag Blood Pressure Guide card white card 1 per nurse bag Measurement Record Cards blue card 8 per assignment Abnormal Blood Pressure Sheets white 2 per assignment Pilot bag checklist (awaiting UCL) white card (A5) 1 per nurse per quarter Nurse Response form A pink 2 per assignment Suggestion sheet white 1 per assignment Interim Appointment Record Form white 10 per assignment Nurse Instructions white 1 per nurse per quarter 1 disc Equipment Pilot bag checklist Dinamap 8100 Child, small adult, adult and large adult blood pressure cuffs Vitalograph Escort Spirometer Vitalograph 1 litre calibration syringe Disposable cardboard mouthpieces (for spirometer) Thermometer and probe in lunchbox Insertion tape Spring Balance British National Formulary (BNF) Demispan tape 2 short paper tapes Skin marker pen micropore tape 30 blood sample packs, each a self-seal polythene bag holding: Plastic PLAIN Vacutainer (6ml) Plastic EDTA Vacutainer (4ml) 9 Plastic CITRATE Vacutainer (4.5ml) 21G Vacutainer needle Plastic transport cocoon Resealable plastic bag Prepaid addressed mailing envelope Additional large polythene bag containing: 6 21G Vacutainer needles 3 23G butterfly needles 6 plastic PLAIN Vacutainers (6ml) 6 plastic EDTA Vacutainers (4ml) 6 plastic CITRATE Vacutainers (4.5ml) 4 needle holders 50 plastic gloves (25 small, 25 medium) 50 Steriwipe/cotton balls/plasters (each) Sharps disposal box 20 small resealable bags 20 large resealable bags 50 saliva tubes 20 straws 40 dental rolls 10 prepaid addressed mailing envelopes If you are working in a vitamin sampling point you will also receive: 40 plastic PLAIN Vacutainer (6ml) 40 small resealable plastic bags 40 large resealable plastic bags 40 small padded envelopes a cool box with cool pack The equipment is described in more detail later in the sections on the measurement protocols. 7. NOTIFYING THE POLICE The interviewer with whom you will be working is responsible for notifying the police about the survey and for informing them that the two of you will be working in the area. Your interviewer- partner will need to collect some details about your car so that he/she can fill in the necessary details on the letter to be left with the police. You can then tell respondents that the police know all about the survey. Some respondents find this very reassuring, and some will telephone the police to check that you are a genuine survey worker before agreeing to see you. 8. LIAISING WITH YOUR INTERVIEWER PARTNER You and your two interviewer partners will need to work very closely together, so a good working relationship is essential. In order to help forge this, it is important that you meet each other. Wherever possible, we will arrange for you and your interviewer partner to attend the same briefing/training day. If this is not possible, you should arrange to meet up or have a chat over the telephone, before you start work. The interviewer has been told to make contact with you to set this up. The formal lines of communication between you are described in the next section. The informal lines are just as important. It has been stressed that an important part of the interviewer’s job is to 10 keep you fully informed about the outcomes of his/her attempts to interview people. We want to minimise the length of time between the interview and your visit. You will therefore need to talk to each other frequently by telephone. Make sure you let your interviewer know the best times to get in touch with you. 8.1 Appointment Diary You and your interviewer have both been given an Appointment Diary covering the relevant survey period. You should go through this together before you start work. Let the interviewer know the days and times on which you are available for appointments to see respondents. Make sure you keep a careful note of the times you give her/him. You will need to liaise frequently in order to update this information. Never put the interviewer in the situation where he/she makes an appointment for you in good faith, only to discover you have a prior commitment. Give the interviewer as much flexibility as possible for making appointments. People lead very busy lives nowadays. They are doing something to help us and may not give it the greatest priority. If you are working in one of the 10 sample points where respondent’s blood will be analysed for vitamins, appointments should ideally be in the morning as the blood tests are affected by the person’s diet over the preceding 4-5 hours. While respondents will not always be available in the morning, it is important that nurses working in these sampling points are available for morning and weekend appointments. If respondents are definitely not available in the morning, the next best times for visiting those who will be having vitamin analyses would be immediately before they have lunch or before they have dinner. The worst time to make an appointment would be immediately after a mealtime. The interviewer will do everything possible to provide you with an even flow of work and to minimise the number of visits you have to make to an area, but this will be limited by respondent availability. Discuss with the interviewer the time you will need to travel to the area so that he/she can take account of this. Plan together how best to make this appointment system work. The interviewer is instructed to give you good warning of all appointments made and will telephone through the details. You should record the name of the respondent, their serial number, their age, their telephone number and their appointment details on the Nurse Record Form. Make sure the interviewer knows the best times to reach you by telephone. If you want more than two days’ notice, tell the interviewer so that she/he can phone through other appointments too. 8.2 What the interviewer has told respondents about your visit The interviewer introduces your visit at the end of the interview by reading out the following: There are two parts to this survey. You have just helped us with the first part. We hope you will also help us with the second part. The second part of the survey is a visit by a qualified nurse to ask a few more questions and to carry out some measurements. I would like to make an appointment for the nurse to come round and explain some more about what is required. May I suggest some dates and times and see when you are free? The list below shows the general points given to interviewers to help them answer questions about your visit. 11 General points to make when introducing the nurse visit * it is an integral part of the survey - the information the nurse collects will make the survey even more valuable. * the nurse is fully trained (Grade E or above). They have all had extensive experience of working in hospitals, health centres or wherever and have also been especially trained for this survey. * if the respondent wants, they will be given the results of the measurements carried out by the nurse, including the results of their blood test. If they like, this information will also be sent to their GP. * we will not be testing for HIV, or any other viruses. * the amount of blood (usually 15ml) taken is tiny compared to the pint that blood donors give. * they are not committing themselves in advance to agreeing to everything the nurse wants to do. Separate permission will be asked for each test - so the respondent can decide at the time if they do not want to help with a particular one. Written permission is needed from a respondent before a blood sample can be taken. * the equipment for taking blood is known as the Vacutainer system. It is safe and efficient. Fresh equipment is used for every sample. * over 30,000 people have already given blood samples on the Health Survey for England and over 6,000 people gave blood samples for the Scottish Health Survey in 1995. * the local medical ethics committee in your area has been consulted and has given their approval to the survey 12 If a person is reluctant, the interviewer is asked to stress the point that all they wish to do is to make an appointment for you to go along and explain exactly what is involved. They point out that by agreeing to see you they are not necessarily agreeing to take part in all, or any, of the tests. We hope your general professional approach will convince nervous respondents more effectively than can an interviewer. At the end of the interview each respondent is given a Stage 1 Information Leaflet by the interviewer. This leaflet briefly describes the purpose of your visit. You have been given a copy of this leaflet. You will be giving respondents a Stage 2 Information Leaflet (pale yellow). This describes in greater detail the measurements and tests involved at Stage 2. 8.3 Appointment Record Card The interviewer will give each respondent an Appointment Record Card. This confirms the appointment time and reminds them that we would like them to avoid eating, smoking and drinking alcohol for 30 minutes before you arrive. It also asks them to wear light, non-restrictive clothing and to find their medicine containers. A copy of this card is in your supplies for information. If you are working in a vitamin sampling area, your interviewer-partners will try to schedule your appointments for mornings, and will ask adults respondents not to eat prior to the appointment so that we may obtain a fasting sample whenever possible. 9. ACHIEVING A HIGH RESPONSE RATE 9.1 The importance of a high response rate A high response rate at both stages of the survey is crucial if the data collected is to be worthwhile. Otherwise, we run the risk of getting findings that are biased and unrepresentative, as people who do not take part are likely to have different characteristics from those who do. Keeping respondent co-operation through to this important second stage of the survey will therefore be vital to its success. 9.2 “You won’t want to test me…” Some people think that they are not typical (they are ill, they are young and healthy, and so on) and that it is therefore not worth while (from both your and their point of view) to take part in the survey. You will have to explain how important they are. The survey must reflect the whole eligible population in Scotland, so we need information from all types of people, whatever their situation. If someone suggests that you see someone else instead of them, explain that you cannot do this, as it would distort the results. Our target is to interview and measure everyone. The measurements carried out by the nurse are an integral part of the survey data and without them, the interview data, although very useful, cannot be fully utilised. 9.3 Health is interesting and important People are interested in health and are concerned about it. This is a high profile survey on a topical issue. Survey reports about both the Scottish and English Health Surveys receive wide press coverage. 13 In any case, your respondents have already co-operated with the first part of the survey, and have agreed to see you. Most of them will be looking forward to your visit and will be keen to help. But some may have become reluctant to co-operate, perhaps because they have become nervous. You will need to use your powers of persuasion to reassure and re-motivate such people, as it is vital that they take part. 9.4 Respondents are not patients Your previous contact with the public as a nurse will normally have been in a clinical capacity. In that relationship, the patient needs the help of the professional. Your contacts with people in the course of this survey will be quite different. Instead of being patients, they will be people who are giving up their leisure time to help us with this survey. You need their help to complete your task. The way you deal with them should reflect this difference. They are under no obligation to take part, and can decline to do so - or can agree, but can then decline to answer particular questions or provide particular measurements. But of course we want as few as possible to decline, and we rely on your skills to persuade them to participate. 10. WHAT TO DO ON INITIAL CONTACT 10.1 Keep your introduction short While you will need to answer queries that respondents may have, you should keep your introduction short and concise. As already noted, some of the people you approach may be hesitant about continuing with the survey, and if you say too much you may simply put them off. The general rule is to keep your initial introduction short, simple, clear and to the immediate point: Introduction * Show your identity card * Say who you are: “I am a nurse called…” * Say who you work for: “I work for Social and Community Planning Research” * Remind respondents about your appointment: “A few days ago you saw an interviewer about the Scottish Health Survey and s/he made an appointment for me to see you today.” For most people this will be enough. They will invite you in and all you will have to do is to explain what your visit will cover and what you want them to do. But others will be reluctant and need further persuading. Build on what has gone before you. Be prepared to answer questions about the survey and its purpose. Use the points in the box on the next page when necessary. 14 * who you are working for - SCPR and UCL (see section 3) * who the survey is for - for the Scottish Office (Department of Health) * why the survey is being carried out - see sections 1 and 2 * what you are going to do - see section 11 * how the respondent was selected for the survey - it was the address that was selected. 46 addresses in this area were selected from the Postcode Address File. This is a publicly available list of addresses to which the Post Office delivers mail. One adult and up to two child respondents are selected at random at each address. The way respondents are selected means that they form a true cross-section of the population of 2-74 year olds of Scotland. Once a respondent is selected, we cannot substitute anyone else. Otherwise we would no longer have a proper sample of the population of 2-74 year olds. * the confidential nature of the survey - individual information is not released to anyone outside the research team. * how much time you need - this varies a bit but it is best to allow about 70 minutes per adult with an additional 15 to 40 minutes per child plus 15 minutes per household (to put equipment away and so on). Length of children’s interview increases with age of the child(ren). Some respondents may have forgotten what the interviewer told them about the survey’s purpose or what your visit involves. You should therefore be prepared to explain again the purpose of the survey. You may also need to answer questions, for example about how the household was sampled. Some points you might need to cover are shown above and in the box on page 12. Only elaborate if you need to, introducing one new idea at a time. Do not give a full explanation right away - you will not have learned what is most likely to convince that particular person to take part. Do not quote points from the boxes except in response to questions raised by the respondent. Be careful to avoid calling your visit a “health check” - it is not. One of the most common reasons given in England for respondents refusing to see the nurse is “I don’t need a medical check - I have just had one.” Avoid getting yourself into this situation. You are asking the respondent to help with a survey. 10.2 Being persuasive It is essential to persuade reluctant people to take part, if at all possible. You will need to tailor your arguments to the particular respondent, meeting his or her objections or worries with reassuring and convincing points. This is a skill that will develop as you get used to visiting respondents. If you would like to discuss ways of persuading people to take part, speak to your Interviewer Supervisor (or to the Scottish Area Manager). 10.3 Broken appointments If someone is out when you arrive for an appointment, it may be a way of telling you they have changed their mind about helping you. On the other hand, they may have simply forgotten all about it or had to go out on an urgent errand. 15 In any case, make every effort to recontact the person and fix another appointment. Start by leaving a Broken Appointment Card at the house saying that you are sorry that you missed them and that you will call back when you are next in the area. Try telephoning them and find out what the problem is. Allay any misconceptions and fears. Make them feel they are important to the success of the survey. A chat with your interviewer partner might help. She/he might be able to give you an indication of what the particular respondent’s fears might be, and may have notes that would tell you when would be the most likely time to find the respondent at home. Keep on trying until you receive a definite outcome of some sort. 10.4 The number of calls you must make You are asked to keep a full account of each call you make at an address on page 2 of the Nurse Record Form (see Section 12.4 for a description of this form). Complete a column for each call you make, telephone calls as well as personal visits. Note the exact time (using the 24 hour clock) you made the call, and the date on which you made it. In the notes section keep a record of the outcome of each call - label your notes with the call number. You must make at least 4 personal visits per respondent before you can give up. Each of these calls must be at different times of the day and on different days of the week. However, we hope you will make a lot more than four calls to get a difficult-to-track down respondent. If you fail to make contact, keep trying. 11. INTRODUCING YOUR MEASUREMENT TASK 11.1 The introduction The interviewer will have introduced your visit, but has been told to give only a brief outline of what it is about. She/he will have told respondents that you are the best person to explain what your visit is about. So before you make any measurement, you will need to explain what you hope to do during your visit and to reassure nervous respondents that every stage is optional. Respondents and their GPs, if the respondent wishes, will be given their blood pressure and lung function readings and the results of the blood tests. 11.2 The Stage 2 Leaflet A copy of the leaflet must be given to all respondents before you start doing any measurements. It describes what you will be doing and sets out the insurance implications of allowing the information to be passed to GPs. Give the Stage 2 Leaflet to respondents after you have explained what you are going to do and the order in which you wish to see them. Ask them to read it while you get your equipment ready. This will give them something to do, give them time to read it and you time to sort yourself out. Be prepared to answer any questions they may have at this point. 12. YOUR SAMPLE 12.1 Your sample The sample for this survey is a random probability sample. This means that all adults aged 16-64 in Scotland have an equal chance of being selected. 16 14,352 addresses have been drawn from the publicly available Postcode Address File. Sampled addresses are clustered into 312 Postcode Sectors (on average, a sector is an area bout the size of an electoral ward) - and 46 addresses per sector have been selected. 26 postcode sectors will be covered each month. Each quarter of the sample is fully representative of the population of Scotland. Each nurse will be assigned 2 interviewer partners who together are responsible for the 46 addresses in a postcode sector. The aim is to interview and measure one randomly selected adult aged 16-74 and up to two children aged 2-15 from each of the addresses. Non-residential addresses and addresses containing no-one in the eligible age-range are excluded; on average, about one third of the addresses will be excluded from each sampling point. The interviewer’s first task is to make contact at each sampled address and identify how many households are resident. In most cases there will be one household, but occasionally an address will contain two or more households (e.g., a house may be split into flats that are not separately identified by the address). Sometimes, an interviewer will be making a selection of up to 3 households within an address for inclusion in the study. The interviewer will send you details of any additional households that have been selected (see section 12.5). The interviewer’s next task is to identify all the persons aged 2-74 who live in each of the households and select one adult and up to two children at random in each for interview. All persons who are interviewed are eligible for the second stage of the survey - the nurse visit. The interviewer will arrange an appointment for you to call. In some cases however the respondent will refuse to co-operate with this second stage. The interviewer will provide you with full details of appointments made and of addresses at which no-one has co-operated with the survey. 12.2 Serial Numbers Each respondent interviewed by the interviewer has been given a unique identity number. This number allows us to distinguish which documents relate to which person. This number is called the Serial Number. The serial number is made up of a number of different components: Point Number - a three-digit number for the postcode sector (the sampling point). This will range from 001 to 312. All addresses you will have in a month will have the same point number. Address Number - a two-digit number for the address sampled from the postcode file. These will run from 01 to 46 within each sampling point (postcode sector). Household Number - a one-digit number for each sampled household at the address (number 1, 2 or 3). This is always 1 on the NRFs you are originally issued with; 2 and 3 are used for additional households selected by the interviewer at an address. Check Letter (CKL) - a letter of the alphabet. Person number - This is always 1 for the selected adult 2 for Child A 17 3 for Child B The serial number of the respondent must be recorded on all documents for that respondent. Great care must be taken to ensure that the correct serial number has been used. It is vital that the information the interviewer collects about someone is matched to the information you collect about them. If the wrong serial numbers are entered on documents, there is a danger that the data from one person will be matched with that from someone else. 12.3 Nurse Sample Sheet (NSS) At the start of each month’s fieldwork, you will be given a list of the 46 addresses in the sampling point that you and your two interviewer partners are covering. You will also be given two Nurse Sample Sheets (NSS, on green paper) - one for each of your interviewer partners. Write in the postcode sector (first three of four characters up to the space in the full postcode) in which you will be working, and its 3-digit point number. The purpose of this sheet is to let you keep an account of the work you receive from each interviewer. At the end of the interviewer’s fieldwork period you should be able to account for all the 46 (or more if multiple occupancy) addresses on your NSSs Each of the two NSSs is divided into 23 rows - so there is one row for each address sampled in the postcode sector. Each address row has been sub-divided into three - to allow for up to three households at each address to be covered (see 12.1 above). Where there is only one household at an address, that household is automatically Household No. 1. If there are additional households to be covered, the interviewer will have given these households Serial Numbers 2 and 3. An example of the first page of a partially-completed NSS is shown on the next page. 18 EXAl'\llPLE OF 'NURSE SAMPLE SHEET' pt P1731 THE SCOiTlSH HEALTH SURVEY: 1998 NURSE SAMPLE SHEET POINT: I D1 0 12 I SURVEY MONTH: C2I1] POSTCODE SECTOR: I KA 8 NU RSE N AME : PAM£Lt\ i3LA KeMORE. NURSE N UM SER : I \ b 5 4- N 1 To be supervised SUPERVISOR TELEPHONE NAME: M. C 16b5 YESGn:~O NUMBER: 0141 533 2.210 If outcome A Address Household Date Interview Number Date of Number Date NRF serial serial received outcome to be appoint- measured posted to number number NRF AorS measured ment by nurse office Notes 1 0\ 2 3 1 51.::r A 3 siT 3 5J1- v--ppt 3.00~m 02 2 3 1 I b l.::r h ,...- .,/' ./' I b I ::t ~ppt 1~.30 03 2 lOl=1- A t 2311- 3 1 Qt 2 3 1 15 Iq. A 2 11) I~ ~Pfi" IQ.~Q· 05 2 J51=t A 3 Ft- 11- 2 Ft-Iq. .'I-~\'\ It-j CV! 1101"\ 3 c~ifC/Og1':30 1 Ob 2 3 1 Oi- 2 3 Please turn over 19 12.4 Nurse Record Form (NRF) This is a four-sided lilac document which records the outcome of each household selected for interview, regardless of whether or not the respondent agreed a nurse visit. Pages 1 and 2 of the NRF are completed by the interviewer who will then post the NRF on to you to complete pages 3 and 4. Once these have been completed you will then post them back to the office. It is vital that you receive an NRF for each household selected for interview by the interviewer, even if there is no nurse visit to be made. You will be sent (by the interviewer) a minimum of 46 of these lilac forms, depending on the number of households found and selected in the sampling point. Although there may be nothing for you to do at some of the addresses (see below), the interviewer will contact you about each address so that you can check that they have all been dealt with by the interviewer-nurse team, and that none have been missed by either of you. If there is more than one household at an address at which an interview has been carried out, you will be sent extra NRFs by the interviewer to cover Household Numbers 2 and 3 as necessary. These extra households will also need to be accounted for on the NSS. You should receive a NRF for every household selected by the interviewer, whether they were successful in getting the interview or not. Please check with your interviewer partners that you receive all NRFs. The Nurse Record Form has two functions. It tells you the outcome at each household of the interviewer’s attempts to obtain an interview and arrange an appointment for you. It is also the form on which you report how successful you are yourself at those households where appointments have been made for you. At the top of page 1 on the NRF, you will find a label containing: - the address - the serial number (all labels are for Household No. 1, so HH = 1 on all address labels) - a code showing if vitamin analyses will be done (BT:S is for standard blood tests only; BT:V is for vitamin tests) - the month of fieldwork An example address label is shown below: POINT: 019 MAR/Y ADD/HH: 23 1 D BT: S 14 Mosside Road AYR KA8 9ET If the interviewer discovered more than one household at the address they will complete a NRF for each of the additional households (selecting up to 3 households in total at each address) and write in the address label information. This information will be the same as for the other households at that address, except for the HH identifier which will be 2 or 3, and the check letter which will be 1 or 2 letters after that for household no. 1 for households numbered 2 or 3 respectively. You will need to write in your own name and nurse number in the space provided at the top of the Address label. You should also write in the name of the interviewer who is covering the address. 20 The interviewer will code the “Interview outcome” in the middle of the page by ringing either code A or code B. Code A = the respondent has agreed to a nurse appointment Code B = no nurse appointment has been made (including situations where the interviewer found that the address was empty, as well as ones where the selected respondent refused to be interviewed or to be visited by a nurse, or where no-one in the household was found in the eligible age-range). If Code A applies, the interviewer will have completed Q2-Q4 on the NRF. He/She will have entered the full name and title of each respondent, the respondents’ ages, the telephone number (if known), the date of the interview and the nurse appointment details (dates and times). There is space on the front of the NRF for the interviewer to write in other information, including the location of the household within the address (if there is more than one household living there), and any tips about the household location or the respondent that the interviewer feels you might find useful. On your NSS, you should enter the date you received the NRF from the interviewer and enter code A (in the fourth column). How you complete the rest of this form is covered in Section 18. If Code B applies, there is nothing for you to do at this household. All you need to do is ring outcome code 80 on page 3 of the NRF, note on your NSS the date you received the NRF and enter code B (in the fourth column). An example of pages 1 and 2 of a completed NRF is shown on the next two pages. 12.5 Additional households The procedure for additional households (HH No 2 and 3) at an address is the same as for cases where only one household exists at an address. For each additional household, the interviewer will complete an extra NRF and post it to you. The interviewer will complete the details in the top left, showing the serial number, address, blood sample type, and month of issue. The interviewer will also ring outcome code A or B. If code A is circled (ie. an appointment has been made for you), the interviewer will complete the details at Q2-Q4 and write in any other useful information before sending the NRF to you. You need to write in your name and nurse number, and make sure that you have complete information at page 2 of the NRF. If code B is circled the interviewer will still send the NRF to you and you will post it straight back to the office. 21 EXAMPLE OF 'SCOITISH HEALTH SURVEY NURSE RECORD FORM (NRF)' pl·2 SLOT NAME: JlI\ L P1731 scomSH HEALTH SURVEY: 1998 RETURN NO: NURSE RECORD FORM (NRF) FINAL OUTCOME I 8J INTERVIEWER NAME: gA R SA RA CLA j( r;::. E No: I 14(,2 D2 NURSE NAME: PA M € LA g LA t::EM,{) R-t No: I I 04:r N I ADDRESS LABEL IF HOUSEHOLD 2 OR 3, WRITE IN: HOUSEHOLD LOCATION DETAILS ADDRESS: POl.ne.; 665 ;"PR h CdU::f:N fR IJ I'IT l)VO R. ;;dd.'HH: 01 1 .:... 6T:S 17 nrndale Crescen~ LAK~E. TRE'6- I N fRo NI Motn,f.!.eth DUNDEE C; A ,K.O E- c'-l POSTCODE DDS "*.:'D MO:: 1 GR: 3..;516 10116 £9 n~me; M~_ D. smith SERIAL NO: USEFUL TIPS , le~flJt1cUVrT ~v\l'fOVH VivOvtT jlv'IV18 hIClOCL. 1. INTERVIEWER INTERVIEWER NURSE OUTCOME SUMMARY TO DO TO 00 AI !east one nurse appointment made Complete PART A Complete PART B 0 below and on page 2 on pages 3-4 No nurse appointment made B Send NRF to Nurse Retum NRF to Office PART A: TO BE COMPLETED BY INTERVIEWER DAY MONTH YEAR 2. DATE HOUSEHOLD INTERVIEW CONDUCTED: 22 3. COMPLETE GRID BELOW FOR THE SELECTED ADULT (AGED 16 - 74). (IF NO SELECTED ADULT, TICK HERE: [] SEX AGREED REFUSED NO INTER· APPOINTMENT DATE APPOINTMENT TIME 1=mal. AGE NURSE NURSE VIEW FULL NAME & TITLE (MRlMRSIMS) 2=lomBI. M..:....:...:R5~Th_~ 0~ L-I _N_£--Cfo--=.;s:::.-,_t_R __---'I rn 1bl1- I G) 2 3 l:t L'l q 8 I 1 00,15 4. HOW MANY CHILDREN AGED 2-15 WERE SELECTED? Non. 0 GO TO QS On. 1 COMPLETE CHILD A GRID BELOW Two CV COMPLETE CHILD A AND B GRIDS BELOW CHILD A IOLDER SELECTED CHILD) SEX AGREED REFUSED NO 1=mal. AGE NURSE NURSE INTERVIEWI APPOINTMENT DATE APPOINTMENT TIME FULL NAME 2:female NO PARENT,.-______---. ~8 a)1 MAR.'! WATSON Imm 2 3 I 1- '3"\1\ L'/ I IL-_I0_, _15_--, 'v PAAENTTYPE '" PARENT LEGAl PARENTAL ReSPQNS!BUTY FULL NAME Parent 1: 8 2 'M RS K-A ~ WA-r50N Parent 2: 1 J\1 R Pf:Tf;K HDLJ)f;N CHILD B (YOUNGER SELECTED CHILD) SEX AGREED REFUSED NO 1=male AGE NURSE NURSE INTERVIEWI APPOINTMENT DATE APPOINTMENT TIME b) FULL NAME 2=lomBI. NO PARENT,.-______---. ',---M,.:-..A_K_K _11_17_L_-Ds_N __ --'1 rn ,0 I=tl (0 2 3' ::r- JV\ L~ ~3 I I lb. 30 PARENT TYPE PARENT LEGAL PARENTAL RESPONSIBILITY FULL NAME Parent 1: P~-re-K. ~OlDE:N 8 2 I MK 1 ~~ Q Parent 2 IAA (Ni WAlSO N 12.6 Interim Appointment Record Form Interviewers are instructed to make nurse appointments for as soon after their visit as possible in order to minimise broken appointments. Although the interviewers will post all NRFs immediately, they will also telephone you to tell you when they have made appointments for you. That way you will know immediately (just in case the NRF gets delayed in the post) and also this helps you to keep track of how many NRFs you should be receiving. The Interim Appointment Record Form is a two page white document. Page 1 provides space for you to write in the address details and the date of the household interview. Page 2 looks identical to page 2 of the NRF. You should make sure that you have all the information recorded for each person selected by the interviewer as you will be unable to conduct your visit without it. The interviewer will contact you about every address issued. An example of page 1 is shown overleaf. 24 EXAMPLE OF THE INTERIM APPOINTMENT RECORD FORM pt P1731 INTERIM APPOINTMENT RECORD FORM (to be completed by nurse when appointment details are initially transmitted by telephone) An appointment has been made at: POINT ADDRESS HHLD CKL Household Serial Number: 1bl ~ 161 [Q[JJ IT] ~ ADDRESS DETAILS (if required) 11- Ay-VI et cd e Cv-.-{ S Cf V\ t MOV1ir{rYl DVI. N D-E ~ boS 4AD Telephone number: I 014 \ ~b2 4o=ts 1. Date details telephoned through: 05 0+ 38 Day Month Year 2. Date of household interview: 05 o:::r ~O Day Month Year Please turn over to complete 25 13. OBTAINING CONSENT TO INTERVIEW MINORS Children aged 2-15 can only be seen by a nurse if they have the permission of their parent(s) or a person with permanent legal parental responsibility for them, and if this parent/legal parent is present during your visit. For children in this age range, the interviewer will have obtained information on which of the people living in the household are their parents, or have permanent legal parental responsibility for them. This information is recorded on the Nurse Record Form (NRF) in order that you know in advance of your visit who to speak to, to obtain permission to interview and measure a child. The term ‘parent’ means the child’s natural or adoptive parent. All other people who claim parental status have been classified on the NRF as having legal parental responsibility. Priority should always be given to someone defined as a parent when obtaining permission. If disagreement arises between parents and/or between parent and child regarding whether or not to co-operate, always respect the wishes of the one who does not wish to co-operate. 16 and 17 year olds: Blood samples can only be obtained with the written consent of both the respondent and the respondent’s parent or the person who has legal parental responsibility for the respondent. If a minor is married, their spouse is not their parent nor have they acquired parental responsibility. The written consent of a spouse is not an acceptable substitute. Written consent must always be obtained in advance of taking a sample. 14. PREPARING FOR THE INTERVIEW During your interview with a respondent you will use the Nurse Schedule which is now on computer and the Consent Booklet (plus an associated Drug Coding Booklet and the equipment needed for measurements). 14.1. The Consent Booklet Immediately before you start to carryout measurements on a respondent, complete the first half of page 1 of the Consent Booklet. Never do this in advance of your visit to the household. Do NOT prepare these documents in advance of your visit, as there is a serious danger that you will use the wrong set of documents for the wrong person. It is all too easy to do in the stress of the moment. Check carefully that you have entered the respondent’s correct serial number. Use a black pen when completing the booklet, and ensure that signatures are always in pen, not pencil. Use capital letters and write clearly. Do not erase any of the personal information. If necessary, cross out errors and re-write so that any corrections can be seen. Write the address at which you are interviewing in the box at the top of the Consent Booklet. Write the survey month next to the box (i.e. December), and then fill in the serial number boxes. Accuracy is vital. Enter your Nurse Number at Item 1 and the date on which you are interviewing at Item 2. At Item 3 record the full name of the respondent. We will be using this to write a thank-you letter to the respondent giving them their test results (if they wish), and to write to their GP (with their permission) to give him/her their test results. The name by which the GP knows the respondent 26 and any other names the respondent is known by should be checked and recorded during the interview. This may, for example, be a maiden name. Code the respondent’s sex at Item 4 and ask the respondent for their date of birth and enter this in the boxes provided at Item 5. The respondent may say they have already given it to the interviewer. Explain that you have been asked to get it again as it will help ensure the right documents get put together. At Item 6, write in the name of the respondent’s parent if the respondent is aged between 5 and 17. Items 7-9 are completed during the course of your interview. At Item 7 you write in the name, address and telephone number of the respondent’s GP, if the respondent gives consent for their blood pressure, lung function and/or blood test results to be sent to their GP. If a respondent does not know the name of their GP, leave the top line blank (otherwise the computer will send out a nonsense letter like Dear Dr. Ash Grove Practice). Fill in the full name and address of the GP on every Consent Booklet for a household, even when all members have the same GP. Each individual is treated separately once they reach the office. At Item 8 record how complete you believe the GP address to be. If you are sure that a letter posted out of the area to that address would arrive, ring code 1. Summary of consents is very important. You record here the outcome of your requests for permission for: a) the blood pressure results to be sent to the GP b) the lung function results to be sent to the GP c) a sample of blood to be taken d) the blood sample results to be sent to the GP e) a small amount of blood to be stored for future use f) their blood sample results to be sent to them. By the end of the interview every respondent should have SIX codes ringed at Item 9. There are six Consent Sheets contained in this booklet: BP(A) and BP(C) Blood pressure information to GP consent forms. BP(A) is for adults aged 16+ to sign and BP(C) is for the parent or person with legal parental responsibility for children aged 5-15 to sign. LF(A) and LF(C) Lung function information to GP consent forms. LF(A) is for adults aged 16+ to sign and LF(C) is for the parent or person with legal parental responsibility for children aged 7-15 to sign. BS(18+) and BS(16-17)Blood sample consent forms. These forms are in three parts: part I obtains consent to take blood; part II obtains consent to give the results to the GP; and part III obtains consent to store part of the blood. B(18+) is for adults aged 18+ to sign and B(16-17) is for 16-17 year olds, and the parent or person with legal parental responsibility for a 16-17 year old, to sign. The last three pages of this booklet are despatch notes for blood samples. Despatch 1 is a tear off sheet to go with samples to the Royal Victoria Infirmary laboratory in Newcastle. Despatch 2 is returned to the office with the rest of the booklet. Despatch 3 is a tear off sheet to pack with the 27 vitamin samples and deliver with the sample to local labs (and is only used in the sampling points where extra blood has been taken for vitamin analysis). 14.2. The Nurse Schedule The Nurse Schedule is no longer on paper, but on computer. Rather than you having to work out which sections to complete, once it knows the respondent’s age, it will tell you which questions to ask and which measurements to take. Before you leave home, you will need to enter the household information manually from the NRF or Interim Appointment Record. Entering the data manually will take several minutes, so you should do this before you leave home. Before setting out to carry out any interviews, you must check to make sure that you have received the household information from the interviewer. You will not be able to conduct the interview without this. 14.3. At the Household When you arrive at the household, before starting to carry out your interview, check whether any of the people you have come to see have eaten, smoked, drunk alcohol or done any vigorous exercise in the last 30 minutes. This could affect their measurements. If someone has done any of these things, arrange to see other members of the household first in order to give time for the effects to wear off. Similarly if someone in the household wants to eat, smoke or drink alcohol in the near future (eg. one person is going out and wants a snack before they leave) then try to measure that person first. Adapt your measurement order to the needs of the household. Below is a grid which shows which measurements apply to which age group. The computer will automatically take you to the correct measurements for each person, so you do not need to know this off by heart. However, you may find it useful to know this information when making your introduction to respondents. Measurement Age group Arm circumference 2-15 Blood pressure 5-74 Demi-span 65-74 Waist/hip 16-74 Lung Function 7-74 Blood 16-74 Saliva 4-74 14.4. Getting into the schedule When you arrive at the household, you should enter the household schedule and check that it is the right one by looking at the serial number and/or viewing the information about the household members. Once you have switched on and entered the keyword, you will see the Project Menu on screen. 14.5. Household information (to be checked/completed before entering household) ScrOut 28 This screen displays 4 options. Code 1 Takes you to the first question in the program to start interviewing. Code 2 Also takes you into the program, either to start interviewing, or to press Code 3 This is used in cases where all eligible respondents refused a nurse visit to the interviewer. In these cases you will be routed to ANurO which says this household will be signed off. Once you enter your nurse number the admin for this household will be computed automatically and the correct outcome code assigned. Code 4 This category allows you to clear cases that are to be reallocated to another nurse or cases opened by mistake (eg. an extra household). If you choose code 4 there is a follow up question asking you why you want to clear the case. 14.6. General tips on how to use the computer program Read out the questions in the Nurse Schedule exactly as worded. This is very important to ensure comparability of answers. You may think you could improve on the wording. Resist the temptation to do so. Enter the code number beside the response appropriate to that respondent, indicating the answers received or the action you took (eg. at the question called PregNTJ, if the respondent is pregnant, you enter code 1). Some questions take the form of a “CHECK” - see Upreg for an example. This is an instruction to you to enter something without needing to ask the respondent a question. If a question appears in capital letters, do not read it out, it is for you to read to yourself only. When you get a response to a question which makes you feel that the respondent has not really understood what you were asking or the response is ambiguous, repeat the question. If necessary, ask the respondent to say a bit more about their response. 15. THE INTERVIEW Once you have verified the information of all the people to be interviewed, go into NURSCHED for the person to be interviewed first. Remember NURSCHED[1] = selected adult NURSCHED[2] = Child A NURSCHED[3] = Child B The first screen for each schedule displays the information for the person you are going to be interviewing. Make sure these details are correct and that you haven’t opened up the wrong schedule. Enter the time and date and check the respondent’s date of birth and age at the appropriate questions. 15.1. Prescribed Medications -- all respondents Prescribed medicines - all respondents There is then a set of questions about prescribed medicines. Ignore any non-prescribed medicines that the respondent may be taking. Medicines that were prescribed in the past, but are currently purchased over-the-counter are considered prescribed medicines for the survey. Record the brand 29 name of all the prescribed medicines currently being taken by the respondent (we are not interested in any medicines prescribed years ago, and no longer being taken). Medicines should be being taken now, or be current prescriptions for use "as required". Keep checking "Are you taking any other medicines, pills, ointments or injections prescribed for you by a doctor?". Try to see the containers for the medicines. Do not probe for the contraceptive pill as this may be embarrassing or awkward for some respondents. If it is mentioned, record it. Pills for hormone replacement therapy should also be included. Include suppositories, injections, eye drops, and hormone implants if they are on prescription. The interviewer will have told the respondents that you will be asking about prescribed medicines, and will have asked the respondents to get their medicines ready prior to your visit. The respondents may have forgotten this, and so you may have to ask them if they can fetch the containers so you can look at them. If possible ask all members of the household to collect together their medicines and prescribed dietary supplements early on in your visit, to avoid multiple trips to the bathroom cabinet. Check the name of the medicine very carefully and type it in accurately. Record the brand name or generic name so that you can code it. One of your tasks is to enter a six-digit code for the drug. It is important that you enter the drug codes while you are in the respondent’s house as it will give you the chance to query any hard-to- find drugs and to ask a respondent what a drug is used for if it has several uses. The computer will not let you leave the schedule until it is done. There are also one or two new follow-up questions for certain drugs which are commonly prescribed for CVD conditions, to find out whether or not it has been prescribed for one or more of these conditions. Once you have entered the name of each prescribed medicine, enter the DrugCoding schedule by pressing To do the drug coding, look in the ‘Coding Prescribed Medicines’ booklet first. This booklet lists the 400 (or so) most commonly used drugs in alphabetical order and gives their code in the format required for the survey. Taking Premarin tablets as an example, the alphabetic listing gives the entry 06 04 01. Enter this as a continuous string of numbers, ie. 060401 (no spaces or dashes). If the medicine is not in the Coding Booklet, use the September 1997 edition of the British National Formulary (BNF) supplied in your equipment bag. There are two important points to remember when entering classification codes from the BNF. Always record to the third level of classification and always add a leading zero to single digits. If you follow these guidelines your codes should always be recorded in a six-digit format. Look for the drug in the back to find its page number. Once you have located the page for that drug, find the chapter numbers that most closely precede the drug listing. For example, if you look up Premarin (tablets) in the BNF, you find it listed in section 6.4.1.1. It is classified to a fourth level. For our purposes we are only interested in the first three levels or 6.4.1. With leading zeros, this becomes 06 04 01. 30 Some drugs only have two section numbers in the BNF. Under these circumstances, add double zeros to the end of the code. For example, Sulphasalizine is in section 1.5 of the BNF. For our purposes the drug code would be 010500. If you are unable to find the correct code, enter ‘999999’. If you cannot find a drug in the BNF, or it is has more than one reference and you are not sure how to deal with it, record its full name clearly and what it is being taken for. If the respondent takes aspirin record the dosage, as this can vary. To get out of the drug coding block, press With practice, you will get to know the more common drugs and will be able to code them quickly. 15.2. Dietary Supplements -- all respondents Vitamin This is asking about non-prescribed diet supplements, eg. multi-vitamins, iron tablets or any other ‘health food’ supplements. This is not asking about medication for an acute illness, eg. cough syrup. Any dietary supplements that are prescribed should be recorded in the previous set of questions. 15.3. Nicotine Replacement Products Upreg -- girls aged 10-15 Be careful not to read this question to the respondent -- only code ‘yes’ if the information has already been given to you. Smoke/LastSmok -- adults only These are new questions for 1998 and they have been included to help with the analysis of the blood pressure readings. UseGum/UseNas/NicPats -- adults only We want to check whether the respondent has been exposed to nicotine other than by smoking or passive smoking, as this may affect some of the blood tests. We are only interested if they have used any of these products in the last seven days. If the respondent has used nicotine chewing gum in the last seven days, check if it was 2mg or 4mg. If they used both, code the strength used most recently. NicPats asks about nicotine patches. There are many types of nicotine patch on the market. Most of them have similar names and many of them have different strengths within a brand. Ask for the name and strength of the product that the respondent uses. Do not prompt the respondent, as they are likely to pick one of the names you say (since so many of them have similar brand names). Ideally, try to see the packet. If they have used more than one brand or strength within the last 7 days, code the most recently used. UseNas asks about nicotine sprays or inhalants which are fairly rare but some respondents may have used them. 31 15.4. Gastrointestinal illness Diarr - lIIDay These questions were asked in 1995 and ask about illnesses which involved vorruung or diarrhoea in the past six months. The purpose of these questions is to estimate the prevalence of gastroenteritis and / or food poisoning. We are only interested in cases where someone had three or more loose stools in a 24 hour period; or had loose stools together with abdominal pain, nausea or vomiting; or was vomiting three times or more in a 24 hour period. You should exclude cases where these symptoms were caused by something other than an infection, such as pregnancy, alcohol, or some irritable bowel diseases. The rest of the program is concerned with the various measurements you have to make and with obtaining blood samples. The protocols for doing these are given separately. The rest of this section describes each measurement in turn and how to enter these measurements into the program and how to fill in the relevant pages of the Consent Booklet. 15.5. Measurement of Mid·Upper i\rm Circumference •• children only 15.5.1. Purpose: The mid upper arm circumference is a key indicator of the nutritional status of children, being reduced substantially in the undernourished and being substantially increased in children who are overweight. 15.5.2. Eligibility: All children aged 2 to 15 are eligible for this measurement. Exclude any child who is known to be pregnant. It is very imponant that the parent is present during this measurement as you will be asking the child to bare hislher arm. 15.5.3. Equipment: You will be provided with a shon tape. One end of this tape is broad and on it you will see the words "READ HERE", with a small arrow. This is the stan of the tape. You will first use this tape to measure the length of the upper arm and then, having found the mid point of the upper arm, you will measure the circumference of the arm. When measuring the circumference of the arm, the tape is threaded as indicated in the illustration below. Pull the tapered end up through slot I, down through slot 2 and up through slot 3. Illustration from HSE '97 Nurse Instructions •• SCPR 15.5.4. PROCEDURE The child must have a bare arm and shoulder for this measurement. The interviewer will have asked the child to wear a sleeveless garment for your visit. Explain to the child and parent the imponance of the accuracy of the measurement and that clothing can substantially affect the reading. If the child is wearing a sleeved garment ask her/him to slip their arm out of the garment or to change into a suitable garment. Where possible the left arm should always be used. If the left arm cannot be used, ego because it is in plaster, then carry out the measurement on the right arm and record that you have done so when prompted by the computer. 32 Measuring the length of the respondent’s upper arm 1. The respondent should be standing with their left arm across their body and held at a right angle at the elbow. 2. Using the skin marker pen, mark the process of the acromium; this is the bony tip of the shoulder. 3. Mark the process of the olecranon of the child, this is the bony tip of the elbow. 4. Using the paper tape, measure the distance between the two points marked. Divide this measurement in half. This will be the mid-point of the upper arm. Mark this using the skin marker pen. Measuring the arm circumference 5. Now let the arm hang loosely by the side, just away from the body. Thread the tape through and slip it up the child’s arm to the mid-point you have marked. The tape should be centred on the mid-point mark ie. it should lie on top of the mark. Check that the tape is passing horizontally about the arm (not sloping) and that is in continuous contact with the skin. It should not be loose, but neither should it be puckering the skin. Read off the measurement where the “READ HERE” arrow appears on the tape. 6. Record the measurement in the computer in centimetres and millimetres to the nearest millimetre, eg. 20.3cm. Always record the response to one decimal point. The computer will not allow a response without a decimal point, so even if the measurement comes to, say, exactly 16cm, you must enter 16.0. If you do enter a measurement ending in 0, the computer will ask you to confirm that you meant to do so. Should the measurement lie between two millimetres, then round it to the nearest even millimetre. For example, if the measurement is half way between 20.3 and 20.4 round up to 20.4. If the measurement is between 20.8 and 20.9 round down to 20.8. 7. Code each measurement’s reliability. ‘Unreliable’ does not refer to any measurement errors that you may have made, but rather to bulky clothes being worn or the child fidgeting and moving too much. 8. Repeat all the above procedure (points 1 to 6) to obtain a second measurement and record this on the nurse schedule. Recheck the process of the acromium and olecranon and remark the midpoint before measuring the arm circumference. Do not re-measure the circumference using the original marks - remark the positions. Explain that this is to improve accuracy. If your second measurement differs from the first by 1.5cm or more, the computer will give you an error message, and instruct you to either amend one of your previous responses, or to take a third measurement. Amend a previous response if you have made a mistake when entering the measurement, eg. entered 15.2 instead of 25.2. Take a third measurement if there is another reason for the measurements being different. If in doubt, take a third measurement rather than over-writing one of the previous two. The computer will automatically work out which two to use. 9. When prompted by the computer, indicate the position of the child when the measurement was taken. Also, give reasons why, if it was not possible to take a measurement or if only one measurement was obtained. 33 10. Offer to write the measurements onto the child’s Measurement Record Card. If the parent/child would like the measurement in inches, use the conversion chart which is in the back of the drug coding booklet. The interviewer should have given them an MRC with their height and weight recorded on it. If the respondent has lost it, or claims never to have had one, make out a new one, ensuring their name is on the front of the card, etc. The computer will display the two measurements on screen for you to copy onto the Measurement Record Card. If you took three measurements, it will only display the two most reliable ones. 15.6. MEASUREMENT of Ambient Air Temperature AirTemp 15.6.1. Purpose: Blood pressure can be affected by air temperature. For this reason, we wish to measure the air temperature in the room at the time blood pressure is being taken. 15.6.2. Equipment: You have been provided with a digital thermometer and probe. 15.6.3. PROCEDURE The thermometer is very sensitive to minor changes in temperature. It is therefore important that you record temperature at the appropriate time in your routine. Immediately after you have settled the respondent down to rest for five minutes prior to taking their blood pressure, set up the thermometer on a surface close to where they are sitting. Just prior to recording the blood pressure note the temperature and record it when prompted by the computer. Always switch the thermometer off after taking a reading, to avoid battery problems. The thermometer automatically switches off if you have left it on for more than 7 minutes. Remember to check that the thermometer has reached its final reading. It can take a few minutes to settle down to a final reading if it is experiencing a large change in temperature (eg. coming into a warm house from the cold outside). Place the thermometer on a surface near the Dinamap. Do not let the probe touch anything - you can for example let it hang over the edge of a table. Do not put it on top of the Dinamap as it will be warm. Instructions for using the thermometer 1. The probe plug fits into the socket at the top of the instrument. 2. Press the solid white circle to turn the instrument on. To turn off, press the white ring. 3. Before taking a reading off the display, ensure that the reading has stabilised. 4. Be careful of the probe - it is quite fragile. 5. When “LO BAT” is shown on the display the battery needs replacing; take no further readings. 6. The battery in your thermometer is a long-life battery and should last at least one year. However, should it run low please purchase a new battery. Take the old one with you to ensure it is the same type. Claim in the usual way. 34 7. To remove old battery and insert a new one, unscrew the screw on the back of the thermometer. 15.7. MEASUREMENT of Blood Pressure -- ages 5-74 BPIntro-BPOffer 15.7.1. Purpose: High blood pressure is an important risk factor for cardiovascular disease. During the first visit, the interviewer will have asked the respondent if he/she has ever had high blood pressure. If this is the case more detailed information will have been collected. However, it is important that we look at the blood pressure of everyone in the survey using a standard method so we can see the distribution of blood pressure across the population. This is vital for monitoring change over time, and monitoring progress towards lower blood pressure. 15.7.2. Eligibility: All children aged 5 and over are eligible for this measurement. The technique is exactly the same as with adults. The survey equipment is not suitable for taking the blood pressure of younger children. The only people not eligible for blood pressure measurement are those who are pregnant. However, if a pregnant woman wishes to have her blood pressure measured, you may do so, but do not record the readings in the computer. All other respondents are eligible, unless they do not wish to give their permission. 15.7.3. Equipment: Dinamap 8100 blood pressure monitor Blue pneumatic hose Child cuff (12-19 cm) Small adult cuff (17-25 cm) Standard adult cuff (23-33 cm) Large adult cuff (31-40 cm) Power cord Extra large cuffs are also available from your Nurse Supervisor, should you require one. The Dinamap 8100 blood pressure monitor is an automated machine. It is designed to measure systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP) and pulse rate automatically at pre-selected time intervals. On this survey three readings are collected at one minute intervals. The Dinamap is equipped with a rechargeable battery, which can run for a minimum of six hours when fully charged. It is essential to keep the battery charged as fully as possible. A yellow battery light will flash as a warning sign on the monitor to alert the user when the charge has fallen below 10%. To recharge the battery, connect the monitor to the mains and press the rear panel AC power switch to the ON (‘I’) position. The green MAINS AC light will indicate that the battery is charging. An overnight charge (eight hours) will provide about four hours of operation. PLEASE REMEMBER TO CHARGE THE BATTERY !! When the Dinamap is switched on the monitor momentarily displays eights (888s) in all the digital displays and all indicators will flash as a check for the operation of all LEDs. The audio alarm is also sounded as a check for its operation. If on turning on the monitor any of the displays fail to show the 888s, contact the nurse supervisor immediately and inform them that there is a problem with the monitor. 15.7.4. Preparing the respondent: As with adults, a child’s blood pressure reading on a single occasion is not enough to define whether a child’s blood pressure is normal or abnormal. In 35 addition, the level at which a child’s blood pressure is considered to be abnormal will be dependent on that child’s age, height and sex. Because of this, unlike the adult situation, you will not be given statements to read out regarding blood pressure for children. Instead we wish you to explain to the parents what the measurement will mean in advance of doing the measurement. The computer will prompt you with a statement at BPBlurb to read out before taking a child’s blood pressure. This procedure must always be followed. Otherwise, the parent may feel you are withholding information later because their child has an unsatisfactory result. BPConst -- If you code ‘refused’ here, the computer will skip you past the measurement. You should code ‘unable’ if the respondent is prepared to co-operate, but for some reason it is not possible to take the measurement (eg. the Dinamap is broken or there is some physical reason). ConSubX -- The respondent should not have eaten, smoked, drunk alcohol or taken vigorous exercise in the 30 minutes preceding the blood pressure measurement as blood pressure can be higher than normal immediately after any of these activities. As already suggested, if you can juggle respondents within a household around to avoid having to break this “half-hour rule”, do so. But sometimes this will not be possible and you will have to take their blood pressure within this time period, in which case enter all the codes that apply. DINNo -- Always note down the SCPR number for the Dinamap you are using. Sometimes we identify an equipment problem and wish to be able to track down all readings that have been taken using the particular piece of equipment. Ask the respondent to remove outer garments (e.g. jumper, cardigan, jacket) and expose the right upper arm. The sleeve should be rolled or slid up to allow sufficient room to place the cuff. If the sleeve constricts the arm, restricting the circulation of blood, ask the respondent if they would mind taking their arm out of the sleeve for the measurement. CufSize -- Selecting the correct cuff Adults aged 16-74: Do not measure the upper arm circumference. Instead, choose the correct cuff size based on the acceptable range which is marked on the inside of the cuff. You will note that there is some overlap between the cuffs. If the respondent falls within this overlap range then use the standard cuff where possible. If you have a particularly large respondent and the large adult cuff is too small, contact your Nurse Supervisor. She holds a small stock of thigh cuffs which can be used to take the blood pressure of very large people. These are used on the arm in the same way as the ordinary cuffs. If you use one of these cuffs, record in the computer Extra large adult. Children aged 5 to 15: It is important to select the correct cuff size. The appropriate cuff is the largest cuff which fits between the axilla (underarm) and the antecubital fossa (front of elbow) without obscuring the brachial pulse and so that the index line is within the range marked on the inside of the cuff. You will be provided with a child’s cuff as well as the other adult cuffs. Many children will not need the children’s cuff and instead will require a small adult cuff or a standard adult cuff. You should choose the cuff that is appropriate to the circumference of the arm. Adults and Children: The appropriate cuff should be connected via the blue pneumatic hose to the two cuff connectors at the bottom of the display. It is important to ensure these screw connectors are properly connected to avoid any 36 air leak. However do not over-tighten. The pneumatic seal is not made by tightening the connector. 15.7.5. PROCEDURE Wrap the correct sized cuff round the upper right arm and check that the index line falls within the range lines. Use the left arm only if it is impossible to use the right. If the left arm is used, record this on the schedule. Locate the brachial pulse just medial to the biceps tendon and position the arrow on the cuff over the brachial artery. The lower edge should be about 2 cm above the cubital fossa (elbow crease). Do not put the cuff on too tightly as bruising may occur on inflation. Ideally, it should be possible to insert two fingers between cuff and arm. However the cuff should not be applied too loosely, as this will result in an inaccurate measurement. The respondent should be sitting in a comfortable chair with a suitable support so that the right arm will be resting at a level to bring the antecubital fossa (elbow) to approximately heart level. They should be seated in a comfortable position with cuff applied, legs uncrossed and feet flat on the floor. Explain that before the blood pressure measurement we need them to sit quietly for five minutes to rest. They should not smoke, eat, drink or during this time. Explain that during the measurement the cuff will inflate three times and they will feel some pressure on their arm during the procedure. It is important that children as well as adults rest for five minutes before the measurement is taken. However, making children sit still for five minutes can be unrealistic. They may move around a little, but they should not be running or taking vigorous exercise. As with adults, they should not eat or drink during this time. After five minutes explain you are starting the measurement. Ask the respondent to relax and not to speak until the measurement is completed as this may affect their reading. 1. Switch the monitor ‘ON’. 2. Press the SILENCE button until the yellow triangle above it lights up. 3. Press the AUTO/MANUAL button until the green triangle above it lights up. The cuff will now start to inflate and take the first measurement. 4. Press the cycle SET button until the number 1 lights up in the minutes box. Blood pressure will then be recorded at one minute intervals thereafter. After each interval record the reading on the computer. 5. It is possible to retrieve any of the three readings if they need to be checked or if you didn’t record them for any reason. To do this wait until the three readings have been taken then press the AUTO/MANUAL button followed by the PRIOR DATA button. This will display the previous reading i.e. the second blood pressure. Press the PRIOR DATA button again to display the first blood pressure reading, and once again to return to the final reading. The minutes display indicates how long ago the measurement was taken. IT IS NOT POSSIBLE to retrieve the readings once the monitor has been switched off. 6. After the three measurements are complete and recorded on the computer switch the monitor ‘OFF’ and remove the cuff. 37 If there are any problems during the blood pressure measurements or the measurement is disturbed for any reason, press the red cancel button or the power OFF button and start the procedure again. If the respondent has to get up to do something, then ask them to sit and rest for five minutes again. 15.7.6. Error readings The most common error reading is 844. This is displayed if one measurement exceeds 120 seconds. This is usually caused by the respondent moving during the measurement. Ask the respondent to sit as still as possible and take the measurement again. Do not palpate the pulse and do not tell the respondent their pulse is erratic. If you still get another 844 error reading, record that it wasn’t possible to get a reading and explain to the respondent that this sometimes happens. Other error readings are detailed on the side of the Dinamap itself. Readings -- Record the blood pressure readings in the order shown on the screen. Double check each entry as you make it to ensure you have correctly entered the reading. If you have got to this point and then become aware that you are not going to be able to get a reading after all, you should enter ‘999’ then press YNoBP -- If you did not get any full readings, you are asked to enter one of three codes. Code 1 should be used if you attempted to take a blood pressure measurement but were unsuccessful. Use code 2 if you did not attempt to take blood pressure for reasons other than a refusal. If you got a refusal, use code 3. NAttBP -- If you failed to get a reading or you managed to obtain only one or two readings, enter a code to show what the problem was. If necessary, write full details at OthNBP. DifBP -- Code whether you experienced any problems obtaining the blood pressure readings. GPRegB -- If you obtained at least one blood pressure reading, you are asked to collect details of the respondent’s GP. If the person agrees to the results going to their GP, turn to the second page of the Consent Booklet (Blood Pressure to GP Consent Form -- sheet BP(A) for adults and BP(C) for children under 16 years). Explain you have to get written consent in order to send the blood pressure readings. Fill in the respondent (parent/child) name at the top of the form. Ask the respondent/parent to sign and date the form. Then turn to the front of the Consent Booklet and ring consent code 01. Ask the respondent for the name, address and telephone number of their GP. If possible, obtain the postcode. Record this at items 7 and 8 of the Consent Booklet (if you have not already done so). If your respondent does not know their GP’s full address and/or postcode, look it up in the relevant telephone directory later (public libraries hold telephone directories for the whole country). You may find it useful to keep a notebook containing the address details of local GPs given by previous respondents, as if you are working the same area, you will almost definitely come across several people with the same GP, and this will save you having to keep looking up the same GP’s details if a respondent cannot give them to you. 15.7.7. Informing respondents of their blood pressure readings If the respondent wishes, record details of the three readings on their Measurement Record Card. 38 Child respondents (aged 5 to 15): We do not wish you to comment on the child’s blood pressure readings to the parents. If they seek comment, reiterate what you have already said about not being able to interpret a single blood pressure measurement without checking to see whether it is normal for the child’s age and height. Reassure them that if it is found to be abnormal and if they have given consent for the results to go to the GP, then the GP will get in touch to have the measurement repeated. This rule applies for all readings you obtain. Adult respondents (aged 16 to 74): In answering queries about the respondent’s blood pressure, it is VERY IMPORTANT to remember that it is not the purpose of the survey to provide respondents with medical advice, nor are you in a position to do so as you do not have the respondent’s full medical history. But, if an adult respondent has a raised blood pressure, you will need to say something. This will be calculated by the computer and will appear on the screen for you to read out exactly as written. Write any advice given onto the MRC. The computer will decide which advice is appropriate based on the following guidelines. (You have been given a Blood Pressure Guide Card which summarises these rules). Comments are based on the last two of the three readings. The first reading can be high because people are nervous of having their pressure taken. Definitions of raised blood pressure differ slightly. It has been decided to adopt the ones given overleaf for this survey. If the blood pressure is Normal, you will be prompted to say, ‘Your blood pressure is normal’. If the blood pressure is Mildly raised, you will be prompted to say, ‘Your blood pressure is a bit high today. Blood pressure can vary from day to day and throughout the day so that one high reading does not necessarily mean that you suffer from high blood pressure. You are advised to visit your GP within 3 months to have a further blood pressure reading to see whether this is a once-off finding or not.’ 39 SURVEY DEFINITION OF BLOOD PRESSURE RATINGS For all women, and men aged less than 50 Rating Systolic Diastolic Normal < 140 and < 85 Mildly raised 140 - 159 or 85 - 99 Moderately raised 160-179 or 100 - 114 Severely raised 180 or higher or 115 or higher Men aged 50 or over Normal < 160 and < 95 Mildly raised 160 - 169 or 96 - 104 Moderately raised 170 - 179 or 105 - 114 Severely raised 180 or higher or 115 or higher NB: < means ‘less than’ If blood pressure is Moderately raised, you will be prompted to say, ‘Your blood pressure is a bit high today. Blood pressure can vary from day to day and throughout the day so that one high reading does not necessarily mean that you suffer from high blood pressure. You are advised to visit your GP within 2-3 weeks to have a further blood pressure reading to see whether this is a once-off finding or not.’ If blood pressure is Severely raised, you will be prompted to say, ‘Your blood pressure is high today. Blood pressure can vary from day to day and throughout the day so that one high reading does not necessarily mean that you suffer from high blood pressure. You are strongly advised to visit your GP within 5 days to have a further blood pressure reading to see whether this is a once-off finding or not.’ Note: If the respondent is elderly and has severely raised blood pressure, amend your advice so that they are advised to contact their GP within the next week or so about this reading. This is because in many cases the GP will be well aware of their high blood pressure and we do not want to worry the respondent unduly. It is however important that they do contact their GP about the reading within 7 to 10 days. In the meantime, we will have informed the GP of their result (providing the respondent has given their permission). 15.7.8. Action to be taken by the nurse after the visit The action you should take after the visit in respect of raised blood pressure readings, differ for children and adults. If you need to contact the Survey Doctor, do not do this from the respondent’s home -- you will cause unnecessary distress. 40 Pulse: for all respondents the survey doctor routinely checks fast and slow pulse rates so no further action is necessary. Children: No further action is required after taking blood pressure readings on children. All high readings are viewed routinely by the Survey team. However, in the rare event that you encounter a child with a very high blood pressure, ie. systolic 160 or above or diastolic 100 or above, please call the Survey Doctor. Adults: The chart below summarises what action you should take as a result of the knowledge you have gained from taking the blood pressure readings. For this purpose you should only take into account the last two readings as the first reading from the Dinamap is prone to error for the reason stated above. The Survey Doctor responsible for dealing with queries regarding blood pressure readings is Dr. James Repper, based in Aberdeen. To contact him, try his number at his surgery (the Foresterhill Health Centre, Aberdeen) 01224-696-949 or his pager number 01426-174-185. Dr. Repper has asked that you leave your contact number and an indication of urgency (ie. whether you want to be contacted immediately). NEVER leave any details about the respondent on the pager, eg. respondent’s name or telephone number, as this would constitute a breach of confidence. If you do not reach Dr. Repper at the surgery or by pager, you may try him at home on 01224-647-230. BLOOD PRESSURE ACTION Normal/mild/moderate bp No further action necessary Systolic < 180 mmHg and If you feel that the circumstances demand further Diastolic < 115 mmHg action, inform Dr. Repper who will then inform the respondent’s GP immediately if he deems it necessary. Severely raised bp Contact Dr. Repper at the earliest opportunity who will inform the respondent’s GP. Systolic = 180 mmHg or Diastolic = 115 mmHg If the respondent has any symptoms of a hypertensive crisis* contact Dr. Repper immediately or call an ambulance. Dr. Repper must be informed as soon as possible. *A hypertensive crisis is an extremely rare complication of high blood pressure. Its signs and symptoms include: diastolic bp > 135 mmHg, headache, confusion, sleepiness, stupor, visual loss, seizures, coma, cardiac failure, oliguria, nausea & vomiting. 41 15.8. MEASUREMENT of Demispan -- ages 65-74 Spanlllt-DsCard 15.8.1. Purpose: When the interviewer visited the respondent slhe attempted to measure the respondent's height and weight. However, measuring height can be quite difficult if the respondent cannot stand straight or is unsteady on their feet. This can occur with some elderly people, and with people who have particular disabilities. Additionally, height decreases with age. This decrease varies from person to person and may be considerable. It is becoming increasingly important to have information about the health of the elderly. Therefore an alternative measure of skeletal size, the demi-span. was developed which can be measured easily and does not cause unnecessary discomfort or distress to the elderly. The demi-span measurement is the distance between the sternal notch and the finger roots with arm out-stretched laterally. 15.8.2. Eligibility: Only those aged 65 to 74 are eligible for the demi-span measurement. Respondents aged 65 to 74 who cannot straighten either arm. should not have this measurement taken. NOIArrM -- Record any reasons why demi-span measurement was refused. not attempted or only one was obtained. 15.8.3. Equipment: a thin retractable demi-span tape calibrated in cm and mm and a skin marker pencil. A hook is attached to the tape and this is anchored between the middle and ring fingers at the finger roots. The tape is then extended horizontally to the sternal notch (see illustration below). The tape is easily damaged if it is bent. Illustration from HSE '97 Nurse Instructions - SCPR J. \ 15.8.4. Preparing the respondent: The measurement is made on the right arm unless this arm cannot be fully stretched in which case the left arm may be used. SpllM -- Record which arm was used and whether the respondent was standing. sitting or lying down. Although the measurement requires minimal undressing. certain items that might distort the measurement will need to be removed. These include: Ties Jackets. jumpers and other thick garments Jewellery items such as chunky necklaceslbracelets Shoulder pads High heeled shoes 42 Shirts should be unbuttoned at the neck. If the respondent does not wish to remove any item that you think might affect the measurement, you should record that the measurement was not reliable (code 2) when prompted by the computer. 15.8.5. PROCEDURE 1. Locate a wall where there is room for the respondent to stretch his/her arm. They should stand with their back to the wall but not support themselves on it. Ask the respondent to stand about 3 inches (7cm) away from it. 2. Ask the respondent to stand with weight evenly distributed on both feet, head facing forward. 3. Ask the respondent to raise their right arm until it is horizontal. The right wrist should be in neutral rotation and neutral inflexion. Rest your left arm against the wall allowing the respondent’s right wrist to rest on your left wrist. 4. When the respondent is standing in the correct position mark the skin at the centre of the sternal notch using the skin marker pencil. (Explain to the respondent that this mark will wash off afterwards). It is important to mark the sternal notch while the respondent is standing in the correct position. If the sternal notch is obscured by clothing or jewellery, use a piece micropore tape on the clothing or jewellery. If the respondent will not allow use of either the marker pencil or the micropore tape, proceed with the measurement but record the measurement as unreliable and explain why in a notepad. 5. Ask the respondent to relax while you get the demi-span tape. 6. Place the hook between the middle and ring fingers so that the tape runs smoothly along the arm. 7. Ask the respondent to raise their arm. Check they are in the correct position, the arm horizontal, the wrist in neutral flexion and rotation. 8. Extend the tape to the sternal notch. If no mark was made, feel the correct position and extend the tape to this position. 9. When ready to record the measurement ask the respondent to stretch his/her arm. Check that: -- the respondent is in the right position; no extension or flexion at the wrist or at the shoulders. -- the hook has not slipped forward and the zero remains anchored at the finger roots. -- the respondent is not leaning against the wall or bending at the waist. 10. Record the measurement in cms and to the nearest mm when prompted by the computer. If the length lies half-way between two millimetres, then round to the nearest even millimetre. For example, if the measurement is halfway between 68.3 and 68.4, round up to 68.4; if the measurement is halfway between 68.8 and 68.9, round down to 68.8. Always record the response to one decimal point (eg. 55.4). The computer will not allow you to enter a response without a decimal point, so even if the measurement come to, say exactly 56cm, you must enter 56.0. If you do enter a measurement ending in 0, the computer will ask you to confirm this. 11. Ask the respondent to relax and loosen up the right arm by shaking it. 43 12. Repeat the measurement from steps 4-11. Explain to the respondent that this is to improve accuracy. If your second measurement differs from the first by 3cm or more, the computer will give you an error message, and instruct you to either amend one of your previous responses, or to take a third measurement. Amend a previous response if you have made a mistake when entering the measurement, eg. entered 65.2 instead of 75.2. Take a third measurement if there is another reason for the measurements being different. If in doubt, take a third measurement rather than over-writing one of the previous two. The computer will automatically work out which two to use. 13. Offer to write the measurements onto the respondent’s Measurement Record Card. If the respondent would like the measurement in inches, there is a conversion chart on the back of your drug coding booklet. Using the tape The tape is fairly fragile. It can be easily damaged and will dent or snap, if bent or pressed too firmly against the respondent’s skin. Also the ring connecting the hook to the tape is a relatively weak point. Avoid putting more strain on this ring than necessary to make the measurements. When extending the tape, hold the tape case rather than the tape itself as this puts less strain on the hook and tape. When holding the tape to the sternal notch, do not press into the sternal notch so much that the tape kinks. Seated and lying measurements If the respondent is unable to stand in the correct position, or finds it difficult to stand steadily, ask them to sit for the measurement. Use an upright chair and position it close to a wall. Still try to support the arm if possible. You may need to sit or kneel to take the reading. If the respondent is much taller than you, take the measurement with the respondent sitting. If the respondent finds both standing and sitting in the correct position difficult, the measurement can be taken with the respondent lying down. If the respondent’s arm is much longer than yours, support the arm close to the elbow rather than wrist level. Your arm must not be between the elbow and shoulder as this will not provide sufficient support. Record at SpnM how the measurement was taken (ie. with respondent standing, sitting, lying down, etc.) 15.9. MEASUREMENT of Waist and Hip Circumferences -- adults only WHMod-WHRes 15.9.1. Purpose: There has been increasing interest in the distribution of body fat as an important indicator of increased risk of cardiovascular disease. The waist-to-hip ratio is a measure of distribution of body fat (both subcutaneous and intra-abdominal). Analyses suggest that this ratio is a predictor of health risk like the body mass index (weight relative to height). 15.9.2. Eligibility: Waist and hip measurements are taken from all respondents aged 16 to 74, except those who are: pregnant, chairbound or have a colostomy/ileostomy. If any of these apply, record code 3 at WHIntro and indicate which reason applies. If the respondent refuses to have his/her waist and hip measured, record code 2 at WHIntro and indicate why. 15.9.3. Equipment: Insertion tape calibrated in mm, with a metal loop at one end which is connected to a spring balance. 15.9.4. Preparing the respondent: The interviewer will have asked the respondent to wear light clothing for your visit. Explain to the respondent the importance of this measurement and that clothing can substantially affect the reading. 44 If possible, without embarrassing you or the respondent, ensure that the following items of clothing are removed: - all outer layers of clothing, such as jackets, heavy or baggy jumpers, cardigans and waistcoats - shoes with heels - tight garments intended to alter the shape of the body, such as corsets, lycra body suits and support tights If the respondent is wearing a belt, ask them if it would be possible to remove it or loosen it for the measurement. Pockets should be emptied. If the respondent is not willing to remove bulky outer garments or tight garments and you are of the opinion that this will significantly affect the measurement, record this when asked by the computer about problems measuring waist, at WJRel, or hip, at HJRel. If possible, ask the respondent to empty their bladder before taking the measurement. 15.9.5. PROCEDURE 1. Ensure the respondent is standing erect in a relaxed manner and breathing normally. Weight should be evenly balanced on both feet and the feet should be about 25-30cm (1 foot) apart. The arms should be hanging loosely at their sides. 2. If possible, kneel or sit on a chair to the side of the respondent. 3. Pass the tape around the body of the respondent and through the loop. To check the tape is horizontal you have to position the tape on the right flank and look round the participant’s back from his/her left flank to check that it is level. This will be easier if you are kneeling or sitting on a chair to the side of the respondent. If the respondent is large, ask him/her to pass the tape around rather than having to “hug” them. Remember though to check that the tape is correctly placed for the measurement being taken and that the tape is horizontal all the way around. 4. Hold the loop flat against the body and flatten the end of the tape. At the same time pull the spring balance to the mark around 600g and then read the measurement from the outer edge of the loop. Do not pull the tape or spring balance towards you, as this will lift away from the respondent’s body, affecting the measurement. Measuring the waist 5. The waist is defined as the point midway between the iliac crest and the costal margin or lower rib (See illustration on page 47). To locate the levels of the costal margin and the iliac crest use the fingers of the right hand held straight and pointing in front of the participant to slide upward over the iliac crest. Men’s waists tend to be above the top of their trousers whereas women’s waists are often under the waistband of their trousers or skirts. If you have problems palpating the rib, ask the respondent to breathe in very deeply. Locate the rib and as the respondent breathes out, follow the rib as it moves down with your finger. 45 6. Do not try to avoid the effects of waistbands by measuring the circumferences at a different position or by lifting or lowering clothing items. For example, if the respondent has a waistband at the correct level of the waist (midway between the lower rib margin and the iliac crest) measure the waist circumference over the waistband. If your respondent has a bow at the back of her skirt, this should be untied as it may add a substantial amount to the waist circumference. Female respondents wearing jeans may present a problem if the waistband of the jeans is on the waist at the back but dips down at the front. It is essential that the waist measurement is taken midway between the iliac crest and the lower rib and that the tape is horizontal. Therefore in this circumstance the waist measurement would be taken on the waist band at the back and off the waist band at the front. Only if the waistband is over the waist all the way around can the measurement be taken on the waistband. If there are belt loops, the tape should be threaded through these so they don’t add to the measurement. 7. Ensure the tape is horizontal. Ask the participant to breathe out gently and to look straight ahead (to prevent the respondent from contracting their muscles or holding their breath). Take the measurement at the end of a normal expiration. Measure to the nearest millimetre and record this into the computer. All measurements should be taken to the nearest millimetre. If the length lies halfway between two millimetres, then round to the nearest even millimetre. For example, if the measurement is halfway between 68.3 and 8.4, round up to 68.4; if the measurement is halfway between 68.8 and 68.9, round down to 68.8. 8. Repeat this measurement again. If your second measurement differs from the first by 3cm or more, the computer will give you an error message, and instruct you to either amend one of your previous responses, or to take a third measurement. Amend a previous response if you have made a mistake when entering the measurement, eg. entered 65.2 instead of 75.2. Take a third measurement if there is another reason for the measurements being different. If in doubt, take a third measurement rather than over- writing one of the previous two. The computer will automatically work out which two to use. If you do decide to take a third measurement, the computer will ask you to enter both waist and hip measurements again, even if only one of the two sets of measurements was more than 3cm apart. 9. If you are of the opinion that clothing, posture or any other factor is significantly affecting the waist measurement, record this when asked about problems measuring waist, at WJRel. We only want to record problems that will affect the measurement by more than would be expected when measuring over light clothing. As a rough guide only record a problem if you feel it affected the measurements by more than 0.5cm. We particularly want to know if waist and hip are affected differently. 46 TAKING WAIST MEASUREMENTS FEMALE MALE I I I '-./~ __ lAST RIB \ ILIAC CREST i I i t, 47 Measurement of the hip 10. The hip circumference is defined as being the widest circumference over the buttocks and below the iliac crest. To obtain an accurate measurement you should measure the circumference at several positions and record the widest circumference. 11. Check the tape is horizontal and the respondent is not contracting the gluteal muscles. Pull the tape, allowing it to maintain its position but not to cause indentation. Record the measurement into the computer to the nearest millimetre, e.g. 095.3. If the measurement falls between two millimetres, the measurement should be recorded to the nearest even millimetre. 12. Repeat this measurement again. If your second measurement differs from the first by 3cm or more, the computer will give you an error message, and instruct you to either amend one of your previous responses, or to take a third measurement. Amend a previous response if you have made a mistake when entering the measurement, eg. entered 65.2 instead of 75.2. Take a third measurement if there is another reason for the measurements being different. If in doubt, take a third measurement rather than over-writing one of the previous two. The computer will automatically work out which two to use. If you do decide to take a third measurement, the computer will ask you to enter both waist and hip measurements again, even if only one of the two sets of measurements was more than 3cm apart. 13. If clothing is significantly affecting the measurement, record this when asked by the computer about problems measuring hip, at HJRel. We only want to record problems that will affect the measurement by more than would be expected when measuring over light clothing. As a rough guide only record a problem if you feel it affected the measurements by more than 0.5cm. We particularly want to know if waist and hip are affected differently. 14. Offer to write the measurements on the Measurement Record Card. You can use the conversion chart on the drug coding booklet, if the respondent wants to know the measurements in inches. 15.10. MEASUREMENT of Lung Function -- ages 7 to 74 only HASurg-NoCodes 15.10.1. Purpose: Lung function tests objectively assess respiratory impairment if it is present. We will be measuring forced expiratory volume in one second (FEV 1), forced vital capacity (FVC) and peak expiratory flow (PEF). These measures can be reduced for a wide range of reasons, e.g. physical unfitness, smoking, chronic bronchitis, those who have had poorly controlled asthma for many years, some muscular disorders and many others. At a population level, these measures tell us a lot about the respiratory health of the population, and are also indicators of general health. The definition of an acceptable level of lung function depends on the person’s age, sex and height. A diagnosis of abnormality is not based on measurement on a single occasion but is rather based on several measurements and on the person’s clinical history. Prior to making the measurement, we wish you to explain this to the respondents. CAPI will prompt you to read a statement you should always read out before carrying out this test. Explain to the respondent that we are very happy to send the results to their GP if they so wish and the GP can then interpret them in light of their knowledge about the respondent. 48 15.10.2. Eligibility: Respondents aged 7 to 74, including those chairbound, EXCEPT: a) Those who are pregnant. b) Those who have had abdominal or chest surgery in the preceding three weeks. The computer prompts you to ask and record this information at HASurg. c) Those who have been admitted to hospital with a HEART complaint or stroke in the preceding six weeks. The computer prompts you to ask and record this information at HaStro. 15.10.3. Equipment: The Vitalograph Escort spirometer and case Power pack 1 litre calibration syringe Disposable cardboard mouthpieces 2 spare mesh filters 15.10.4. PROCEDURE Since air is a gas, its volume changes with changes in temperature. For this reason room temperature is of critical importance when measuring lung function. To take account of air temperature (and humidity) the spirometer MUST be calibrated in each household prior to the first measurement carried out. In addition, the room temperature must be noted and entered into the spirometer prior to measuring each respondent. It is also important that your equipment is at room temperature when you use it. For this reason, take it out of its container as soon as possible when you enter the house. Otherwise it will be too cold (or in summer too hot!) from being in the boot of your car. Calibrating the spirometer Remember, the spirometer MUST be calibrated in the household prior to measuring each respondent. SpirNo The computer will prompt you to calibrate the spirometer and enter the three-digit spirometer serial number here. 1. The first step is to circulate the room air through the calibration syringe and the spirometer. To do this, connect the syringe to the flow head and simply pump through a few litres of air. 2. Next you enter the calibration routine of the spirometer. To do this, hold the spirometer level, press the arrow button and blue “on” button at the same time, then release both buttons. 3. You will see an equipment number displayed, followed by the message “zeroing sensor”, then “please wait”. The message “pump air” is then displayed. 4. Making sure the syringe handle is fully extended, connect the syringe to the flow head. The handle of the spirometer should be pointing upwards. Pump in the volume of air from the syringe in a smooth swift stroke, taking approximately 1 second to do so. It is important that the air is pumped in smoothly and swiftly in this way. Be careful not to occlude the outlet of the spirometer with your hand. 5. During calibration the message “sampling flow” is displayed. Following this “*” is displayed if the spirometer is calibrated. If a volume is displayed rather than “*”, then the unit is not fully calibrated and you must repeat the procedure again by pumping in another litre of air from the syringe. Do this until “*” is displayed. If you encounter problems 49 during calibration consult the “troubleshooting advice” at the end of this section. If after six attempts the spirometer has not calibrated, remove cone and end cap, check that you have not forgotten to insert a mesh and ensure the cone and end cap are replaced tightly. If calibration is still not possible, abandon procedure and record it on the schedule. Check the equipment later and contact the Field Office immediately for a replacement. 6. Then press the C button to switch off. LFTemp The computer will prompt you to record the ambient air temperature in centigrade to one decimal place here. Performing the test 1. The first step is to measure the room temperature. Switch on your thermometer as before. Allow it to settle, then record the temperature on your schedule and switch off. 2. Holding the spirometer level, press the blue ON button. The last temperature entered will be displayed. Enter the temperature you have just recorded to the nearest degree. Do this by pressing the arrow button until the correct temperature is displayed. The arrow button allows you to scroll through to 40ºC. Note that the lowest temperature you can enter is 10ºC. If the temperature is lower than 10ºC or higher than 40ºC reliable measurements cannot be made and spirometry must be deferred until the room heats up/cools down, or be abandoned. If the latter is the case, note it on the appropriate section of the computer schedule. 3. When the correct temperature is displayed, press the on button again. The display will read “zeroing sensor” followed by “please wait”, then “perform test”. 4. Instruct the respondent to blow as described in the next section. As the respondent is blowing the message “sampling flow” is displayed. The FVC is then displayed in litres (L). Record this into the computer where prompted. Press the arrow button again and the FEV1 will be displayed. Record this too. Press the arrow again and the PEF (Peak Flow) will be displayed. Record this. Then record whether the blow has been technically satisfactory (this is defined below). 5. Press the C button to clear the results and then press the ON button to start again. The temperature will be displayed again. This time you can ignore it as the room temperature will not have changed much from the first blow. It is very important that you press the C button before the ON button. If you do not do this the screen will go on to tell you the results of the best blow rather than each individual blow. 6. Press the on button again, and get the respondent to blow as before. Repeat the procedure until you have recorded five blows. Don’t forget to switch off by pressing the C button. 7. GPSend LF -- Once you have entered details of the five blows into the computer, obtain consent to send the results of the lung function to the respondent’s GP. If the respondent agrees, have them sign LF(A) Lung Function to GP Consent Form (Adults 16+) if they are aged 16 to 74 or have the respondent’s parents sign LF(C) Lung Function Result to GP Consent Form (Ages 7-15) if the respondent is aged 7 to 15. Circle code 04 on the front of the Consent Booklet if consent is obtained to send the respondent’s lung function results to the GP, or 03 if consent is not obtained. 50 8. NCIns2 -- Offer to record the lung function readings on the respondent’s Measurement Record Card. Never attempt to interpret these readings. This has to be done in the office, taking other information about the respondent into account. Instructing the respondent to blow 1. LFStand -- After the five blows, record whether the respondent was standing or sitting. The respondent should be in the standing position. If the respondent is chairbound you can still carry out the test. 2. Tight clothing should be loosened. 3. Dentures should be worn unless they fit so badly that they become loose and obstruct the airflow. 4. Explain to the respondent that the aim of the test is to find out how much air they can blow out and how quickly it is blown out. Then explain that “you must try to blow out as much air as possible as hard and as fast and as completely as you can”. 5. You should demonstrate the correct technique first, using a mouthpiece unconnected to the spirometer. Explain that the mouthpiece should be held in place by the lips rather than the teeth and the lips should be wrapped firmly around it. Demonstrate a blow. 6. Attach a clean disposable mouthpiece to the flow head. Explain to the respondent that they must now make their first attempt. 7. Instruct the respondent to take as deep a breath as possible and then to hold the mouthpiece with their lips. The respondent should hold the spirometer with the handle downwards. 8. Then say “now blow”. As the respondent is blowing encourage her/him by saying “keep going, keep going, keep going”. 9. It is important to observe the respondent closely during the blow so that you can note whether it was technically satisfactory and advise her/him how to do it better. 10. LFRes/ProbLF -- Record whether you obtained 5 technically satisfactory blows and, if not, why not. You must attempt to get five blows from each respondent. However, there will be some respondents, e.g. some elderly respondents or those with severe lung disease who are unable to complete five attempts. You must strike the right balance between encouragement and over-insistence. Technically unsatisfactory blows A technically unsatisfactory blow is any of the following: 1. An unsatisfactory start, e.g. excessive hesitating or a “false start”. If you see * on either side of the *FEV1* then this tells you that it is an excessively slow start. 2. Laughing or coughing especially during the first second of the blow. Many people will cough a little towards the end of their effort but this is acceptable. 3. Holding the breath in (i.e. a valsalva manoeuvre). 51 4. A leak in the system or around the mouthpiece. This would include those where the mouthpiece is not firmly held by the lips. 5. An obstructed mouthpiece e.g. tongue in front of the mouthpiece or false teeth obstructing the mouthpiece. 6. Note that a result of 0.00 on an FEV1 also means that the test has not been carried out properly. Guidelines on expected values of lung function Please note that for any individual their expected level of lung function is calculated using their height, age and sex. The values given here are for your guidance only and are based on the best expected levels in persons of average height. There is in fact wide variation in the normal level acceptable so these values are just a rough guide. They will give you an idea of whether a respondent is not blowing adequately so that you can encourage them to improve. You should not say to respondents that their lung function is poor since the variation in acceptable values is so wide. FOR NURSE GUIDANCE ONLY: Male Female Adults: Aged 16-39: FVC 4.5 FVC 3.5 FEV 4.0 FEV 3.0 PF 550 PF 400 Aged 40-64: FVC 4.0 FVC 3.0 FEV 3.0 FEV 2.5 PF 500 PF 350 Aged 65+: FVC 3.5 FVC 2.5 FEV 2.5 FEV 2.0 PF 450 PF 320 Children: Aged 7-9: FVC 2.3 FVC 2.3 FEV 2.0 FEV 2.0 PF 300 PF 300 Aged 10-15: FVC 3.2 FVC 3.2 FEV 3.0 FEV 3.0 PF 400 PF 400 15.10.5. Cleaning procedure for the Escort spirometer For the respondent’s safety, the mouthpieces you use are valved so that it is not possible to inhale through them. Please always ensure that you use a new disposable mouthpiece for each respondent. The mouthpiece may be given to the respondent to dispose of in their own household rubbish. It is not necessary to clean equipment between households. It is essential, however, that the filters are removed and cleaned each evening (see diagram below). 1. Remove the cone (1) and end cap (2) from each end of the flowhead. Do not disassemble the remaining part of the spirometer. 52 2. Remove the filter meshes (3). 3. Replace with the two clean spare mesh filters. Put the deep edge of the plastic rim facing towards the centre of the spirometer. 4. Wash the soiled filters carefully in warm soapy water and rinse thoroughly with clean water. The filters should be left overnight to dry out completely. The Structure of the Spirometer (diagram) 5. Fl_he.d S.al'n; RIn;s e. Spireme,., 90dy 15.10.6. Important points to note I. When fully charged from the power supply unit provided, a test duration of at least 90 minutes can be expected. After the "LOW BA TIERY" message first flashes on the screen, only a further I minute of valid testing can be guaranteed after which the unit must be recharged or operated from the mains supply to carry out further tests. The spirometer should be charged immediately before each visit. Take the power pack with you in case of battery failure. 2. Whenever the "ON" button is pressed to perform a new test, ensure that the spirometer is placed on a flat surface with the mouthpiece pointing upwards. 3. The respondent should hold the unit with the handle pointing downwards during the testing. This is different to the procedure during calibration when the handle should be pointing upwards. .. 53 15.10.7. Fault finding guide PROBLEMS SOLUTIONS Nothing is displayed when the “ON” button is pressed: Connect to PowerSAFE as battery may be discharged. “ON” button not being held down long enough. False readings suspected: Ensure unit is being held correctly during test. Recalibrate. Calibration values vary greatly: Ensure the correct calibration procedure is being followed. Start calibration syringe stroke sharply. Unit remains in “ZEROING SENSOR” mode: Ensure the ambient air temperature is within the specified operating temperature. Unit does not operate for the specified length of time when battery is fully charged: Replace battery. “PUMP AIR” stays on screen instead of calibration result: Not a smooth system of air from the calibration syringe. Too long a delay between switching on and pumping air through. Handle of spirometer not directed upward when calibrating. Occluding the “end cap” with your hand 15.11. BLOOD SAMPLE -- Ages 16 to 74 (Ages 11 to 15 are likely to be added during the second quarter of the study) BlIntro-Code11 15.11.1. Purpose: The blood sample is being taken to obtain indicators of risk factors for cardiovascular disease and of other measures of health and nutrition. The blood will be analysed for total serum cholesterol, HDL cholesterol, fibrinogen, haemoglobin, ferritin, gamma GT and C Reactive Protein. For a sub-group of adults (in 5 sampling points each month), the blood will also be analysed for vitamins A,C,E and carotenoids; respondents receiving these additional blood tests are shown as “BT:V” on the address label on the NRF. Cholesterol and fibrinogen are being measured because raised levels are associated with higher risks of heart attacks. C Reactive Protein is an indictor of inflammatory activity in the body which is also associated with risk of heart disease. Haemoglobin and ferritin are being measured as indicators of iron status. Gamma GT levels are affected by alcohol consumption. Vitamins are being measured because it is thought that they might offer protection against heart disease. The blood will not be tested for any viruses, such as HIV/AIDS. 15.11.2. Eligibility: All adult respondents aged 16 to 74 will be eligible to provide a blood sample EXCEPT respondents who are: a) Pregnant. b) Have a clotting or bleeding disorder. By clotting or bleeding disorders we mean conditions such as haemophilia, low platelets or thrombocytopenia. There are many different types of bleeding/clotting disorders but they are all quite rare. These respondents are excluded from blood sampling because the integrity of their veins is extremely precious and we do not wish to cause prolonged blood loss. For purposes of blood sampling, those who have had, for example, a past history of thrombophlebitis, a deep venous thrombosis, a stroke caused by a clot, a myocardial infarction an embolus are not considered to have clotting disorders. 54 c) Aged 16 or 17, who do not live with a parent or guardian and whose parent or guardian cannot be contacted to provide written consent. d) Not willing to give their consent in writing. e) Are currently on Warfarin therapy. Warfarin thins the blood so that respondents would not stop bleeding easily. f) Anyone who has ever had any kind of fit. Aspirin therapy is not a contraindication to blood sampling. ClotB -- Record whether the respondent has a clotting or bleeding disorder or is currently on Warfarin. Fit -- Record whether the respondent has ever had a fit (eg. epileptic fit, convulsion). Respondents who have ever had a fit will not be asked to provide a blood sample. This applies even if the fit(s) occurred some years ago. The computer will decide whether the respondent is eligible to provide a blood sample based on the information you have recorded. 15.11.3. Equipment: All nurses will have the following equipment: Needle holders Alcohol swabs/cotton balls/plasters Vacutainer needles 21G Butterfly needles 23G Rubber gloves Needle disposal box Vacutainer 6 ml plain tubes (red) Plastic postal cocoons Vacutainer 4 ml EDTA tubes (purple) Prepaid addressed padded mailing envelope Vacutainer 4.5 ml citrate tubes (blue) Resealable plastic bags Micropore tape Set of labels for blood sample tubes Nurses working in sampling points where “BT:V” is shown will also have cold box Vacutainer 6 ml plain tube (red) cold packs plastic bags (large and small) padded envelope The tubes should be filled in the following order: Plain tube (red cap) (6ml) EDTA tube (lavender cap) (4ml) Citrate tube (blue cap) (4.5ml) When vitamins are being analysed (BT:V sampling points), a fourth tube should then be filled: Plain tube (6ml) 55 Getting consent: As blood taking is an invasive procedure, we need to obtain written consent in all cases. BSWill -- Ask the respondent whether they are willing to have a blood sample taken. BSConsC/BSCons -- Obtain written consent before taking the blood sample. On no account should you ever take blood before you have obtained written consent to do so from the respondent. If you cannot obtain written consent, the computer will direct you to circle consent codes 06, 08, 10 and 12 on the Consent Booklet and filter you around the remaining questions. As there are two other written consents we wish to obtain with respect to blood sampling -- consent to send the results to the GP and consent to store a small amount of the blood -- you should seek to obtain all these consents before you take any blood. SendSam/BSSign -- Obtain written consent to send results of the blood sample analysis to the respondent’s GP. ConStorB/Code09 -- Obtain written consent for storage of any remaining blood from the sample. The Blood Sample Consent Forms (BS) are divided into three sections -- one for each of these consents. If the respondent agrees to all three, s/he will have to sign the Consent Form three times. Small quantities of blood are being stored in special freezers in order that further analysis may be undertaken in the future. Future analysis will definitely not involve a test for viruses (eg. HIV/AIDS). Remember: 1. Ask the respondent if they would be willing to have a blood sample taken. Try to reassure respondents about the process, and be prepared to answer their concerns. You will need to explain to the respondent the need for written consent and how important it is. 2. Obtain written consents on the appropriate Blood Sample Consent Form. Remember to enter your name at the head of this form before asking the respondent to sign. 3. Obtain consent to send results to GP 4. Obtain consent to store blood. 5. Check that you have circled the correct consent codes on the front of the Consent Booklet. There should be a code ringed in each row at Item 9b)-9e). Before taking blood from both 16-17 year olds, you must make sure that you always get both the respondent’s own signature and the signature of their parent or person who has legal parental responsibility. Remember that even if a 16 or 17 year old respondent is married and not living with their parent or person who has legal parental responsibility, you cannot take blood until you have their parent’s consent. It is not sufficient to simply have one signature - you must make sure you have all relevant signatures. 15.11.4 Preparing the respondent Ask the respondent if they have had any problems taking blood before. 1. Explain the procedure to the respondent. They should be seated comfortably in a chair, or if they wish , lying down on a bed or sofa. Cover the respondent’s furniture with kitchen roll. 2. Ask the respondent to roll up their left sleeve and rest their arm on a suitable surface. Ask 56 them to remove their jacket or any thick clothing, if it is difficult for them to roll up their sleeve. The antecubital fossae may then be inspected. It may be necessary to inspect both arms for a suitable choice to be made, and the respondent may have to be repositioned accordingly. If both arms are suitable, use the left arm. Do not ask the respondent to clench his/her fist. 3. Select a suitable vein and apply the tourniquet around the subject’s arm. Blood may not be collected from the respondent’s wrist. However, it is desirable to use the tourniquet applying minimal pressure and for the shortest duration of time. Do not leave the tourniquet in place for longer than 2 minutes. Ask the respondent to keep his/her arm as still as possible during the procedure. 4. Put on your rubber gloves at this point. You are required to wear rubber gloves when collecting blood for the survey. 5. Clean the venepuncture site gently with an alcohol swab. Allow the area to dry completely before the sample is drawn. 15.11.5. Taking the sample 1. Venepuncture is performed with a green twenty gauge vacutainer needle or butterfly. 2. Grasp the respondent’s arm firmly at the elbow to control the natural tendency for the respondent to pull the arm away when the skin is punctured. 3. Place your thumb an inch or two below the vein and pull gently to make the skin a little taut. This will anchor the vein and make it more visible. 4. Ensure the needle is bevelled upwards. Do not bend needles for venepuncture. Enter the vein in a smooth continuous motion. 5. Remember to take the tubes in the correct order. The first tube should always be the large plain tube with the red cap followed by the mauve EDTA tube. 6. The vacutainers should be filled to capacity in turn and inverted gently on removal to ensure complete mixing of blood and preservative. TakeSam -- The computer will prompt you to take the tubes in the correct order. SampF1 -- Enter whether the plain tube (red) has been filled. This tube should always be filled first for adults and children. SampF2 -- Enter whether the EDTA tube (lavender)has been filled. This tube should always be filled second. SampF3 -- Enter whether the Citrate tube (blue) has been filled. This tube should always be filled third for adults. SampF4 -- In BT:V sampling points, Enter whether the additional plain tube has been filled. 57 7. Release the tourniquet (if not already loosened) as the blood starts to be drawn into the tube. Remove the needle and place a cotton ball firmly placed over the venepuncture site. Ask the respondent to hold the pad firmly for three minutes to prevent haematoma formation. SampArm -- Record which arm the sample was drawn from. 8. Remove the needle from the vacutainer holder by inserting it into the slot at the top of the needle disposal box. Push it towards the narrow end of the slot until the hub fins are engaged. Twist the holder anti-clockwise to unthread the needle. Then slide the holder towards the centre of the slot, allowing the needle to drop into the container. IMPORTANT WARNING Never re-sheath the needle after use. Do not allow the disposal box to become overfull as this can present a potential hazard. 9. Check on the venepuncture site and affix an plaster /adhesive dressing, if the respondent is not allergic to them. If they are allergic, use a cotton ball secured with micropore. SamDif -- Record whether you had any problems taking the blood sample and what they were. NoBSM -- If you did not manage to get any blood, explain why and circle codes 06, 08, 10 and 12 on the front of the Consent Booklet. SnDrSam/Code11 -- Ask the respondent whether they would like to be sent the results of their blood sample analysis. The computer will prompt you to circle 11 or 12 on the front of the Consent Booklet depending on the response. 15.11.6. Fainting respondents If a respondent looks or feels faint during the procedure, it should be discontinued. The respondent should be asked to place their head between their knees. They should subsequently be asked to lie down. If they are happy for the test to be continued after a suitable length of time, it should be done so with the respondent supine and the circumstances should be recorded. They may wish to discontinue the procedure at this point, but be willing to give the blood sample at a later time. 15.11.7. Disposal of needles and other materials Place the used cotton wool balls, gloves, etc. in the self-seal disposal bag. This bag, together with the needle disposable box, should be taken to your local hospital for incineration. Telephone them beforehand, if you are not sure where to go. If you come across any problems with the disposal, contact Anne McMunn (0171-391-1730) at UCL who will contact your local hospital. 15.11.8. Needle stick injuries Any nurse who sustains such an injury should seek immediate advice from their GP. The nurse should inform his/her nurse supervisor of the incident, and the nurse supervisor should inform Anne McMunn at UCL. 58 15.11.9. Respondents who are HIV or Hepatitis B positive If a respondent volunteers that they are HIV or Hepatitis B positive, do not take a blood sample. Record this as the reason on the Schedule. You should never, of course, seek this information. 15.12. SALIVA SAMPLE -- Ages 4 to 74 only SalInt1-SalObt1 15.12.1. Purpose: We wish to obtain a measure of exposure to both smoking and passive smoking in both children and adults. This can be detected by measuring the level of cotinine in saliva. Cotinine is a derivative of nicotine and shows recent exposure to tobacco smoke, either because the individual is a smoker or because they have been exposed to other people’s tobacco smoke. Note that the respondents’ cotinine analysis results will not be sent to them or their GP. 15.12.2. Eligibility: A saliva sample should be obtained from everyone aged 4 to 74 inclusive. 15.12.3. Equipment: Adults aged 16 to 74: Dental rolls Plain 5ml tubes kitchen roll Children aged 4 to 15: Short wide bore straws Plain 5ml tubes Kitchen roll 15.12.4. PROCEDURE Adults aged 16 to 74 1. SalIntr1 -- Introduce the saliva sample to the respondent. 2. SalInst -- Respondent takes the dental roll from the tube, inserts it in his / her mouth and leaves it there until it is soaked. 3. Ask the respondent to move the roll around the mouth, without chewing. 3 minutes will be ample. 4. The respondent needs to get the dental roll saturated in order for the lab to be able to do the analysis. If the respondent has a dry mouth, ask them to drink some water. Wait some time before starting again in order to obtain saliva rather than water. 5. Check that the roll is soaked. 6. SalObt1 -- Code if saliva has been obtained, even if it is only a small amount SalNObt -- If no saliva is obtained, please code reasons and give fuller explanations as appropriate. Children aged 4 to 15 1. SalIntr1 -- Introduce the saliva sample to the respondent 59 2. Remove the cap from the plain tube. 3. SalInst -- Ask the respondent to gather up their saliva and to dribble through the straw into the tube. Discourage the child from clearing his / her chest before spitting. 4. Give the straw to the child and allow up to three minutes to do this. Collect as much as you can in this time. The saliva will be frothy, so it is easy to think you have collected more than you actually have. Do not give up too soon. 5. If the child finds it difficult to use the straw, s/he may dribble into the tube directly. This is acceptable, but encourage them to use the straw where possible. 6. If the child’s mouth is excessively dry and s/he cannot produce saliva, allow him/her to have a drink of plain water. Wait for a few minutes to ensure that no water is retained when they provide the saliva sample. 7. SalObt1 -- Code if saliva has been obtained, even if it is only a small amount. SalNObt -- If no saliva is obtained, please code reasons and give fuller explanations as appropriate. 15.13. LABELLING AND SENDING BLOOD AND SALIVA SAMPLES TO THE ROYAL VICTORIA INFIRMARY LABORATORY IN NEWCASTLE. The blood samples (first 3 tubes) and the saliva sample are to be sent to the Royal Victoria Infirmary Laboratory in Newcastle. It is important that the blood is sent properly labelled and safely packaged and that it is despatched immediately after it has been taken. (If you are in a BT:V sampling point and have taken 4 tubes of blood, the following instructions apply to the first 3 tubes only; the fourth tube will be taken to a local processing laboratory - see section 14.4.14..) 15.13.1. Labelling and Packaging the Saliva tube: 1. Make sure that the lid of the saliva tube is secure. 2. Write the respondent’s serial number and date of birth on the label and attach the label to the tube horizontally. It is vital that you write on the labels clearly and do not confuse respondents’ saliva or blood tubes. 3. Wrap the tube in kitchen towel and place it in a resealable plastic bag. 4. Place the tube and bag in the padded envelope with the respondent’s blood samples and despatch form. Each respondent’s samples must be packed separately unless none of the respondents in the household are providing blood, in which case, saliva only samples may be put in the same envelope for the same household. Put the despatch notes loose in the envelope. 15.13.2. Labelling the Blood Tubes: Label the tubes as you take the blood. It is vital that you do not confuse respondents’ blood tubes. Write the respondent’s serial number and date of birth on each label as clearly and carefully as possible -- the laboratory has had problems reading some nurses’ writing in the past. Attach the label to the vacutainer tube. Attach a serial number label to every tube that you send to the lab. Make sure you use black biro - it will not run if it gets damp. Check the date of birth with the respondent again verbally. 60 Stick the label over the label already on the tube. The laboratory needs to be able to see on receipt how much blood there is in the tube. We cannot stress too much the importance of ensuring that you label each tube with the correct serial number for the person from whom the blood was obtained. Apart from the risk of matching up the findings of the blood analyses to the wrong person’s data, we will be sending the GP the wrong results. Imagine if we detect an abnormality and you have attached the wrong label to the tube! 15.13.3. Packaging the blood samples: Pack the tubes for each respondent separately from those of other respondents. All the tubes from one person can be packed together in one container. The following procedures are designed to minimise accidental damage and, should there be any damage, any blood spillage. 1. You are supplied with plastic containers designed to take tubes. Place the filled tubes in a container. Press the two halves of the container firmly together. 2. Wrap a piece of kitchen towelling paper around the plastic container. 3. Place the wrapped container into the resealable plastic bag (in your supplies), with the opening of the bag covering the hinged part of the plastic container. Ensure that the bag is sealed. 4. Place the wrapped container with the saliva sample into the pre-addressed envelope, inserting it so that the opening of the plastic bag goes in first (i.e. away from the entrance to the envelope). 5. Put the Blood Sample Despatch Note 1 in the envelope. 6. Fold over the end of the envelope, and seal firmly with sellotape. Wrap the tape right round the envelope. NEVER use staples to seal the envelope Staples can cut post office workers’ hands. When blood is transported this can be dangerous. 7. Post the envelope immediately. It will go by special delivery. This ensures that it arrives the next day. If you do your interview too late to catch the last post, post it to catch the next post. If you miss the Saturday post collection, take the envelope to a box that has a Sunday collection. The blood should not be refrigerated. 8. When you have posted the blood samples, fill in the time and date of posting on the office copy of the Blood Sample Despatch Form 2. 15.13.4. Completing the Blood Despatch Form (DESPATCH 1) The Consent Booklet contains a despatch note that should be filled in and sent to the laboratory with the blood sample. Be sure you use the correct despatch note; use DESPATCH 1 for sending blood samples to the Newcastle laboratory. 61 * Enter the respondent’s serial number very carefully. This should correspond both to your entry on page 1 of the Consent Booklet and to the serial numbers you have recorded on the tubes. * Complete items 2 and 3. * At Item 4, circle the code for the age of the respondent and at Item 5 tick a box for each tube you are sending to the laboratory. It may be that you only managed to obtain two tubes from the respondent, in which case you would ring the appropriate codes. * Complete Item 6. * At Item 7, circle a code to tell the laboratory whether or not permission has been obtained to store part of the blood. Your entry here should correspond to your entry at d) in the ‘Summary of Consents’ on the front page of the booklet. * At Item 8 enter your SCPR Nurse Number. Tear off this despatch note and send with the blood to the laboratory. Complete the Office Despatch Form (DESPATCH 2) on the next page of the Consent Booklet. This tells us the date you sent samples to the lab and indicates what we should expect back from the laboratory. You complete the top part only (Q1, 2, and 3) for tubes sent to the Newcastle lab. 15.14. DELIVERING BLOOD TO LOCAL PROCESSING LABORATORIES If you are working in a BT:V sampling point, you will have taken a fourth tube of blood which will be analysed for vitamins. This needs to be taken to one of the local processing laboratories within 4 hours of venepuncture. You will be given the name of your local processing laboratory and a contact name there before you start work. You should contact this person before delivering your first sample to warn him/her when to expect deliveries on a regular basis. If you require any assistance, contact your nurse supervisor for advice. 15.14.1. Packaging and delivering the blood sample: 1 You should meet with your contact at the local lab before you begin work to agree procedures for delivery and become familiar with the lab. 2 Label the fourth tube (which is a 6ml plain tube) as clearly as possible with the serial number and date of birth label using a black biro. 3 After venepuncture, the tube should immediately be placed inside a plastic bag, then placed in a small padded envelope with Despatch Form 3, then placed inside a larger plastic resealable bag and onto a pre-frozen cold pack in the cold box. It is your responsibility to keep the cold pack cold. If you are working at another job and do not have facilities to keep the cool pack frozen at your place of employment, you will need to return home to collect your cool box before going the household. 4 Deliver the tube as soon as possible (and definitely within 4 hours of venepuncture) to your contact at the local hospital laboratory. If the named contact at the laboratory is unavailable for any reason, ask to speak to a colleague of the named person instead. Do not 62 leave the sample in Reception, but always make sure that you hand them over to someone who can deal with them immediately. If you do not keep the sample cold and deliver it promptly it will no longer be of use to us. 4 You should also write the serial number and date of birth on two extra green labels; these should be left at the lab along with the despatch note (see below). 15.14.2. Completing the Blood Delivery Note (DESPATCH 3) The Consent Booklet contains a delivery note that should be filled in and handed over to the laboratory with the blood sample. Be sure you use the correct despatch note; use DESPATCH 3 when delivering blood samples to the local laboratory. You need only complete the top half of despatch note 3: * Enter the respondent’s serial number very carefully. This should both correspond to your entry on page 1 of the Consent Booklet and to the serial number you have recorded on the tube. * Complete items 2-5. * At Item 6 enter your SCPR Nurse Number. * At Item 7, write in the name of the hospital/laboratory you delivered the blood to. Do not complete the bottom half of the form; this will be completed by the local laboratory. Tear off this despatch note and hand it over with the blood to the laboratory, along with two more serial number/date of birth labels. Complete the bottom part of Office Despatch Form (DESPATCH 2) in the Consent Booklet. This tells us the name of the lab you delivered the blood to along with the date of delivery. Complete the bottom part only for tubes delivered to local labs. 15.15. FINISHING THE INTERVIEW Ensure that you have six codes ringed on the front of the Consent Booklet. If any results are to go to the GP (either consent code 01 or 03 or 07 ringed) check that you have details of the GP. The GP details are needed so that we can telephone and write to the GP, if there is an abnormal result. Therefore the GP address should be as full as possible, and the telephone number should include the local area code. At the end of the interview, thank the respondent for all their help. We will be writing to thank them also. EndTime-- Record the time that the interview ended. 15.15.1. The admin block: The computerised nurse schedule consists of four main components: 1. The household information 63 2. The individual schedule 3. The drug coding block 4. The admin block Each component is known as a ‘parallel block’. This means that you can enter any component at any time, no matter where you are in the schedule. For example, you can enter the drug coding block at any convenient moment in the individual schedule. 15.15.2 Parallel Blocks The way to move between parallel blocks is by pressing Goto parallel blocks Parallel blocks + NURSEHH + Nursched[1] + Nursched[2] - Nursched[3] + Drugcode[1] - Admin The list of blocks will vary depending on the number of people in the household and the extent to which you have completed the drug coding. There will always be a ‘NURSEHH’ and an ‘Admin’ for each household. In addition, there will be a ‘Nursched’ for each eligible individual in the household (in the above example, there are three eligible individuals). As soon as you tell the computer that an individual has some prescribed drugs, it will create a ‘Drugcode’ block for that individual. Thus, you may have fewer ‘Drugcode’ blocks than ‘Nursched’ blocks, since a ‘Drugcode’ block will not be created for individuals who have no prescribed drugs. It is important to remember that ‘Nursched[1]’ is the individual schedule for the first person entered in the household grid - ie. the selected ADULT. This is why you must enter the details in the order Adult, Child A, Child B. If the individuals are entered in the wrong order (eg. if a household member is added to the grid late) and you subsequently find yourself unsure as to which ‘Nursched’ corresponds to which person number, you should enter each ‘Nursched’ in turn and look at the details given on the first screen until you find the person you want. Please also note that the ‘Drugcode’ block will have the same number suffix as the respective ‘Nursched’ block, ie. ‘Nursched[1]’ will be the same person as ‘Drugcode[1]’, and so on. The final thing to note about the parallel blocks screen is the ‘+’ or ‘-’ which precedes each block. All blocks will have a ‘-’ to start with, and this will turn into a ‘+’ when the computer is satisfied that that block has been fully completed. In the above example, the nurse has completed the household grid, the schedule for the first two people in the grid, and the drug coding for the first person. (The fact that (s)he has completed the schedule for the second person and there is no ‘Drugcode[2]’ on the list means that the second person had no prescribed drugs.) 64 15.15.3. Saving work: It is a good idea to save your work regularly while in the interview, especially if you are having to get up and leave the computer to take measurements etc. It has been known for children or pets to interfere with the computer and cause nurses to lose their work while they were not looking. A good habit to get into is to save the schedule every time you stand up to do a measurement, using 16. COMPLETING THE NRF AND RETURNING WORK 16.1. Recording the outcome of your attempts to interview and measure: You should complete page 3 and 4 of the Nurse Record Form (NRF) to report the outcome of your attempts to interview and measure all respondents who your interviewer has fixed up an appointment for. Q6/7 The codes in these questions are referred to as Outcome Codes. The code you ring will tell the office whether or not you completed the Nurse Schedule, and if not, why this was so. Code 80 should only be used if there was no interview at the address, or if the interviewer did not make an appointment for you (i.e., if the interviewer outcome was code B on page 1). If the interviewer did arrange an appointment for you to visit the respondent (outcome A), you should use one of the codes 81-89 to record your final outcome. Use code 81 if you went through the whole schedule with the respondent and completed all the relevant questions. This code applies even if the respondent refused any of the measurements. A proxy refusal is the situation where someone else refuses on behalf of the respondent - for example, a husband who says he will not allow his wife to be seen by a nurse. Obviously you should do your best to try and see the person yourself but sometimes this is not possible. Codes 85-87 should be used only if the respondent is unavailable for interview for these reasons throughout the whole of your fieldwork period. If they are likely to return, and be fit to be seen, during that time, then try again later. 16.2. Returning work to the office: Post the NRFs and the Consent Forms back to the office the same day as you send the blood samples to the Newcastle lab. Referral back to GPs and respondents in the event of any serious abnormalities can be seriously delayed if work is not returned promptly by nurses. Before returning work, check that you have all the documents you should have and that they are properly serial numbered and so on. Check that they match with your NRF entries. You should return a Consent Booklet for each person who has an Outcome Code of 81. Send the Nurse Record Form to the office when you have completed everything you have to do at a household. Pin together the Nurse Record Form and Consent Booklets and return them in one envelope. Do not entrust other people to post your envelopes - always post them yourself. 65 Before returning CAPI work: * Make sure you have a Backup copy of your most recent work. * Connect up your modem * Select 'T' for ‘Transmit/Return data to HQ’ from the Action menu, and follow the instructions on the screen. CAPI questionnaire data will be transferred back to the office via the modem. The computer will decide what to transmit - you do not need to tell it which addresses to take and which to leave. Remember you still need to return the paper documents. When your assignment is completed, make your last return of work as follows: * Make sure that you have taken a Backup of your most recent work. * Do your last Return-of-work via modem, by selecting 'T' for 'Transmit/Return data to HQ' from the Action menu. Follow the instructions on the screen. * Then carry out the 'End of Assignment clear-out' routine by selecting 'E' from the Action menu. This routine requires the use of the Backup disk for the last time. At the end of your assignment, check that you have accounted for all the serial numbers on the Nurse Sample Sheet. Keep this NSS. It will help sort out queries, should there be any, about work done by you. 66 MISCELLANEOUS SUPPLEMENTARY INSTRUCTIONS Date of original household interview Please note that the computer has no way of checking that the date you enter for the date of the original household interview is correct. So please be extra careful when entering this date, and always enter it as DAY-MONTH-YEAR. Questions and measurements can be missed out or asked by mistake if this date is wrong. Be sure to copy it correctly from the NRF into your programme. If you enter it wrongly you will have to exit the questionnaire and then come back in again to reset it. ‘ScrOut’ When you enter the household questionnaire for a household, after you put in the first 10 characters of the first line of the address you come to a question called ‘ScrOut’. ScrOut looks like this: What do you want to do now? 1) proceed with the interview, 2) leave it for now and try again later, 3) screen the household out as NOT eligible for a nurse visit 4) screen the household out for another reason. Use option 1 if there is at least one person to be interviewed at the household and you are ready to start interviewing at the household. Do not use option 2. This option was used in an earlier version of the program. Use option 3 ONLY if the interviewer has been to the household and no one in the household has agreed to a nurse visit. Use option 4 if a) the household is to be reallocated to another nurse, OR b) you are in an extra household that has been opened by mistake, OR c) you have been advised to do so by Head Office. If you are at all unsure, ask for help from the usual sources. Vitamin points - Fasting samples There have been some queries regarding fasting status for the vitamin samples. A respondent is considered to have a fasting blood sample if s/he has not had anything to eat or drink in the 4 hours prior to venepuncture. When working in a vitamin month, a vitamin sample should be taken regardless of whether the respondent has fasted, and the fasting status should be recorded on despatch forms 2 and 3. 67 In vitamin points, interviewers will ask the respondent not to eat or drink anything for 4 hours before the nurse appointment, if possible. They will also try to schedule the nurse appointment early in the morning in order to facilitate fasting. CAPI contains two food questions prior to venepuncture when a vitamin sample is to be collected. The first has to do with fruit and fruit juice consumption and does not reflect whether or not a respondent has fasted. The second question is used to determine whether the sample is a fasting sample. Sample tube labels The laboratory is receiving very many samples where the collection date is being put on the label instead of the respondent’s date of birth. Please could you be very careful to put that you put their date of birth on the label - this is very important identifying information. 68 17. CONTACT NAMES AND TELEPHONE NUMBERS MEDICAL EMERGENCIES: AREA MANAGER: ASST AREA MANAGER: FIELD DEPARTMENT: UCL RESEARCHERS: SCPR RESEARCHERS: Nurse to complete: INTERVIEWER PARTNER: NURSE SUPERVISOR: INTERVIEWER SUPERVISOR: 69 P1731 THE SCOTTISH HEALTH SURVEY 1998 Instructions for the introduction of blood sample from 11-15 year olds 1 This document contains: - Revised blood sample collection protocol - to replace section 51.11 - Revised consent form instructions - to replace section 14.1 - New EMLA CAPI instructions Please ensure you have read and understood these instructions before proceeding with your next sample point. 1. THE CONSENT BOOKLET...... 3 2. BLOOD SAMPLE COLLECTION...... 5 15.11 SUMMARY OF PROCEDURES...... 5 15.11.1 Purpose...... 5 15.11.2 Eligibility...... 6 15.11.3 Equipment...... 6 Blood tubes ...... 6 15.11.4 EMLA cream...... 6 13.11.5 Procedure for taking blood sample ...... 7 15.11.6 General information about EMLA cream ...... 8 15.11.7 Applying EMLA cream...... 9 15.11.8 Preparing the respondent ...... 10 15.11.9 Taking the sample ...... 10 15.11.10 EMLA cream for respondents aged 16+ ...... 11 15.11.11 Fainting respondents...... 12 15.11.12 Disposal of needles and other materials ...... 12 15.11.13 Needle stick injuries ...... 12 15.11.14 Respondents who are HIV or Hepatitis B positive ...... 12 3. CAPI INSTRUCTIONS ...... 13 2 1. THE CONSENT BOOKLET This should replace the existing section 14 of the current nurse instructions. The main change outlined below is that the revised Consent booklet still contains six Consent Sheets but has been revised to take account of the fact that respondents aged 16 and above are, in Scottish law, considered to be adults and therefore no counter-signature from a parent is required. 14.1. The Consent Booklet Immediately before you start to carry out measurements on a respondent, complete the first half of page 1 of the Consent Booklet. Never do this in advance of your visit to the household. Do NOT prepare these documents in advance of your visit, as there is a serious danger that you will use the wrong set of documents for the wrong person. It is all too easy to do in the stress of the moment. Check carefully that you have entered the respondent’s correct serial number. Use a black pen when completing the booklet, and ensure that signatures are always in pen, not pencil. Use capital letters and write clearly. Do not erase any of the personal information. If necessary, cross out errors and re-write so that any corrections can be seen. Write the address at which you are interviewing in the box at the top of the Consent Booklet. Write the survey month next to the box (i.e. December), and then fill in the serial number boxes. Accuracy is vital. Enter your Nurse Number at Item 1 and the date on which you are interviewing at Item 2. At Item 3 record the full name of the respondent. We will be using this to write a thank-you letter to the respondent giving them their test results (if they wish), and to write to their GP (with their permission) to give him/her their test results. The name by which the GP knows the respondent and any other names the respondent is known by should be checked and recorded during the interview. This may, for example, be a maiden name. Code the respondent’s sex at Item 4 and ask the respondent for their date of birth and enter this in the boxes provided at Item 5. The respondent may say they have already given it to the interviewer. Explain that you have been asked to get it again as it will help ensure the right documents get put together. At Item 6, write in the name of the respondent’s parent if the respondent is aged between 5 and 15. Items 7-9 are completed during the course of your interview. At Item 7 you write in the name, address and telephone number of the respondent’s GP, if the respondent gives consent for their blood pressure, lung function and/or blood test results to be sent to their GP. If a respondent does not know the name of their GP, leave the top line blank (otherwise the computer will send out a nonsense letter like Dear Dr. Ash Grove Practice). Fill in the full name and address of the GP on every Consent Booklet for a household, even when all members have the same GP. Each individual is treated separately once they reach the office. At Item 8 record how complete you believe the GP address to be. If you are sure that a letter posted out of the area to that address would arrive, ring code 1. 3 Summary of consents is very important. You record here the outcome of your requests for permission for: a) the blood pressure results to be sent to the GP b) the lung function results to be sent to the GP c) a sample of blood to be taken d) the blood sample results to be sent to the GP e) a small amount of blood to be stored for future use f) their blood sample results to be sent to them. By the end of the interview every respondent should have SIX codes ringed at Item 9. *** Instructions relating to the change in consent forms to reflect the legal status of 16 year olds. The revised Consent booklet still contains six Consent Sheets but has been revised to take account of the fact that respondents aged 16 and above are, in Scottish law, considered to be adults and therefore no counter- signature from a parent is required. BP(A) and BP(C) Blood pressure information to GP consent forms. BP(A) is for adults aged 16+ to sign and BP(C) is for the parent or person with legal parental responsibility for children aged 5-15 to sign. LF(A) and LF(C) Lung function information to GP consent forms. LF(A) is for adults aged 16+ to sign and LF(C) is for the parent or person with legal parental responsibility for children aged 7-15 to sign. BS(16+) and BS(11-15) REVISED CONSENT FORMS Blood sample consent forms. These forms are in three parts: part I obtains consent to take blood; part II obtains consent to give the results to the GP; and part III obtains consent to store part of the blood. BS(16+) is for adults aged 16-74 to sign and BS(11-15) is for 11-15 year olds, and the parent or person with legal parental responsibility for an 11-15 year old, to sign. Please note, no counter- signature is required for BS(16+). The last three pages of this booklet are despatch notes for blood samples. Despatch 1 is a tear off sheet to go with samples to the Royal Victoria Infirmary laboratory in Newcastle. Despatch 2 is returned to the office with the rest of the booklet. Despatch 3 is a tear off sheet to pack with the vitamin samples and deliver with the sample to local labs (and is only used in the sampling points where extra blood has been taken for vitamin analysis). 4 2. BLOOD SAMPLE COLLECTION This should replace the existing section 15 of the current nurse instructions. The main change outlined below is that from July onwards children aged 11-15 will also be eligible for a blood sample. 15.11 SUMMARY OF PROCEDURES 15.11.1 Purpose Different analytes will be carried out for children and adults. For: Children age 11-15 years inclusive the blood will be analysed for haemoglobin and ferritin, total and house dust mite specific IgE and lead. Adults age 16 years and over the blood will be analysed for total cholesterol, HDL cholesterol, haemoglobin, ferritin, fibrinogen, Gamma GT and C-reactive protein. Cholesterol is a type of fat present in the blood, related to our diet. Too much cholesterol in the blood increases the risk of heart disease. But HDL cholesterol is a good type of cholesterol which is thought to be protective. Fibrinogen is a protein necessary for blood clotting and high levels are also associated with a higher risk of heart disease. Haemoglobin is the red pigment in the blood which carries oxygen. A low level of haemoglobin in the blood is called anaemia. One reason for a low level of haemoglobin may be a shortage of iron. Ferritin is a measure of the body's iron stores. Gamma GT is an enzyme present in the liver and its level in the blood can provide an indication of alcohol consumption and health of the liver. The level of C-reactive protein in the blood gives information on inflammatory activity in the body, and it is also associated with risk of heart disease. Vitamins are important for good health, and a lack of them can cause disorders. It is now thought that some vitamins offer protection against certain diseases. IgE is a substance in the blood, and the level of IgE is higher in some people who have allergies. House dust mite specific IgE indicates allergy to dust mites. The Scottish Office is very keen to know whether the level of allergy in the population is increasing or not and, if so, to what extent this is linked to dust mites. The blood will not be tested for any viruses, such as HIV (AIDS). 5 15.11.2 Eligibility All persons aged 11 and over are eligible to give blood, with the following exceptions: · Pregnant women · People with a clotting or bleeding disorder · People who have ever had a fit · Aged 11-15 and not living with a parent or guardian · People who are not willing to give their consent in writing and/or parent or guardian not willing · People who are currently on anticoagulant drugs, eg. Warfarin therapy 15.11.3 Equipment Tourniquet Vacutainer needles 21G (green) Alcohol swabs Butterfly needles 23G Dental rolls Needle disposal box Rubber gloves Vacutainer plain red tubes Adhesive dressing Vacutainer EDTA dark purple tubes (for Plastic postal containers adults) Padded envelopes Vacutainer EDTA light purple tubes (for Sealable plastic bags children) Kitchen roll Vacutainer citrate blue tubes Micropore tape Vacutainer vitamin tubes Vacutainer holder Vacutainer needles 22G (black) Set of labels for blood sample tubes EMLA cream tubes and Tegaderm dressings Blood tubes FOR RESPONDENTS AGED 16 AND OVER Three (or four) tubes need to be filled. They should be filled in the following order so that, if a situation arises where there will be insufficient blood to fill all the tubes, the analyses with the highest priority can still be undertaken. 1. Plain (red, large) tube. Only use tubes with white inset in lid. 2. One EDTA (purple, small) tube. Only use tubes with dark purple lids. Do NOT confuse with children’s EDTA tube which has a light purple lid and only extracts 2ml of blood. 3. Citrate (blue, small) tube. 4. Vitamin tube (for sub-sample of cases only) FOR CHILDREN AGED 11-15 Three tubes need to be filled. They should be filled in the following order so that, if a situation arises where there will be insufficient blood to fill all the tubes, the analyses with the highest priority can still be undertaken. 1. Plain (red, large) tube. Only use tubes with white inset in lid. 2. Two EDTA (purple, small) tube. Only use tubes with light purple lids which extract 2ml of blood. Do NOT confuse with adult’s EDTA tubes which have dark purple lids and extract 4ml of blood. 15.11.4 EMLA cream All respondents aged 11 to 15 who consent to give a blood sample must be offered EMLA cream. EMLA cream may also be used with older respondents who request it, but should not specifically be offered to older respondents. 6 Respondents who have had a reaction to any anaesthetic (local or general) are not eligible to have EMLA cream. This means that you may not take a blood sample from these respondents, unless they consent to give a sample without using EMLA. 13.11.5 Procedure for taking blood sample 1. Pregnant women are not eligible to give a blood sample 2. Ask the screening question to check whether the respondent has a clotting or bleeding disorder, or is currently on anticoagulant therapy eg. Warfarin. 3. Ask the screening question to find out whether the respondent has ever had a fit. Respondents who have a clotting or bleeding disorder, or are currently on anticoagulant therapy, or who have ever had a fit, are NOT ELIGIBLE to give a blood sample. 4. Explain the purpose and procedures for taking blood. In addition if the respondent is aged 11 to 15: · explain that there is the option of using EMLA cream - but that a sample can be given without EMLA. · give parent/young person the information sheet about EMLA and allow them time to read it · answer any questions about use of EMLA, advantages and disadvantages - side effects, time taken to work, etc · explain that EMLA cannot be used if the young person has a known allergic reaction to any local or general anaesthetic 5. Ask if respondent is willing to give blood sample 6. If yes and respondent is aged 11-15 Ask if respondent wishes EMLA cream to be used. 7. If respondent is aged 11-15 and wishes EMLA cream to be used Ask screening question to determine whether respondent has ever had allergic reaction to anaesthetic. If they have had an allergic reaction, they are not eligible to use EMLA cream, so you cannot take a blood sample unless they are willing to give a sample without EMLA. 8. If respondent wishes EMLA cream to be used Decide with respondent whether you will take blood sample now or arrange another time to return to take the sample. Remember you will need to allow 1 hour for the EMLA cream to work before taking the blood sample. NB. THE CONCEPT OF BLOOD TAKING AND USE OF EMLA CREAM MUST NOT BE RAISED WITH THE RESPONDENT BEFORE THE APPROPRIATE POINT IN THE CAPI SCHEDULE. DO NOT INTRODUCE BLOOD TAKING BEFORE THIS, AS THIS MIGHT RISK AFFECTING OTHER MEASUREMENTS (EG. BLOOD PRESSURE). YOU MUST NOT APPLY EMLA CREAM TO ANY RESPONDENT BEFORE YOU ARE PROMPTED TO DO SO IN THE CAPI SCHEDULE. If blood sample will be taken NOW, follow 9. onwards. If you will be returning on a separate occasion, complete remainder of interview and arrange separate appointment to return to take blood sample. 7 9. WHEN YOU ARE READY TO COMMENCE BLOOD-TAKING PROCEDURE: Obtain necessary written consents to give blood sample, notify GP of results, and for storage of blood sample (see consent sheets attached). If respondent is aged 11-15 you must make sure that you always obtain both the respondent’s own signature and the signature of their parent or the person who has parental responsibility. Remember that we no longer require a counter-signature from parents of 16-17 year olds. Note that there are tick boxes on the consent sheet to indicate whether the respondent/parent consented to give a blood sample with or without the use of EMLA cream. Make sure you tick the appropriate box. It is not sufficient to simply have one signature at items I-III on the BS pages of the Consent Booklet. You must make sure that you have all relevant signatures. 10. IF EMLA CREAM IS TO BE USED: Apply EMLA cream following the instructions in Section 15.11.7. 11. Take blood sample following the instructions in Section 15.11.9. 15.11.6 GENERAL INFORMATION ABOUT EMLA CREAM EMLA cream is an effective local anaesthetic cream with minimal side-effects. Occasionally mild local skin reactions are experienced. You will need to explain the pros and cons of using EMLA to each respondent and parent, in addition to giving them the written note to read. It is important that respondents understand that you are not a doctor and cannot treat unexpected reactions. Pros: Cons: · reduces sensation of needle prick · takes one hour to work, and so may increase · easy to apply anxiety · generally safe · occasionally makes veins harder to see · risk of local reaction in people known to be allergic to similar drugs · other possible side effects: - reddening of skin - whitening of skin - itching · theoretical risk of anaphylaxis (severe allergy), though this has never been reported None of the local skin side-effects (if they occur) requires treatment. The whitening or reddening will disappear by itself over a period of hours. A local allergic reaction may involve itching, but is unlikely to require treatment. EMLA contains two anaesthetics: lignocaine and prilocaine. It is important that you ask the question below (also within CAPI) to determine whether the respondent has any known anaesthetic allergies. Has the person giving this blood sample ever had a bad reaction to a local or general anaesthetic bought over the counter at a chemist, or given by a doctor, dentist or in hospital? 8 If the respondent has ever had a bad reaction to an anaesthetic then EMLA cream MUST NOT be used. However, the respondent can still give ablood sample w'ithout EMLAirthey are willing. EMLA is a prescription medication, so it is very important that you account for all EMLA tubes used on the record sheet supplied. Any EMLA tubes you have left at the end of your assignment should be returned to the Brentwood office with the record sheet. For safety, EMLA must not be left lying around where young children could get at it. 15.11.7 APPLYING EMLA CREAM EMLA cream must only be applied to healthy skin; therefore it must not be applied to sore or broken skin (eg. eczema or cuts). Make sure the EMLA cream is kept away from eyes or ears. If the young person requires EMLA to be applied prior to venepuncture, inspect the antecubital fossae and decide which arm you will use for blood-taking. If both arms are suitable, use the left arm. EMLA cream must be applied to ONE arm only. This means that, if you encounter problems during blood taking (eg. collapsing vein), NO ATTEMPT can be made to take blood from the other arm. Apply EMLA cream over the antecubital fossa. Cover with a Tegaderm dressing (a vapour permeable and self-sticking film dressing) to keep the EMLA in place. See details about how to apply EMLA below. N.B. Please note the illustration in the "Revised blood sample collection protocol (section 15)" shows EMLA used on the hand. However, all blood samples on the Scottish Health Survey should be taken from the arm. 1. Squl!l!ze Vl a lubl: in a 2. Peel the beige 3. Peel the paper layer 4. Apply the adhesive 5. Remove the paper 6. After 60 minules mound on Iht': area 10 be coloured 'centre CU1·0U1' marked 3M Tegaderm dressing with its paper frame usmg the cut (rnax. 5hrs). remove the anaestheust:d. Do not from the dressing. from the dressing. frame to cover the mark. Smooth down the dressing. Wipe off the rub in. EMLA. Do not spread edges of the dressing EMLA. Clean entire area the cream. carefully and leave in with alcohol and begm place for at k;u;t an hour. procedure The lime of J.pplicJ.lion c::m be wnnen on (he occlUSive dreSSing. 9 As you may well be aware, removing the Tegaderm is sometimes painful so take care on hairy arms! It is very important that the used tubes of EMLA should not be left lying around. Make sure you have removed them from the household on completion of the phlebotomy. 15.11.8 PREPARING THE RESPONDENT Ask the respondent if they have had any problems having blood taken before. 1. Explain the procedure to the respondent (and parent if respondent aged under 16). The respondent should be seated comfortably in a chair, or if they wish, lying down on a bed or sofa. 2. IF NO EMLA CREAM HAS BEEN USED: Ask the respondent to roll up their left sleeve and rest their arm on a suitable surface. Ask them to remove their jacket or any thick clothing, if it is difficult to roll up their sleeve. The antecubital fossae may then be inspected. It may be necessary to inspect both arms for a suitable choice to be made, and the respondent may have to be repositioned accordingly. IF EMLA CREAM HAS BEEN USED: Remove the Tegaderm dressing and wipe away excess EMLA cream. 3. Do not ask the respondent to clench his/her fist. Select a suitable vein and apply the tourniquet around the respondent’s arm. However, it is desirable to use the tourniquet applying minimal pressure and for the shortest duration of time. Do not leave the tourniquet in place for longer than 2 minutes. Ask the respondent to keep his/her arm as still as possible during the procedure. 4. Put on your rubber gloves at this point. Clean the venepuncture site gently with an alcohol swab. Allow the area to dry completely before the sample is drawn. 15.11.9 TAKING THE SAMPLE Venepuncture is performed with a green 21 gauge Vacutainer needle or butterfly. For children you have the option of using a black 22 gauge Vacutainer needle if it is more appropriate. Grasp the respondent’s arm firmly at the elbow to control the natural tendency for the respondent to pull the arm away when the skin is punctured. Place your thumb an inch or two below the vein and pull gently to make the skin a little taut. This will anchor the vein and make it more visible. Ensuring that the needle is bevelled upwards, enter the vein in a smooth continuous motion. Remember to take the tubes in the correct order. The first tube should always be the large plain tube with the red cap followed by the two light purple EDTA tubes (for 11-15yr olds) or (if respondent aged 16 or older) one dark purple EDTA tube followed by the blue citrate tube. The 10 vacutainers should be filled to capacity in turn and inverted gently on removal to ensure complete mixing of blood and preservative. (A fourth tube for 16-74 year olds may be required if you are working a vitamin point). Release the tourniquet (if not already loosened) as the blood starts to be drawn into the tube. Remove the needle and place a dental roll firmly over the venepuncture site. Ask the respondent to hold the pad firmly for three minutes to prevent haematoma formation. FOR ADULTS (aged 16-74) : a) IF NO EMLA CREAM HAS BEEN USED: if venepuncture is unsuccessful on the first attempt, make a second attempt on the other arm. If a second attempt is unsuccessful, DO NOT attempt to try again. Record the number of attempts within CAPI. b) IF EMLA CREAM HAS BEEN USED (see section 15.11.10): you must only make one attempt at venepuncture. If venepuncture is unsuccessful at the first attempt, DO NOT attempt to try again. FOR CHILDREN (aged 11-15): WHETHER OR NOT EMLA CREAM WAS USED: you must only make one attempt at venepuncture. If venepuncture is unsuccessful at the first attempt, DO NOT attempt to try again. FOR BOTH ADULTS AND CHILDREN: Record which arm the sample was drawn from. Remove the needle from the Vacutainer holder by inserting it into the slot at the top of the needle disposal box. Push it towards the narrow end of the slot until the hub fins are engaged. Twist the holder anti-clockwise to unthread the needle. Then slide the holder towards the centre of the slot, allowing the needle to drop into the container. IMPORTANT WARNING Never re-sheath the needle after use. Do not allow the box to become overfull as this can present a potential hazard. Check on the venepuncture site and affix an adhesive dressing, if the respondent is not allergic to them. If they are allergic, use a dental roll secured with micropore. 15.11.10 EMLA CREAM FOR RESPONDENTS AGED 16+ If a respondent aged 16 or over requests EMLA cream then you may use it, following the procedures outlined above for children (including the screening question about a reaction to an anaesthetic). However you should not explicitly offer EMLA to respondents aged 16+. This may arise for example if a child in a household has been offered EMLA and an older household member also requests EMLA. EMLA should never be OFFERED in a household where NO person aged under 16 is eligible for phlebotomy. 11 15.11.11 FAINTING RESPONDENTS If a respondent looks or feels faint during the procedure, it should be discontinued. The respondent should be asked to place their head between their knees. They should subsequently be asked to lie down. If the respondent is happy for the test to be continued after a suitable length of time, it should be done so with the respondent supine and the circumstances should be recorded. The respondent may wish to discontinue the procedure at this point, but be willing to give the blood sample at a later time. 15.11.12 DISPOSAL OF NEEDLES AND OTHER MATERIALS Place the used cotton wool balls in the sharps box and put gloves etc. in the self-seal disposal bag. The needle disposal box should be taken to your local hospital for incineration. Telephone them beforehand, if you are not sure where to go. If you come across any problems with the disposal, contact the Survey Doctor who will contact your local hospital. The sealed bag can be disposed of with household waste as long as it does not have any items in it that are contaminated by blood. 15.11.13 NEEDLE STICK INJURIES Any nurse who sustains such an injury should seek immediate advice from their GP. The nurse should inform his/her nurse supervisor of the incident, and the nurse supervisor should inform the Survey Doctor at UCL. 15.11.14 RESPONDENTS WHO ARE HIV OR HEPATITIS B POSITIVE If a respondent volunteers that they are HIV or Hepatitis B positive, do not take a blood sample. Record this as the reason in the questionnaire. You should never, of course, seek this information. 12 3. CAPI INSTRUCTIONS EMLAnow If the respondent wishes to use EMLA cream for the blood sample, there is an option of taking the blood sample during the first visit or on a return visit. Blood sample using EMLA on the first visit First the schedule will take you through the Blood Sample Consent Form BS (11-15). The form is divided into three sections. If the respondent agrees to all three (s)he will sign the form three times. For children aged 11-15 years these signatures must be countersigned by the parent or person with legal parental responsibility for the respondent. Remember to tick the box ‘With the use of EMLA cream’ on the consent form. Make sure you follow the instructions on the laptop carefully - recording consent codes as instructed and giving reasons for refusals, if applicable. Follow the instructions for applying EMLA in the revised blood sample protocol enclosed. After applying the EMLA cream, you can continue with the remainder of the current respondent’s Individual Schedule and complete other Individual Schedules. To complete another Individual Schedule (while waiting for the EMLA cream to take effect) press < Crtl + Enter> and select an Individual Schedule from the parallel block screen. When you are ready to take the blood sample, press < Crtl +Enter> to go to the parallel blocks screen and select the Individual Schedule you want to complete. The screen will then display the following message “YOU HAVE YET TO TAKE A BLOOD SAMPLE FROM THIS RESPONDENT”. Press Blood sample using EMLA on a return visit BEFORE YOU CONTINUE CHECK YOU HAVE THE CORRECT SERIAL NUMBER, HOUSEHOLD AND RESPONDENT. On the return visit, press Press First the schedule will take you through the Blood Sample Consent Form BS (11-15). The form is divided into three sections. If the respondent agrees to all three (s)he will sign the form three times. For children aged 11-15 years these signatures must be countersigned by the parent or person with legal parental responsibility for the respondent. Remember to tick the box ‘With the use of EMLA cream’ on the consent form. Make sure you follow the laptop instructions carefully - recording consent codes as instructed and giving reasons for refusals, if applicable. 13 Follow the instructions for applying EMLA cream in the revised blood sample protocol enclosed. After one hour, when the EMLA has had time to take effect, you can continue with taking the blood sample following the instructions on the laptop. 14 P1731 SCOTTISH HEALTH SURVEY 1998 EDITING AND CODING MANUAL Version 1 October 1998 1 Table of Contents: INTRODUCTION ...... 4 1. HOUSEHOLD QUESTIONNAIRE...... 5 1.1 HOUSEHOLD GRID...... 5 2. GENERAL HEALTH...... 5 2.1 ILLSM: LONGSTANDING ILLNESS ...... 5 3. CARDIOVASCULAR DISEASE ...... 6 3.1 CVDOTH: OTHER CVD CONDITION ...... 6 3.2 WHATOTH: OTHER TREATMENT/ADVICE FOR HEART CONDITION OR STROKE...... 6 3.3 WHATTSP: OTHER TREATMENT FOR HIGH BP...... 6 3.3 WHATDSP: OTHER TREATMENT FOR DIABETES...... 6 4. ASTHMA ...... 7 5. ACCIDENTS ...... 7 5.1 WYROTH: OTHER LOCATION OF ACCIDENT ...... 7 5.2 CAUSEOTH: OTHER CAUSE OF ACCIDENT ...... 7 5.3 INJOTH: OTHER INJURY SUFFERED ...... 7 6. ACTIVITY...... 7 6.1 OTHACT: OTHER PHYSICAL ACTIVITY ...... 7 7. EATING HABITS ...... 8 7.1 BREADOTH: OTHER TYPE OF BREAD...... 8 7.2 OTHSPR: OTHER TYPE OF SPREAD ...... 8 7.3 FRYOTHER: OTHER TYPE OF COOKING FAT/OIL...... 9 7.4 MILKOTH: OTHER TYPE OF MILK ...... 9 7.5 OTHCER: OTHER KINDS OF CEREAL...... 9 8. SMOKING...... 9 8.1 SMOKOTH: OTHER HEALTH REASON WHY GAVE UP ...... 9 9. DRINKING...... 9 9.1 NBEER: NORMAL STRENGTH BEER ...... 10 9.2 SPIRITS:SPIRITS...... 10 9.3 WINE:WINE ...... 10 9.4 SHERRY: SHERRY & VERMOUTH: ...... 10 9.5 OTHDRNKA-C: OTHER ALCOHOLIC DRINKS ...... 10 10. DENTAL HEALTH...... 11 10.1 OTHT:OTHER KINDS OF DENTAL TREATMENT...... 11 11. CLASSIFICATION ...... 11 11.1 SIC AND SOC CODING: ...... 11 11.2 TOPQUAL: HIGHEST EDUCATIONAL QUALIFICATION ...... 12 11.3 ACOTHSP: OTHER ACADEMIC QUALIFICATIONS ...... 12 11.4 VOCOTHSP: OTHER VOCATIONAL/PROFESSIONAL QUALIFICATIONS ...... 12 11.5 OTHETHNI: OTHER ETHNIC ORIGIN ...... 14 12. SELF-COMPLETION...... 14 12.1 SCOMP6O: OTHER REASON FOR RESPONDENT NEEDING ASSISTANCE/NOT COMPLETING ...... 14 13. MEASUREMENTS ...... 14 13.1 HEIGHTS & WEIGHTS:...... 14 13.2 NOHITMO: OTHER REASON FOR NO HEIGHT MEASUREMENT ...... 14 13.3 NOWAITMO: OTHER REASON FOR NO WEIGHT MEASUREMENT...... 14 14. CONSENTS ...... 14 14.1 NRSREFO: OTHER REASON FOR REFUSING NURSE...... 15 15. ADMIN BLOCK...... 15 15.1 DWELLTYP0: OTHER TYPE OF HOUSEHOLD DWELLING ...... 15 APPENDIX II: LONGSTANDING ILLNESS CODE FRAME:CAPI VARIABLES ILLCODE1, ILLCODE2, ILLCODE3...... 17 APPENDIX III:LONG-STANDING ILLNESS FRAME: ALPHABETICAL ...... 30 APPENDIX IV RECODING OF OTHER ACTIVITIES...... 46 APPENDIX V: CODING FRAMESERROR! BOOKMARK NOT DEFINED. FOR QUALIFICATIONS .49 APPENDIX VI: CODING PRESCRIBED MEDICINES...... 50 APPENDIX VII: CODING QUERY RESPONSE FORM ...... 63 APPENDIX VIII:VOLUME OF MISCELLANEOUS BOTTLED LAGER/CIDER/BEER ...... 64 APPENDIX IX :CIGARETTE BRAND CHECK LIST...... 67 APPENDIX X:CODING LIST FOR CODING BUTTER/MARGARINE ...... 82 APPENDX X1:CODING LIST FOR CODING BREAKFAST CEREALS...... 83 APPENDIX X11:CODING FRAME FOR HEART TROUBLE...... 84 SHS 1998: Coding and Editing Instructions INTRODUCTION This document details the editing and coding requirements for the Scottish Health Survey 1998. General Points: * FACTSHEETS The FACTSHEET is provided to aid editing of the CAPI questionnaire. All questions which will require editing should be printed on the FACTSHEET. Editing decisions should be written alongside the appropriate questions, or at the end of the FACTSHEET if the question has not been printed. The FACTSHEET will then contain a record of all coding and editing decisions made on any individual questionnaire. * SOFT CHECKS All soft checks that were triggered by the interviewer and which have not been resolved will trigger in the edit programme. Where appropriate these should be investigated. If no editing action can be taken to resolve these checks they should be cancelled by the editor (press Shift *). If particular checks are frequently activated and are not useful in editing these can be removed in further updates to the editing programme, so keep us informed. * "OTHER (SPECIFY)" QUESTIONS All "Other (specify)" questions which are answered should be investigated for back coding. The specific variables are detailed below by section. In the CADI edit programme, extra questions giving editing instructions will appear on the route after all "Other (Specify)" questions which have been answered. Any “Other (specify)” answers in the self-completion booklets that have not been recoded should be listed with the serial number. “Other” answers in CAPI can be transferred electronically and so don’t require listing. Listing sheets should be sent to researchers every month. Where an `other' answer is to be recoded back into a multi-coded question, ensure to edit using Where problems arrise that do not appear in these editing instructions, please contact the research team for further advice. 4 SHS 1998: Coding and Editing Instructions 1. HOUSEHOLD QUESTIONNAIRE 1.1 Household Grid Children aged less than one year are recorded as ‘0’. If Age/Date of birth are missing, check whether is was collected at the nurse visit. Add DoB and age calculated from Individual Questionnaire Date to the Household Grid if available from Nurse Schedule. 2. GENERAL HEALTH 2.1 IllsM: Longstanding Illness Description of longstanding illness is asked a maximum of six times. The answers to these questions are given in the variables IllsM which should be coded using the Longstanding Illness frame given in Appendix II Code up to three times in the CAPI fields which have been especially allocated for this purpose: IllCode1 - IllCode6 which appear at the end of all the longstanding illness questions. Any illnesses listed which cannot be found in either the code frame or the ICD should be sent to UCL for a decision using a coding query response form (see Appendix VII Rules for coding long-standing illness Code 41 Unclassifiable (no other codable complaint) Exclusive code - this should only be used when the whole response is too vague to be coded into one of the codes 01-40. This includes unspecific conditions like ‘old age’, ‘war wounds’ etc (see codeframe for examples). Th is code can only be used in the ‘first mention’ columns. The editing program issues a warning if code 41 is used in any of the other columns. Code 42 Complaint no longer present Exclusive code - again it should only be used when the response given is only about a condition(s) that no longer affects the respondent. This code can only be used in the ‘first mention’ columns. The editing program issues a warning if code 42 is used in any of the other columns. Codes 01-40 can be used more than once if two different conditions are mentioned which both fall into the same category. An exception to this is ‘arthritis and rheumatism’. This is not two conditions, and so should not be given two separate codes; instead, code only one occurrence of code 34. (If two (If two specific conditions were mentioned - eg osteoarthritis and rheumatoid arthritis - this should be coded as two occurrences.) 5 SHS 1998: Coding and Editing Instructions Code 97 Used to denote coding is complete The edit program will not move on until 97 is coded except where there are six illnesses coded. If more than 6 illnesses have been typed in by the interviewer, the first 6 mentioned should be coded. 3. CARDIOVASCULAR DISEASE 3.1 CVDOth: Other CVD condition FACTSHEETS of questionnaires which have an answer recorded in CVDOth should be kept aside, until you have consulted Anne McMunn at UCL. She will be able to tell you how to deal with all `other' heart conditions - whether they should be excluded or kept in under `other'. New codes: 09 Too vague to code 06 Other Any conditions given which could have been coded at CVD1-CVD5 or CVD7 or CVD8 will be coded 01-05, 07 or 08, but will remain coded under CVDOth rather than being recoded. If ‘High cholesterol’ only is mentioned, change CVD6 to ‘No’ 3.2 WhatOth: Other treatment/advice for heart condition or stroke Recode into WhatOth if possible, otherwise leave. New code: 04 Taking medication 3.3 WhatTSp: Other treatment for high BP Recode into WhatTrt if possible, otherwise leave. New codes: 05 Advised to stop smoking 08 Lifestyle in general (not elsewhere specified) 3.3 WhatDSp: Other treatment for diabetes 6 SHS 1998: Coding and Editing Instructions Recode into OtherDi if possible, otherwise leave. 4. ASTHMA No coding or editing required for this section 5. ACCIDENTS 5.1 WyrOth: Other location of accident Recode into DrWyr where possible, otherwise leave 5.2 CauseOth: Other cause of accident Recode into AxCause where possible, otherwise leave Note new code 10 - "Lifting" - added in edit program 5.3 InjOth: Other injury suffered Recode into DrInj where possible, otherwise leave 6. ACTIVITY ADULT PHYSICAL ACTIVITY 6.1 OthAct: Other physical activity The data can store up to 16 codes (10 from WhtAct and a further 6 back-coded from OActQ[11- 16]). All activities at OActQ should be back-coded to WhtAct (multi-coded variable) if possible. Note that: Code 5 Any other type of dancing: Includes any answer mentioning 'dancing' (i.e. sequence dancing, tap dancing etc.). Does not include Ice dancing, see code 46 below. 7 SHS 1998: Coding and Editing Instructions Code 7 Football/ rugby: Includes those participating in the sport as referees and linesmen. Code 10 Exercises (e.g. press-ups, sit ups): Includes any answer mentioning 'exercises' (i.e. back exercises, office exercises etc.) or ‘working out’ Otherwise enter a code from the codeframe given in Appendix IV. If the sport is not listed, then it will need to be coded in one of codes 92-95 or in code 96. Please send listings of any sports not listed in Appendix IV to one of the researchers for instructions on which code to use. Note: It is possible to have two codes the same if "times" of activity cannot be amalgamated e.g. Horseriding = Code 45 and Showjumping = Code 45. No coding or editing required for Children’s Physical Activity module 7. EATING HABITS 7.1 BreadOth: Other type of bread These are 'Other' answers which are to be coded back to UsBread if possible. Interviewers have been instructed to ask if a bread is white or wholemeal. If type (white, wheatmeal, wholemeal) is specifically mentioned in UsBread then code appropriately to 1, 2 or 3. Code 4 will remain for those 'Other' breads where no flour type was established. For example, if all that is specified is: pitta, naan, soda bread, chapatis, French bread, baguettes, ciabatta, bagels, etc. and flour type is not given, use Code 4. Gluten free bread should also remain Code 4 if flour type is not mentioned. For crispbreads and crisprolls, such as Ryvita, use Code 9 "Does not eat any type of bread". 7.2 OthSpr: Other type of spread These are 'Other' answers which are to be coded back to Spr if possible. If "low fat spread" or “reduced fat spread” is specifically mentioned use Code 2. Brand names are listed on Coding List 1.(see Appendix X) Responses such as peanut butter, tahini spread, chocolate spread or jam - use Code 5 "Does not use fat spread". 8 SHS 1998: Coding and Editing Instructions 7.3 FryOther: Other type of cooking fat/oil These are 'Other' answers which are to be coded back to FryFat if possible. 7.4 MilkOth: Other type of milk These are 'Other' answers which are to be coded back to Milk if possible. Goats’ milk should recoded to Code 1 at Milk. Leave the following as “other kind of milk”: sterilised or pasteurised milk, powdered milk if semi-skimmed/ skimmed etc. not specified. Also leave breast milk and lactose-free milk as ‘other’. 7.5 OthCer: Other kinds of cereal These are 'Other' answers which are to be coded back to NCereal if possible. Appendix XI lists all cereals which should be given a Code 1 or 2, ie contain bran, oats or wheat. If a cereal mentioned in OthCer is not on the list and does not mention bran, oats or wheat in the title, it should be coded 4. This would include: Corn Flakes, Cheerios, Rice Krispies, Special K, Sugar Puffs, Honey Smacks, CocoPops, etc. Mentions of manufacturers or supermarket names without reference to a specific cereal i.e. Sainsbury's, Tesco's, Nestle, or Kelloggs, should be left as Code 3. Only cereals mentioned where grain content is unknown remain as Code 3. 8. SMOKING 8.1 SmokOth: Other health reason why gave up Recode into SmokCond where possible, otherwise leave Note new code 13 - "Circulation problems /pain in legs due to this" - has been added in edit program 9. DRINKING Exclusion/Inclusions for drinks categories: 9 SHS 1998: Coding and Editing Instructions * Remember to exclude all low/non-alcoholic drinks. * Home made drinks should be coded into the appropriate category. For recoding of `other' answers please note the following inclusions/exclusions: 9.1 Nbeer: Normal strength beer Exclude: Bottles/Canned shandy Exclude: Ginger Beer. Non alcoholic lagers - B arbican, Kaliber. Include: Export, Heavy, Bland and Tan, Barley Wine, Diabetic Beer, Home Brew Lager, Special Brew Lager, Lager and Lime, Home Brew Beer, Gold Label, Pommagne, Stout, Scrumpy. 9.2 Spirits:Spirits Include: Cocktails, Egg Flip, Snowball, Bacardi, Pernod, Sloe Gin, Pimms, Bourbon, Whisky Mac, Schnapps, Liqueur (nes), Bluemoon, Vodka, Rum (and pep), Souther Comfort, Tia Maria, Ouzo/Aniseed, Cheery Brandy, Arak (strong spirit), Irish Velvet, Brandy, 150 proof Moonshine, Gaelic Coffee, Advocaat, Tequila, Amagnac, Clan Dew, Campari, Malibu, Taboo. 9.3 Wine:Wine Include: Punch, Mead, Moussec, Concorde, Champagne, Babycham, Saki, Cherry B, Calypso Orange Perry, Home made wine, Thunder bird. Exclude: Non alcoholic wines such as Eisberg 9.4 Sherry: Sherry & Vermouth: Include: Cinzano, Dubonnet, Bianco, Rocardo, Noilly Prat, Ginger Wine, Home made Sherry, Tonic wine, Sanatogen, Scotsmac and similar British wines fortified with spirits, Port and Lemon. 9.5 OthDrnkA-C: Other alcoholic drinks All `other alcoholic drinks' need to be recoded into the appropriate drinks category. The following rules will apply: · If the appropriate drinks category is not already coded then information on frequency and 10 SHS 1998: Coding and Editing Instructions amount should be edited into appropriate variables and data in the `other' drinks category deleted. · If the appropriate drinks category is already coded then the highest frequency and the associated amount should coded. For example if frequency of Spirits is already coded as 2 and Campari, with a frequency of 1, is to be recoded into the Spirits category then the frequency should be changed to 1 and the amount variable should be recoded to that associated with Campari. · If the frequency of the other alcoholic drink is less than that contained in the drinks category into which it is to be recoded then the information in that `other' alcoholic drink should be ignored. · If the frequency in the other alcoholic drink and the category into which it is being coded are the same then the amounts should be added together. · If the frequency of both the `other' alcoholic drink and the appropriate drinks category exceed once or twice a week please contact Kavita for advice. 10. DENTAL HEALTH 10.1 Otht:Other kinds of dental treatment Back-code into Treat1-Treat4 otherwise list for researcher. 11. CLASSIFICATION 11.1 SIC and SOC coding: SIC and SOC coding is to be carried out up to two times (for the respondents and chief income earners). Occupations will need to be coded using SOC 1990 and the industry in which they work coded to the SIC 1992. The edit programme provides variables for coding of this information (variables names SIC, SOC). Where SIC or SOC is not adequately defined code as follows: SOC = 997; SIC=87. 11 SHS 1998: Coding and Editing Instructions 11.2 TopQual: Highest educational qualification To ease recoding, the existing code-frames are reproduced in Appendix V. 11.3 AcOthSP: Other academic qualifications Recode into TopQual where possible, otherwise leave. See rules blow for what to include/exclude. 11.4 VocOthSP: Other vocational/professional qualifications Recode into TopVocat where possible, otherwise leave. Note that 2 new codes have been added to TopVocat: 18 NVQDK "SVQ/NVQ - level not specified" 19 Nursery "Nursery Nurse Examination Board Qualification" See rules blow for what to include/exclude. Inclusions/Exclusions for qualifications This is a guide to what should be included and excluded from the qualification variables, if you are unsure. Academic qualifications: Include: Degree (code 1): - All higher degrees - CNAA degrees (granted by the Council for National Academic Awards for degrees in colleges other than universities) - Bachelor of Education (B.Ed) - not code 2 GCE/CSE codes: - Clerical or commercial subjects obtained in these types of qualifications should be coded to the relevant GCE/CSE codes Other academic quals (code 18): - Banking Exams - Certificate of Extended Education - Certificate of Prevocational Training - 16+ exam certificate 12 SHS 1998: Coding and Editing Instructions - Local, regional and RSA school certificates - Scottish School Attendance, Leaving or Day School Certificate Vocational/professional quals: Include: Nursing Qualifications (code 6) - State Enrolled Auxiliary Midwife - * Exclude : Dental Nurses's/Hygienists qualifications - code to other (code 16) Clerical or commercial qualifications (code 14) - RSA - provided at least one subject is commercial e.g. commerce, shorthand, typing, bookkeeping, office practise, commercial and company law, cost accounting - Pitmans - except for their school certificate, code as other = 16 - Regional Examining Union (REU) Commercial Awards, provided that at least one subject is commercial. REU include - East Midland Education Union (EMEU) Academic & Vocational quals: Exclude: Civil Service Examinations for entrance, promotion, establishment, typing etc. Dancing Awards (including ballet qualifications Drawing Certificates awarded by Royal Drawing Society Driving Certificates and Driving Instructor's Qualifications including Heavy Goods Vehicle Licence. Fire Brigade Examinations First Aid Certificates (deletes all Red Cross/St John's Ambulance qualifications Forces Preliminary Examinations (to gain admission to university) GPO telecommunications, telegraphy etc Labour Examinations (pre 1918). This allowed a child to leave school and start work at 13 Internal school examinations Local Authority Examinations for entrance, promotion etc Music Grade Examinations and Certificates for learners (eg Associated Board of the Royal School of Music) Ordination/Lay Preachers Qualifications Play Group Leader's Qualifications Police Force Examinations Pre HNC/HND bridging or conversion courses Prison/Borstal Training Qualifications Scholarships other than for GCE 'A' Level Swimming Certificates including life saving and instructors' certificates Sports Coaching and Refereeing Qualifications Union Membership e.g. Equity, National Association of Head Teachers, IPCS 13 SHS 1998: Coding and Editing Instructions (Institute of Professional Civil Servants) 11.5 OthEthni: Other ethnic origin Recode into Ethnic where possible, otherwise leave. 12. SELF-COMPLETION 12.1 SComp6O: Other reason for respondent needing assistance/not completing Recode into SComp6 where possible, otherwise leave. 13. MEASUREMENTS 13.1 Heights & weights: The soft checks for height and weight have been amended in the edit programme so only extremely unusual heights and weights will trigger these checks. We have put these in as a safety guard against very unlikely results. Please contact research staff if the height or the weight check activates for a particular questionnaire. 13.2 NoHitMO: Other reason for no height measurement Recode into NoHitM where possible, otherwise leave. 13.3 NoWaitMO: Other reason for no weight measurement Recode into NoWaitM where possible, otherwise leave. 14. CONSENTS 14 SHS 1998: Coding and Editing Instructions 14.1 NrsRefO: Other reason for refusing nurse Recode into NurseRef where possible, otherwise leave. 15. ADMIN BLOCK 15.1 DwellTyp0: Other type of household dwelling Recode into DwellTyp where applicable, otherwise leave. 15 SHS 1998: Coding and Editing Instructions APPENDIX I: ITEMS WHICH NEED LISTING List to SCPR researchers if not otherwise codable: CAPI Otht Other kinds of dental treatment Self-completions Adults Q24:DUBLAD - incontinence products Young adults Q9: DCIGBRAN, DCIGTYP Cigarette brand and type Q16G: DODRKA, Q16H:DODRINKB - Other alcoholic drinks Q20: DDRKTYP7, DDRKTYP8 - drinks in last week Q44: DUBLAD - incontinence products 13-15s Q15: AODRINK1-3 Other alcoholic drinks Q30: AUBLAD - incontinence products List to UCL, then send copy of query form to researchers after decision has been taken: IllsM - illnesses not found in coding frame or the ICD MEDBI - drugs not found in the BNF PLBRAND/ DPILBRAN - drugs which fail the edit check 16 SHS 1998: Coding and Editing Instructions APPENDIX II: LONGSTANDING ILLNESS CODE FRAME:CAPI variables IllCode1, IllCode2, IllCode3 Code Complaint 01 Cancer (neoplasm) including lumps, masses, tumours and growths Inch. leukaemia (cancer of the blood) Hodgkin's disease Lymphoma Acoustic neuroma Neurofibromatosis Hereditary cancer Cancers sited in any part of the body or system eg. Lung cancer, breast cancer, stomach cancer Skin cancer, bone cancer All tumours, growths, masses, lumps and cysts whether malignant or benign eg. tumour on brain, growth in bowel, growth on spinal cord, lump in breast Cyst on eye, cyst in kidney. Wilms tumour Rodent ulcers Sarcomas, carcinomas Mastectomy (nes) Hysterectomy for cancer of womb Colostomy caused by cancer Part of intestines removed (cancer) After affect of cancer (nes) NB benign (non-malignant) lumps and cysts = code 43 Endocrine/nutritional/metabolic diseases and immunity disorders 02 Diabetes - Incl. Hyperglycemia 03 Other endocrine/metabolic - Incl. underactive/overactive t hyroid, goitre Hormone deficiency, deficiency of growth hormone, dwarfism Beckwith - Wiedemann syndrome Addison's disease Cushing's syndrome Gilbert's syndrome Coeliac disease Phenylketonuria Cystic fibrosis 17 SHS 1998: Coding and Editing Instructions Rickets Malacia Wilson's disease Myxoedema (nes) Obesity/overweight Gout Water/fluid retention Hypopotassaemia, lack of potassium Hypercalcemia NB Thyroid trouble and tiredness - code 03 only Overactive thyroid and swelling in neck - code 03 only. AIDS, AIDS carrier, HIV positive - code 44 Code Mental, behavioural and personality disorders 04 Mental illness/anxiety/depression/nerves (nes) - Incl. schizophrenia, manic depressive Nervous breakdown, neurasthenia, nervous trouble Anxiety, panic attacks Stress Nerves (nes) Depression Phobias Autism Anorexia nervosa Alcoholism, recovered not cured alcoholic Drug addict Speech impediment, stammer Dyslexia Catalepsy Post-concussion syndrome NB Alzheimer's disease, degenerative brain disease = code 45 Senile dementia, forgetfulness, gets confused = code 45 05 Mental handicap - Incl. Down's syndrome, mongol Mentally retarded, subnormal Code Nervous system (central and peripheral including brain) - Not mental illness 06 Epilepsy/fits/convulsions - 18 SHS 1998: Coding and Editing Instructions Incl. grand mal, petit mal, Jacksonian fit, blackouts, febrile convulsions, fit(nes) 07 Migraine/headaches 08 Other problems of nervous system - Incl. Multiple Sclerosis (MS), disseminated sclerosis Cerebral palsy (spastic) Spina bifida Physically handicapped - spasticity of all limbs Hydrocephalus, microcephaly, fluid on brain Parkinson's disease (paralysis agitans) Motor neurone disease Muscular dystrophy Huntington's chorea Alzheimer's disease Degenerative brain disease Friedreich's Ataxia Abscess on brain Brain damage resulting from infection (eg. meningitis, encephalitis) or injury Injury to spine resulting in paralysis Paraplegia (paralysis of lower - limbs) Partially paralysed (nes) Metachromatic leucodystrophy Myotonic dystrophy Guillain - Barre syndrome Myasthenia gravis Syringomyelia Myalgic encephalomyelitis (ME) Post viral syndrome (ME) Bell's palsy Trigeminal neuralgia Neuralgia, neuritis Carpal tunnel syndrome Sciatica Trapped nerve Numbness/loss of feeling in fingers, hand, leg etc Pins and needles in arm Removal of nerve in arm Shingles Restless legs Code Eye complaints 09 Cataract/poor eye sight/blindness - Incl. operation for cataracts, now need glasses 19 SHS 1998: Coding and Editing Instructions Bad eyesight/nearly blind because of cataracts Hardening of lens Lens implants in both eyes Dad eyesight, restricted vision, partially sighted Short sighted, long sighted, myopia Trouble with eyes (nes), eyes not good (nes) Blind in one eye, loss of one eye Blindnes Detached/scarred retina Tunnel vision Blurred vision 10 Other eye complaints - Incl. glaucoma Buphthalmos Iritis Retinitis pigmentosa Night blindness Astigmatism Double vision Colour blind Squint, lazy eye Scarred cornea, corneal ulcers Haemorrhage behind eye Dry eye syndrome, trouble with tear ducts, watery eyes Eyes are light sensitive Injury to eye Eye infection, conjunctivitis Sty on eye Floater in eye Code Ear complaints 11 Poor hearing/deafness Incl. heard of hearing, slightly deaf Conductive/nerve/noise induced deafness Deaf and dumb Otosclerosis Poor hearing after mastoid operation 12 Tinnitus/noises in the ear - Incl. pulsing in the ear 13 Meniere's disease/ear complaints causing balance problems - Incl. labryrinthitis, loss of balance - inner ear 20 SHS 1998: Coding and Editing Instructions Vertigo 14 Other ear complaints - Incl. otitis media - glue ear Disorders of Eustachian tube Perforated ear drum (nes) Middle/inner ear problems Mastoiditis Ear trouble (nes), ear problem (wax) Ear aches and discharges Ear infection Code Complaints of heart, blood vessels and circulatory system 15 Stroke/cerebral haemorrhage/cerebral thrombosis - Incl. stroke victim - partially paralysed and speech difficulty Hemiplegia, apoplexy, cerebral embolism, Cerebro - vascular accident 16 Heart attack/angina - Incl. coronary thrombosis, myocardial infarction 17 Hypertension/high blood pressure/blood pressure (nes) 18 Other heart problems - Incl. heart disease, heart complaint Cardiac problems, heart trouble (nes) Weak heart because of rheumatic fever Hole in the heart Valvular heart disease Wolff - Parkinson - White syndrome Aortic stenosis, aorta replacement Pacemaker Heart failure Weak Heart because of St Vitus dance Pericarditis Ischaemic heart disease Mitral stenosis Cardiac diffusion Cardiac asthma Heart murmur, palpitations Tachycardia, sick sinus syndrome Hardening of arteries in heart Tired heart Pains in chest (nes) Dizziness, giddiness, balance problems (nes) Too much cholesterol in blood 21 SHS 1998: Coding and Editing Instructions NB Balance problems due to ear complaint = code 13 19 Piles/haemorrhoids incl. Varicose Veins in anus. 20 Varicose veins/phlebitis in lower extremities - Incl. various ulcers, varicose eczema 21 Other blood vessels/embolic - Incl. arteriosclerosis, hardening of arteries (nes) Artificial arteries (nes) Arterial thrombosis Thrombosis (nes) Wright's syndrome Varicose veins in Oesophagus Polyarteritis Nodosa Blocked arteries in leg Raynaud's disease Pulmonary embolism Intermittent claudication Telangiectasia (nes) Blood clots (nes) Swollen legs and feet Low blood pressure/hypertension Hypersensitive to the cold Poor circulation NB Haemorrhage behind eye = code 10 Code Complaints of respiratory system 22 Bronchitis/emphysema - Incl. chronic bronchitis Bronchiectasis 23 Asthma - Incl. bronchial asthma, allergic asthma Asthma - allergy to house dust/grass/cat fur NB Exclude cardiac asthma - code 18 24 Hayfever - Incl. allergic rhinitis 22 SHS 1998: Coding and Editing Instructions 25 Other respiratory complaints - Incl. bronchial trouble, chest trouble (nes) Bad chest (nes), weak chest - wheezy Breathlessness Pneumoconiosis, byssinosis, asbestosis and other industrial, respiratory disease Pigeon fanciers' s lung Lung complaint (nes), lung problems (nes) Damaged lung (nes), lost lower lobe of left lung Lung damage by viral pneumonia Fibrosis of lung Water on lung, fluid on lung Furred up airways, collapsed lung Chest infections, get a lot of colds Recurrent pleurisy Sinus trouble, sinusitis Rhinitis (nes) Catarrh Adenoid problems, nasal polyps Sore throat, pharyngitis Throat trouble (nes), throat irritation Throat infection Tonsillitis Abscess on larynx Coughing fits Allergy to dust/cat fur Paralysis of vocal cords Croup NB TB (pulmonary tuberculosis) - code 37 Cystic fibrosis - code 03 Skin allergy - code 39 Food allergy - code 27 Allergy (nes) - code 41 Pilonidal sinus - code 39 Sick sinus syndrome - code 18 Whooping cough - code 37 If complaint is breathlessness with the cause also stated, code the cause: eg. breathlessness as a result of anaemia (code 38) breathlessness due to hole in heart (code 18) breathlessness due to angina (code 16) Code Complaints of the digestive system 23 SHS 1998: Coding and Editing Instructions 26 Stomach ulcer/ulcer (nes)/abdominal hernia/rupture - Incl. gastric/duodenal/peptic ulcer Ulcer (nes) Double/inguinal/diaphragm/hiatus/umbilical hernia Hernia (nes), rupture (nes) 27 Other digestive complaints (stomach, liver, pancreas, bile ducts, small intestine - duodenum, jejunum and ileum) - Incl. stomach trouble (nes), abdominal trouble (nes) Indigestion, heart burn, dyspepsia Nervous stomach, acid stomach Inflamed duodenum Weakness in intestines Ileostomy Pancreas problems Throat trouble - difficulty in swallowing Stone in gallbladder, gallbladder problems Liver disease, biliary artesia Cirrhosis of the liver, liver problems Food allergies 28 Complaints of bowel/colon (large intestine, caecum, bowel, colon, rectum) - Incl. colitis, colon trouble, ulcerative colitis Spastic colon Enteritis Diverticulitis Irritable bowel, inflammation of bowel Polyp on bowel Colostomy (nes) Crohn's disease Hirschsprung's disease Frequent diarrhoea, constipation Faecal incontinence/encopresis. Grumbling appendix NB Exclude piles - code 19 Cancer of stomach/bowel - code 01 29 Complaints of teeth/mouth/tongue - Incl. impacted wisdom tooth, gingivitis Ulcers on tongue, mouth ulcers Cleft palate, hare lip No sense of taste Code Complaints of genito-urinary system 24 SHS 1998: Coding and Editing Instructions 30 Kidney complaints - Incl. kidney trouble, tube damage, stone in the kidney Nephritis, pyelonephritis Chronic renal failure Uraemia Renal TB Horseshoe kidney, cystic kidney Only one kidney, double kidney on right side 31 Urinary tract infection - Incl. cystitis, urine infection 32 Other bladder problems/incontinence - Incl. weak bladder, bladder complaint (nes) Bladder restriction Bed wetting, enuresis Water trouble (nes) NB Prostrate trouble - code 33 33 Reproductive system disorders - Incl. endometriosis Prolapsed womb Prolapse (nes) if female Vaginitis, vulvitis, dysmenorrhoea Gynaecological problems Menopause Hysterectomy (nes) Period problems, flooding, premenstrual tension Abscess on breast, mastitis, cracked nipple Damaged testicles Prostrate gland trouble Impotence, infertility Turner's syndrome Pelvic inflammatory disease (female) Code Musculoskeletal - complaints of bones/joints/muscles 34 Arthritis/rheumatism/fibrositis - Incl. arthritis/rheumatism in any part of the body Osteoarthritis, rheumatoid arthritis, polymyalgia rheumatica Psoriasis arthritis (also code psoriasis) Still's disease Rheumatic symptoms 25 SHS 1998: Coding and Editing Instructions Arthritis as result of broken limb 35 Back problems/slipped disc/spine/neck - Incl. back trouble, lower back problems, back ache Spondylitis, spondylosis Prolapsed invertebral discs Worn discs in spine - affects legs Damage, fracture or injury to back/spine/neck Curvature of spine Lumbago, inflammation of spinal joint Disc trouble Schuermann's disease NB Exclude if damage/injury to spine results in paralysis - code 08 Sciatica - code 08 Trapped nerve in spine - code 08 36 Other problems of bones/joints/muscles - Incl. osteomyelitis Brittle bones, osteoporosis Pierre Robin syndrome Paget's disease Perthe's disease Schlatter's disease Sever's disease Dislocations eg. dislocation of hip, clicky hip, dislocated knee/finger Fracture, damage or injury to extremities, ribs, collarbone, pelvis, skull, eg. knee injury, broken leg, gun shot wounds in leg and shoulder, can't hold left arm out flat - broke it as a child, broken nose, Deviated septum Absence or loss of limb eg. lost leg in war, finger amputated, born without arms Deformity of limbs eg. club foot, clawhand, malformed jaw Walk with limp as a result of polio, polio (nes), after affects of polio (nes) Systemic sclerosis, myotonia (nes) Disseminated lupus Hip replacement (nes) Hip infection, TB hip Torn muscle in leg, torn ligaments, tendinitis Bad shoulder, bad leg, collapsed knee cap, knee cap removed Cartilage problems Frozen shoulder Aching arm, stiff arm, sore arm muscle Strained leg muscles, pain in thigh muscles Stiff joints, joint pains, contraction of sinews, muscle wastage Dupuytren's contraction 26 SHS 1998: Coding and Editing Instructions Bursitis, housemaid's knee, tennis elbow Delayed healing of bones or badly set fractures Weak legs, leg trouble, pain in legs Legs won't go, difficulty in walking Cramp in hand Physically handicapped (nes) Flat feet, bunions, Chondrodystrophia Tenosynovitis NB Muscular dystrophy - code 08 37 Infectious and parasitic disease Incl. pulmonary tuberculosis (TB) Tuberculosis of abdomen Sarcoidosis Toxoplasmosis (nes) Hepatitis A, B or C Glandular fever Malaria Typhoid fever Tetanus Venereal diseases Thrush, candida Athlete's foot, fungal infection of nail Ringworm Whooping cough NB After effect of Poliomyelitis, meningitis, meningitis, encephalitis - code to site/system Ear/throat infections etc - code to site 38 Disorders of blood and blood forming organs Incl. anaemia, pernicious anaemia Sickle cell anaemia/disease Thalassaemia Haemophilia Purpura (nes) Blood condition (nes), blood deficiency Polycthaemia (blood thickening), blood too thick Removal of spleen NB Leukaemia - code 01 27 SHS 1998: Coding and Editing Instructions 39 Skin complaints Incl. eczema Psoriasis, psoriasis arthritis (also code arthritis) dermatitis epidermolysis, bulosa pilonidal sinusitis impetigo acne skin rashes and irritations skin allergies, leaf rash, angio-oedema skin ulcer, ulcer on limb (nes) birth mark burned arm (nes) cellulitis (nes) carbuncles, boils, warts, verruca corns, callouses ingrown toenails chilblains abscess in groin NB Rodent ulcer - code 01 Varicose ulcer, varicose eczema - code 20 40 Other complaints incl. insomnia sleepwalking fainting adhesions hair falling out, alopecia travel sickness nose bleeds no sense of smell dumb, no speech NB Deaf and dumb - code 11 only 41 Unclassifiable (no other codable complaint) incl. old age/weak with old age general infirmity allergy (nes), allergic reaction to some drugs (nes) war wound (nes), road accident injury (nes) tiredness (nes) generally run down (nes) 28 SHS 1998: Coding and Editing Instructions weight loss (nes) after affects of meningitis (nes) had meningitis - left me susceptible to other things (nes) electrical treatment on cheek (nes) swollen glands (nes) embarrassing itch (nes) glass in head - too near temple to be removed (nes) 42 Complaint no longer present NB Only use this code if it is actually stated that the complaint no longer affects the informant. Exclude if complaint kept under control by medication - code to site/system. 43 Benign (non-malignant) lumps and cysts NB Only use this code for benign lumps and cysts. Malignant lumps, masses, tumours and growths = code 01. 44 AIDS, AIDS carrier, HIV positive 45 Alzheimer's disease, degenerative brain disease Senile dementia, forgetfulness, gets confused 99 Not Answered/Refusal 29 SHS 1998: Coding and Editing Instructions APPENDIX III:LONG-STANDING ILLNESS FRAME: ALPHABETICAL Abdominal trouble (nes) 27 Alcoholism, recovered not cured alcoholic 04 Abdominal hernia/rupture 26 Tumours, growths, masses, lumps and Abscess on brain 08 cysts whether eg. tumour on brain, growth in bowel, growth on spinal cord, lump in Abscess on larynx 25 breast-malignant 01/benign 43 Allergic rhinitis 24 Abscess on breast 33 Allergic reaction to some drugs (nes) 41 Absence or loss of limb eg. lost leg in war 36 Allergic asthma 23 Absence of eye 09 Allergy to dust/cat fur 25 Aching arm 36 Allergy (nes) 41 Acne 39 Alopecia 40 Acoustic neuroma 01 Alzheimer's disease 45 Addison's disease 03 Anaemia, pernicious anaemia 38 Adenoid problems 25 Anaemia (nes) 38 Adhesions (nes) 40 Angina 16 After affect of cancer (nes) 01 Angio-oedema 39 After affects of polio (nes) 36 Anorexia nervosa 04 After affects of meningitis (nes)...41 Anxiety 04 Agoraphobia 04 Aorta replacement AIDS,18 AIDS carrier, HIV positive 44 30 SHS 1998: Coding and Editing Instructions Aortic stenosis 18 Bad eyesight 09 Apoplexy 15 Bad shoulder 36 Arterial thrombosis 21 Beckwith - Wiedemann syndrome 03 Arteriosclerosis (nes) 21 Bed wetting 32 Arthritis/rheumatism in any part of the Bell's palsy 08 body 34 Biliary artesia 27 Arthritis as result of broken limb 34 Birth mark 39 Arthritis 34 Blackouts 06 Artificial arteries (nes) 21 Bladder complaint (nes) 32 Asbestosis and other industrial respiratory disease 25 Bladder restriction 32 Asthma (nes) 23 Blindness 09 Astigmatism 10 Blindness (nes) 09 Athlete's foot 37 Blocked artery (nes) 21 Autism 04 Blood condition (nes), blood deficiency 38 Back ache 35 Blood too thick 38 Back trouble 35 Blood clots (nes) 21 Bad leg 36 Blood Pressure (nes) 17 Bad eyesight 09 Blurred vision 09 Bad chest (nes) 25 31 SHS 1998: Coding and Editing Instructions Boils 39 Brain damage resulting from infection or Cancer (neoplasm) including lumps, injury 08 masses, tumours and growths, lumps and cysts (not incl. Brain - fluid on 08 benign) 01 Breathlessness 25 Cancers sited in any part of the body or system eg. Lung cancer, breast cancer, Brittle bones 36 stomach cancer Skin cancer, bone cancer 01 Broken nose 36 Candida 37 Broken rib 36 Carbuncles 39 Broken leg 36 Cardiac problems 18 Bronchial asthma 23 Cardiac asthma 18 Bronchial trouble 25 Cardiac diffusion 18 Bronchiectasis 22 Carpal tunnel syndrome 08 Bronchitis 22 Cartilage problems 36 Bulosa 39 Catalepsy 04 Bunions Cataracts 09 Buphthalmos 10 Catarrh 25 Burned arm (nes) 39 Cellulitis (nes) 39 Bursitis 36 Cerebral haemorrhage 15 Byssinosis 25 Cerebral palsy (spastic) 08 Callouses 39 32 SHS 1998: Coding and Editing Instructions Cerebral embolism 15 Common Cold 25 Cerebral thrombosis 15 Conductive/nerve/noise induced deafness 11 Cerebro - vascular accident 15 Conjunctivitis 10 Chest infections 25 Constipation 28 Chest trouble (nes) 25 Contraction of sinews 36 Chilblains 39 Convulsions 06 Cholesterol - too much in blood 18 Corneal ulcers 10 Chondrodystrophia 36 Corns 39 Chronic Bronchitis 22 Coronary thrombosis 16 Chronic renal failure 30 Cough (nes) 25 Cirrhosis of the liver 27 Cough (nes) 25 Cleft palate 29 Coughing fits 25 Coeliac disease 03 Cracked nipple 33 Colitis (nes) 28 Cramp in limb 36 Collapsed knee cap 36 Cramp in limb 36 Colon trouble 28 Crohn's disease 28 Colostomy caused by cancer 01 Croup 25 Colostomy (nes) 28 Curvature of spine 35 Colour blind 10 Cushing's syndrome 03 33 SHS 1998: Coding and Editing Instructions Cyst on eye, cyst in kidney (malignant) 01 Diabetes 02 Cystic kidney 30 Diarrhoea 28 Cystic fibrosis 03 Difficulty in walking (nes) 36 Cystitis 31 Disc trouble 35 Damage or injury to extremities, ribs, Dislocations (nes) 36 collarbone, pelvis, skull, limbs 36 Disseminated sclerosis 08 Damage, fracture or injury to disk/back/spine/neck 35 Disseminated lupus 36 Damaged lung (nes) 25 Diverticulitis 28 Damaged testicles 33 Dizziness, giddiness, balance problems (nes) 18 Deaf and dumb 11 Double vision 10 Deafness 11 Down's syndrome 05 Deficiency of growth hormone 03 Drug addict 04 Deformity of limbs eg. club foot, clawhand, malformed jaw 36 Dry eye syndrome 10 Degenerative brain disease 45 Dumb, no speech (nes) 40 Depression 04 Dupuytren's contraction 36 Dermatitis 39 Dwarfism 03 Detached/scarred retina 09 Dyslexia 04 Deviated septum 36 Dysmenorrhoea 33 34 SHS 1998: Coding and Editing Instructions Dyspepsia 27 Epilepsy 06 Ear complaints causing balance problems Eye infection 10 13 Eyes are light sensitive 10 Ear trouble (nes) 14 Faecal incontinence 28 Ear otitis media - glue ear 14 Fainting (nes) 40 Ear problem (wax) 14 Farmer's lung 25 Ear Disorders of Eustachian tube 14 Febrile convulsions 06 Ear Perforated ear drum (nes) 14 Fibrosis of lung 25 Ear Middle/inner ear problems 14 Fibrositis 34 Ear infection 14 Finger amputated 36 Ear aches and discharges 14 Fits (nes) 06 Eczema 39 Flat feet 36 Emphysema 22 Floater in eye 10 Encephalitis 08 Food allergies 27 Encopresis. 28 Forgetfulness 45 Endometriosis 33 Fracture (nes) 36 Enteritis 28 Frequent diarrhoea 28 Enuresis 32 Friedreich's Ataxia 08 Epidermolysis 39 35 SHS 1998: Coding and Editing Instructions Frozen shoulder 36 Hardening of arteries (nes) 21 Fungal infection of nail 37 Hardening of lens 09 Gallbladder problems 27 Hardening lens 09 Gallstone 27 Hardening arteries in heart 18 Gilbert's syndrome 03 Hardening of arteries in heart 18 Gingivitis 29 Hare lip 29 Glandular fever 37 Hayfever 24 Glaucoma 10 Heart failure 18 Goitre 03 Heart disease 18 Gout 03 Heart trouble (nes) 18 Grand mal, petit mal 06 Heart attack 16 Growth (any site) 01 Heart burn 27 Grumbling appendix 28 Heart complaint 18 Guillain - Barre syndrome 08 Heart murmur 18 Gynaecological problems 33 Hemiplegia 15 Haemophilia 38 Hepatitis A, B or C 37 Haemorrhage behind eye 10 Hereditary cancer 01 Haemorrhoids 19 Hernia (nes) 26 Hair falling out 40 Hernia Double/inguinal/diaphragm/hiatus/umbilical 36 SHS 1998: Coding and Editing Instructions 26 Hysterectomy for cancer of womb 01 High blood pressure 17 Ileostomy 27 Hip infection 36 Impacted wisdom tooth 29 Hip replacement (nes) 36 Impetigo 39 Hirschsprung's disease 28 Impotence 33 Hodgkin's disease 01 Incontinence - bladder 32 Hole in the heart 18 Incontinence - double 28 & 32 Hormone deficiency 03 Incontinence (nes) 32 Horseshoe kidney 30 Indigestion 27 Housemaid's knee 36 Infertility 33 Huntington's chorea 08 Inflamed duodenum 27 Hydrocephalus 08 Inflammation of tendon 36 Hypercalcemia 03 Inflammation of bowel 28 Hyperglycemia 03 Inflammation of spinal joint 35 Hypersensitive to the cold 21 Ingrown toenails 39 Hypertension 17 Injury to spine resulting in paralysis 08 Hypopotassaemia, lack of potassium 03 Injury to eye 10 Hypotension 21 Insomnia 40 Hysterectomy (nes) 33 Intermittent claudication 21 37 SHS 1998: Coding and Editing Instructions Iritis 10 Loss of balance 13 Irritable bowel 28 Loss of lung 25 Ischaemic heart disease 18 Loss of limb 30 Jacksonian fit 06 Loss of one eye 09 Joint pains 36 Low blood pressure/hypertension 21 Kidney removal 30 Lumbago 35 Kidney tube damage 30 Lump (any site)- malignant 01/benign 43 Kidney stone 30 Lung collapsed 25 Kidney trouble 30 Lung ulcer 25 Kidney double 30 Lung - fluid on lung 25 Knee cap removed 36 Lung damage 25 Labryrinthitis 13 Lung problems (nes) 25 Lazy eye 10 Lung complaint (nes) 25 Leaf rash 39 Lymphoma 01 Lens implants in both eyes 09 Malaria 37 Leukaemia 01 Malacia 03 Limp (nes) 36 Manic depressive 04 Liver disease 27 Mass (any site) 01 Liver problems 27 Mastectomy (nes) 01 38 SHS 1998: Coding and Editing Instructions Mastitis 33 Myasthenia gravis 08 Mastoiditis 14 Myocardial infarction 16 Meniere's disease 13 Myopia 09 Meningitis 08 Myotonia (nes) 36 Menopause 33 Myotonic dystrophy 08 Mental handicap 05 Myxoedema (nes) 03 Mental illness 04 Nasal polyps 25 Mentally retarded 05 Neoplasm (any site) 01 Metachromatic leucodystrophy 08 Nephritis 30 Microcephaly, fluid on brain 08 Nerves (nes) 04 Migraine/headaches 07 Nervous breakdown 04 Mitral stenosis 18 Nervous trouble 04 Mongol 05 Neuralgia 08 Motor neurone disease 08 Neurasthenia 04 Mouth ulcers 29 Neuritis 08 Multiple Sclerosis (MS) 08 Neurofibromatosis 01 Muscle wastage 36 Night blindness 10 Muscular dystrophy 08 Nose bleeds 40 Myalgic encephalomyelitis (ME) 08 Numbness/loss of feeling in fingers, hand, leg etc 08 39 SHS 1998: Coding and Editing Instructions Parkinson's disease (paralysis agitans) 08 Obesity/overweight 03 Part of intestines removed (cancer) 01 Old age/weak with old age (nes) 41 Partially paralysed because of stroke 15 Osteoarthritis 34 Partially paralysed (nes) 08 Osteomyelitis 36 Partially sighted 09 Osteoporosis 36 Pelvic inflammatory disease (female) 33 Otitis Media 14 Pericarditis 18 Otosclerosis 11 Period problems, flooding 33, Overactive Thyroid 03 Perthe's disease 36 Pacemaker 18 Pharyngitis 25 Paget's disease 36 Phenylketonuria 03 Pains in chest (nes) 18 Phlebitis in lower extremities 20 Palpitations 18 Phobias 04 Pancreas problems 27 Physically handicapped (nes) 36 Panic attacks 04 Physically handicapped - spasticity of all limbs 08 Paralysis - Agitans 08 Pierre Robin syndrome 36 Paralysis (nes) 08 Pigeon fanciers' s lung 25 Paralysis of vocal cords 25 Piles 19 Paraplegia (paralysis of lower - limbs) 08 Pilonidal sinusitis 39 40 SHS 1998: Coding and Editing Instructions Prostrate trouble 33 Pins and needles in limbs 08 Psoriasis arthritis (also code psoriasis) 34 Pleurisy 25 Psoriasis 39 Pneumoconiosis 25 Psoriasis arthritis (also code arthritis) 39 Polio (nes) 36 Pulmonary tuberculosis (TB) 37 Polyarteritis Nodosa 21 Pulmonary embolism 21 Polycthaemia (blood thickening)38 Purpura (nes) 38 Polymyalgia rheumatica 34 Pyelonephritis 30 Polyp on bowel 28 Raynaud's disease 21 Poor hearing 11 Removal of nerve in limb 08 Poor eye sight 09 Removal of spleen 38 Poor circulation 21 Renal TB 30 Post-concussion syndrome 04 Restless legs 08 Post viral syndrome (ME) 08 Restricted vision 09 Premenstrual tension 33 Retinitis pigmentosa 10 Prolapse (nes) if female 33 Rheumatism 34 Prolapsed womb 33 Rheumatoid arthritis 34 Prolapsed invertebral discs 35 Rhinitis (nes) 25 Prostrate gland trouble 33 Rickets 03 41 SHS 1998: Coding and Editing Instructions Ringworm 37 Skin allergies 39 Rodent ulcers 01 Skin complaints 39 Rupture (nes) 26 Skin rashes and irritations 39 Sarcoidosis 37 Sleepwalking 40 Sarcomas, carcinomas 01 Smell - no sense of 40 Scarred cornea 10 Sore throat 25 Schizophrenia 04 Sore arm muscle 36 Schlatter's disease 36 Spastic (nes) 08 Schuermann's disease 35 Spastic colon 28 Sciatica 08 Speech impediment because of stroke 15 Senile dementia 45 Speech impediment, stammer 04 Sever's disease 36 Spina bifida 08 Shingles 08 Spondylitis 35 Short sighted 09 Spondylosis 35 Sick sinus syndrome 18 Squint 10 Sickle cell anaemia/disease 38 Still's disease 34 Sinus trouble 25 Stomach - acid 27 Sinusitis 25 Stomach trouble (nes) 27 Skin ulcer 39 Stomach - nervous 27 42 SHS 1998: Coding and Editing Instructions Stomach ulcer 26 Stone in gallbladder 27 Tetanus 37 Stress 04 Thalassaemia 38 Stroke 15 Throat irritation 25 Stye on eye 10 Throat trouble - difficulty in swallowing 27 Subnormal 05 Throat trouble (nes) 25 Swollen legs and feet 21 Throat infection 25 Swollen glands (nes) 41 Thrombosis (nes) 21 Syringomyelia 08 Thrush 37 Systemic sclerosis 36 Thyroid 03 Tachycardia 18 Tinnitus/noises in the ear 12 Taste - no sense of 29 Tired heart 18 TB hip 36 Tiredness (nes) 41 TB - limb 36 Tonsillitis 25 Teeth - complaints of teeth/mouth/tongue 29 Torn muscle in leg 36 Telangiectasia (nes) 21 Torn ligaments 36 Tendinitis 36 Toxoplasmosis (nes) 37 Tennis elbow 36 Trapped nerve 08 Tenosynovitis 36 Travel sickness 40 43 SHS 1998: Coding and Editing Instructions Trigeminal neuralgia 08 Varicose veins - lower extremities 20 Tuberculosis of abdomen 37 Varicose veins - anus 19 Tunnel vision 09 Varicose eczema 20 Turner's syndrome 33 Varicose veins in Oesophagus 21 Typhoid fever 37 Varicose veins 20 Ulcer gastric 26 Varicose ulcer, varicose eczema - code 20 Ulcer duodenal 26 Venereal diseases 37 Ulcer on lung 25 Verruca 39 Ulcer (nes) 26 Vertigo 13 Ulcer peptic 26 Vulvitis 33 Ulcer on limb (nes) War wound (nes) 41 Ulcerative colitis 28 Warts 39 Ulcers on tongue 29 Water trouble (nes) 32 Underactive Thyroid 03 Water/fluid retention 03 Uraemia 30 Watery eyes 10 Urinary tract infection 31 Weak legs 36 Urine infection 31 Weak chest 25 Vaginitis 33 Weak bladder 32 Valvular heart disease 18 44 SHS 1998: Coding and Editing Instructions Weak heart because of rheumatic fever 18 Weakness in intestines 27 Wheezy 25 Whooping cough 37 Wilms tumour 01 Wilson's disease 03 Wolff - Parkinson - White syndrome 18 Worn discs in spine - affects legs 35 Wright's syndrome 21 45 SHS 1998: Coding and Editing Instructions APPENDIX IV RECODING OF OTHER ACTIVITIES Existing code-frame for ActPhy 1 "Swimming", 2 "Cycling", 3 “Workout at a gym / Exercise bike / Weight” 4 "Aerobics/keep fit/gymnastics/dance for fitness", 5 "Any other types of dancing", 6 "Running/jogging", 7 "Football/rugby", 8 "Badminton/tennis", 9 "Squash", 10 "Exercises (eg press-ups, sit-ups)" Coding of `other' answers (recorded at OthAct) Sport Code Abseiling/ Paraseiling 11 Adventure playground 12 Aquarobics 13 American football 14 Archery 15 Assault course 16 Back packing 17 Baseball/softball 18 Basketball 19 Battle re-enactment 20 Bowls - indoor, outdoor, crown, green, Petanque 21 Boxing 22 Canal cruising (if resp responsible for working locks) 23 Canoeing 24 Circuit training 25 Climbing 26 Cricket 27 Croquet 28 Curling 29 46 SHS 1998: Coding and Editing Instructions Darts 30 Diving 31 Dog training 32 Drumming (in a group) 33 Fell walking 34 Fencing 35 Field athletics 36 Fishing/ Fly fishing 37 Fives 38 Golf 39 Hang gliding/parachuting 41 Hiking 42 Hitting punch sack 43 Hockey 44 Horse riding 45 Ice skating/ Ice dancing 46 Juggling 47 Kabadi 48 Kick boxing 49 Lacrosse 50 Marathon running 51 Martial arts (Karate, Tai Chi etc.) 52 Motor sports (ie. Motor-cross, go-karting, jet-skiing etc.) 53 Netball/handball 54 Orienteering 55 Polo 56 Post natal exercise 57 Power boat 58 Racketball 59 Rambling 60 Riding 61 Roller skating 62 Rounders 63 Rowing (inc machine) 64 Sailing (inc dingy) 65 Scuba/subaqua diving 66 Shooting 67 Skateboarding 68 Skiing/dry slope skiing 69 Skipping 70 Skirmishing (war games) 71 Skittles 72 Snooker 73 Snorkelling 74 Sumo wrestling 75 Surfing 76 Swing ball 77 Table tennis 78 Tenpin bowling 79 Territorial Army 80 Toning table/bed 81 47 SHS 1998: Coding and Editing Instructions Trampolining 82 Volley ball 83 Walking on a jogging machine/treadmill 84 Water skiing 85 Weight lifting 86 Wind surfing 87 Wrestling 88 Yoga 89 Other light exercise (incl mini-trampoline, harness racing, Alexander Technique) 90 Other moderate exercise (incl tug of war) 91 Other vigorous exercise (incl water-polo, football training, body building) 92 Other - don't know energy level (incl tehouk ball) 98 Special cases: Alexander Technique - code as other light exercise (90) Go-karting - code as motor sport (53) Handball - code as netball (54) Jet-skiing - code as motor sport (53) Parachuting - code as hang-gliding (41) Petanque - code as bowls (21) 48 SHS 1998: Coding and Editing Instructions APPENDIX V: CODING FRAMES FOR QUALIFICATIONS Frame for TopQual 1 Degree or degree level qualification 2 SCE Higher/CSYS/A-levels 3 SCE Ordinary (Bands A - C) 4 Standard Grade (Level 1 - 3) 5 SLC Lower 6 SUPE Lower or Ordinary 7 `O'-level passes (Grade A - C if after 1975) 8 GCSE (Grade A - C) 9 CSE Grade 1 10 School Certificate or Matric 11 SCE Ordinary (‘O’ Grades) Bands D & E 12 Standard Grade (Level 4, 5) 13 CSE Grades 2 - 5 14 GCE `O' Levels D & E (if after 1975) 15 GCSE (Grades D, E, F, G) 16 CSE ungraded 17 Foreign quals - please specify 18 Other academic quals - please specify 19 No academic quals Frame for TopVocat 1 SCOTVEC National Certificate modules 2 HNC/HND, BEC/TEC Higher, BTEC Higher/SCOTECH Higher ONC/OND, BEC/TEC/BTEC not higher 3 ONC, OND, BEC/TEC not higher 4 City and Guilds Full Technological Certificate 5 City and Guilds Advanced/Final Level 6 City and Guilds Craft/Ordinary 7 Nursing qualifications (SRN, RGN, RMN, SEN, RSCN, RM, RHV) 8 Teaching qualification 9 SVQ/NVQ Level 5 10 SVQ/NVQ Level 4 11 SVQ/NVQ Level 3/Advanced level GNVQ 12 SVQ/NVQ Level 2/Intermediate level GNVQ 13 SVQ/NVQ Level 1/Foundation level GNVQ 14 SCOTVEC National Certificate Modules 15 Clerical or Commercial Qualification (eg typing/book-keeping/commerce) 16 Recognised Trade Apprenticeship completed 17 Other vocational or professional qualification 18 No vocational/professional quals *19 SVQ/NVQ - level not specified *20 Nursery Nurse Examination Board Qualification *New codes SHS 1998: Coding and Editing Instructions APPENDIX VI: Coding Prescribed Medicines Coding of Prescribed Medicines : Alphabetical Index Abidec ...... 09.06.07 Adalat,…………………………………………………… Adalat LA, Adalat Retard ...... 02.06.02 Aerolin…………………………………………………… ...... 03.01.01 Allopurinol…………………………………………………… ...... 10.01.04 Alupent…………………………………………………… ...... 03.01.01 Amiloride…………………………………………………… ...... 02.02.03 Amiodarone…………………………………………………… (hydrochloride) ...... 02.03.02 Amitriptyline…………………………………………………… ...... 04.03.01 Amlodipine…………………………………………………… Besylate ...... 02.06.02 Amoxil…………………………………………………… ...... 05.01.01 Amoxycillin…………………………………………………… ...... 05.01.01 Ampicillin…………………………………………………… ...... 05.01.01 Aqueous cream ...... 13.02.01 Arthrotech ...... 10.01.01 Asacol ...... 01.05.00 Asilone………………………………………………… suspension ...... 01.01.01 antacid liquid ...... 01.01.03 Aspirin analgesic ...... 04.07.01 antiplatelet ...... 02.09.00 migraine ...... 04.07.04 myocardial infarction ...... 02.10.01 rheumatic disease ...... 10.01.01 Atenolol ...... 02.04.00 Atrovent…………………………………………………… ...... 03.01.02 Augmentin,…………………………………………………… Augmentin-Duo ...... 05.01.01 Axid…………………………………………………… ...... 01.03.01 Azathioprine transplant rejection ...... 08.02.01 myasthenia gravis ...... 10.02.01 rheumatic disease ...... 10.01.03 ulcerative colitis ...... 01.05.00 Baclofen ...... 10.02.02 Bactroban…………………………………………………… ...... 13.10.01 Balneum,…………………………………………………… Balneum Plus ...... 13.02.01 Balneum…………………………………………………… with tar ...... 13.05.02 Beclazone…………………………………………………… (inhaler) ...... 03.02.00 Becloforte…………………………………………………… (inhaler) ...... 03.02.00 Beclomethasone…………………………………………………… Dipropionate asthma ...... 03.02.00 nasal allergy ...... 12.02.01 skin ...... 13.04.00 Beconase (nasal spray) ...... 12.02.01 Becotide…………………………………………………… ...... 03.02.00 SHS 1998: Coding and Editing Instructions Bendrofluazide ...... 02.02.01 Betagan…………………………………………………… (eye drops) ...... 11.06.00 Betahistine…………………………………………………… HCL, Betahistine dihydrochloride ...... 04.06.00 Betnesol…………………………………………………… ear ...... 12.01.01 eye ...... 11.04.01 nose ...... 12.02.01 Betnesol N ear ...... 12.01.01 eye ...... 11.04.01 nose ...... 12.02.03 Betnovate rectal ...... 01.07.02 skin (incl Betnovate-RD, Betnovate-C, 13.04.00 BetopticBetnovate-N) (eye drops) ...... 11.06.00 Bezalip, Bezalip-mono ...... 02.12.00 Bisacodyl ...... 01.06.02 BM-Accutest…………………………………………………… ...... 06.01.06 BM…………………………………………………… Test 1-44 ...... 06.01.06 Bricanyl, Bricanyl SA ...... 03.01.01 Brufen,…………………………………………………… Brufen Retard ...... 10.01.01 Burinex A ...... 02.02.04 K ...... 02.02.08 Buscopan ...... 01.02.00 Calcichew…………………………………………………… ...... 09.05.01 Calcichew D3, Calcichew D3 Forte ...... 09.06.04 Calpol ...... 04.07.01 Canesten…………………………………………………… AF (skin) ...... 13.10.02 anogential ...... 07.02.02 ear ...... 12.01.01 HC ...... 13.04.00 Capoten ...... 02.05.05 Carbamazepine…………………………………………………… diabetes ...... 06.05.02 diabetic neuropathy ...... 06.01.05 analgesic ...... 04.07.01 epilepsy ...... 04.08.01 manic depression ...... 04.02.03 trigeminal neuralgia ...... 04.07.03 Cardura cardiovascular ...... 02.05.04 prostatic hyperplasia ...... 07.04.01 SHS 1998: Coding and Editing Instructions Cefaclor ...... 05.01.02 Cephalexin…………………………………………………… ...... 05.01.02 Cerumol…………………………………………………… (ear drops) ...... 12.01.03 Chloramphenicol…………………………………………………… antibiotic ...... 05.01.07 ear ...... 12.01.01 eye ...... 11.03.01 Chloromycetin antibiotic ...... 05.01.07 eye drops ...... 11.03.01 Chlorpheniramine (maleate) ...... 03.04.01 Cilest…………………………………………………… ...... 07.03.01 Cimetidine…………………………………………………… ...... 01.03.01 Ciproxin ...... 05.01.12 Clarityn ...... 03.04.01 Clinistix ...... 06.01.06 Clotrimazole vaginal ...... 07.02.02 ear ...... 12.01.01 skin ...... 13.10.02 Co-amilofruse ...... 02.02.04 Co-amilozide diuretic ...... 02.02.04 beta-blocker ...... 02.04.00 Co-codamol ...... 04.07.01 Co-danthramer ...... 01.06.02 Co-danthrusate ...... 01.06.02 Co-dydramol ...... 04.07.01 Co-proxamol ...... 04.07.01 Codeine ...... 04.07.02 Codeine Linctus ...... 03.09.01 Codeine Phosphate cough suppressant ...... 03.09.01 diarrhoea ...... 01.04.02 diabetes ...... 06.01.05 analgesic ...... 04.07.02 Colofac ...... 01.02.00 Colpermin ...... 01.02.00 Combivent ...... 03.01.04 Coracten ...... 02.06.02 Corsodyl ...... 12.03.04 Daktacort ...... 13.04.00 SHS 1998: Coding and Editing Instructions Dalacin -C ...... 05.01.06 -T (acne) ...... 13.06.01 vaginal ...... 07.02.02 Dalmane ...... 04.01.01 Deltacortril ( Enteric) ...... 06.03.02 Depo-Provera contraceptive ...... 07.03.02 malignant disease ...... 08.03.02 sex hormone - see ‘Provera’ Derbac C, Derbac-M ...... 13.10.04 Dermovate, Dermovate-NN ...... 13.04.00 Diabur Test - 5000...... 06.01.06 Diamicron ...... 06.01.02 Dianette ...... 13.06.02 Diastix ( Reagent) ...... 06.01.06 Diazepam anxiety ...... 04.01.02 febrile convulsions ...... 04.08.03 hypnotic ...... 04.01.01 muscle spasm ...... 10.02.02 epilepsy ...... 04.08.02 Diclofenac sodium rheumatic disease and gout (long-term 10.01.01 control) ...... gout (acute attack) ...... 10.01.04 eye ...... 11.08.02 postoperative pain ...... 15.01.04 ureteric colic ...... 07.04.03 Diclomax Retard, Diclomax SR ...... 10.01.01 Didronel, Didronel PMO ...... 06.06.02 Difflam cream ...... 10.03.02 oral rinse / spray ...... 12.03.01 Diflucan ...... 05.02.00 Digoxin ...... 02.01.01 Dihydrocodeine ...... 04.07.02 Diltiazem ...... 02.06.02 Dimotane allergic disorders ...... 03.04.01 cough and decongestant ...... 03.09.02 Dioralyte ...... 09.02.01 Diprobase ...... 13.02.01 Distaclor, Distaclor MR ...... 05.01.02 Ditropan ...... 07.04.02 Dixarit ...... 04.07.04 SHS 1998: Coding and Editing Instructions Doralese ...... 07.04.01 Dothiepin ...... 04.03.01 Dovonex ...... 13.05.02 Doxycycline antibacterial ...... 05.01.03 acne ...... 13.06.02 malaria ...... 05.04.01 Duovent ...... 03.01.04 Dyazide ...... 02.02.04 E45 (cream) ...... 13.02.01 Efamast ...... 06.07.02 Emulsifying ointment ...... 13.02.01 Enalapril - Maleate ...... 02.05.05 Epanutin ...... 04.08.01 Epanutin ready-mixed parenteral ...... 04.08.02 Epilim, Epilim Chrono, Epilim Intravenous ...... 04.08.01 Epogam ...... 13.05.01 Erymax ...... 05.01.05 Erythromycin antibacterial, enteritis ...... 05.01.05 acne ...... 13.06.01 ear ...... 12.01.02 Erythroped, Erythroped A ...... 05.01.05 Estracombi ...... 06.04.01 Estraderm MX/TTS (patches) ...... 06.04.01 Eumovate (cream) ...... 13.04.00 ExacTech (biosensor strips) ...... 06.01.06 Feldene tablets/capsules ...... 10.01.01 gel ...... 10.03.02 Femodene, Femodene ED ...... 07.03.01 Femulen ...... 07.03.02 Ferrograd, Ferrograd C, Ferrograd Folic ...... 09.01.01 Ferrous Fumarate ...... 09.01.01 Ferrous gluconate ...... 09.01.01 Ferrous sulphate ...... 09.01.01 Flixonase ...... 12.02.01 Flixotide ...... 03.02.00 Flucloxacillin antibacterial ...... 05.01.01 ear ...... 12.01.01 Folic Acid ...... 09.01.02 Forceval ...... 09.06.07 Frumil, Frumil Forte ...... 02.02.04 Frusemide ...... 02.02.02 Fucibet ...... 13.04.00 SHS 1998: Coding and Editing Instructions Fucidin antibiotic ...... 05.01.07 skin ...... 13.10.01 -H (hydrocortisone) ...... 13.04.00 Fucithalmic ...... 11.03.01 Fybogel ...... 01.06.01 Galenphol ...... 03.09.01 Galpseud ...... 03.09.02 Gastrocote ...... 01.01.03 Gaviscon, Gaviscon Advance, Infant Gaviscon ...... 01.01.03 Gentisone HC ...... 12.01.01 Glibenclamide ...... 06.01.02 Gliclazide ...... 06.01.02 Glucostix ...... 06.01.06 Glyceryl Trinitrate ...... 02.06.01 Half-Inderal LA ...... 02.04.00 Harmogen ...... 06.04.01 Heminevrin hypnotics ...... 04.01.01 epilepsy ...... 04.08.02 substance dependence ...... 04.10.00 Hydrocortisone corticosteroid ...... 06.03.02 diarrhoea ...... 01.05.00 haemorrhoids ...... 01.07.02 eye drops ...... 11.04.01 mouth treatment ...... 12.03.01 skin treatment ...... 13.04.00 Hydroxocobalmin (injections) ...... 09.01.02 Hypromellose (eye drops) ...... 11.08.01 Ibugel ...... 10.03.02 Ibuprofen analgesic ...... 04.07.01 rheumatic disease and gout ...... 10.01.01 topical antirheumatic ...... 10.03.02 Imdur ...... 02.06.01 Imigran ...... 04.07.04 Imipramine ...... 04.03.01 Imodium ...... 01.04.02 Indapamide ...... 02.02.01 Inderal, Inderal LA ...... 02.04.00 Indomethacin rheumatic disease and gout (long-term 10.01.01 control) ...... gout (acute attack) ...... 10.01.04 obstetrics ...... 07.01.01 SHS 1998: Coding and Editing Instructions Infacol ...... 01.01.03 Innovace ...... 02.05.05 Insulin ...... 06.01.01 Isosorbide Dinitrate ...... 02.06.01 Isosorbide Mononitrate ...... 02.06.01 Istin ...... 02.06.02 Kapake ...... 04.07.01 Klaricid ...... 05.01.05 Kliofem ...... 06.04.01 Lacri-Lube ...... 11.08.01 Lactulose ...... 01.06.04 Lamisil tablets ...... 05.02.00 cream ...... 13.10.02 Lipostat ...... 02.12.00 Lisinopril ...... 02.05.05 Livial ...... 06.04.01 Locorten - Vioform ...... 12.01.01 Loestrin 20, Loestrin 30 ...... 07.03.01 Lofepramine HCL ...... 04.03.01 Logynon, Logynon ED ...... 07.03.01 Lomotil ...... 01.04.02 Loperamide ...... 01.04.02 Loprazolam ...... 04.01.01 Lorazepam anxiolytic ...... 04.01.02 anaesthesia ...... 15.01.04 epilepsy ...... 04.08.02 Losec ...... 01.03.05 Lustral ...... 04.03.03 Lyclear ...... 13.10.04 Maalox, Maalox TC, Maalox Plus ...... 01.01.01 Magnesium Trisilicate ...... 01.01.01 Magnapen ...... 05.01.01 Manevac ...... 01.06.02 Marvelon ...... 07.03.01 Mebeverine ...... 01.02.00 Mefenamic Acid ...... 10.01.01 Melleril ...... 04.02.01 Metformin ...... 06.01.02 Methadone analgesic ...... 04.07.02 cough linctus ...... 03.09.01 substance dependence ...... 04.10.00 Methotrexate malignant diseases ...... 08.01.03 skin ...... 13.05.02 SHS 1998: Coding and Editing Instructions rheumatic diseases ...... 10.01.03 Methyldopa ...... 02.05.02 Metoclopramide nausea and vertigo ...... 04.06.00 gastro-intestinal ...... 01.02.00 migraine ...... 04.07.04 Metoprolol ...... 04.07.04 Metoprolol Tartrate ...... 02.04.00 Metronidazole antibacterial ...... 05.01.11 amoebiasis ...... 05.04.02 Crohn’s disease, diarrhoea ...... 01.05.00 giardiasis ...... 05.04.04 skin ...... 13.10.01 ulcerative gingivitis ...... 12.03.02 Microgynon 30, Microgynon 30 ED ...... 07.03.01 Micronor ...... 07.03.02 Minocin MR ...... 05.01.03 Moduretic ...... 02.02.04 Monocor ...... 02.04.00 Motens ...... 02.06.02 Motilium ...... 04.06.00 Movelat cream, Movelat gel ...... 10.03.02 MST Continus ...... 04.07.02 Mucaine ...... 01.01.01 Mucogel ...... 01.01.01 Naprosyn S/R ...... 10.01.01 Naproxen rheumatic disease ...... 10.01.01 gout ...... 10.01.04 pain ...... 10.01.01 Naseptin ...... 12.02.03 Natrilix ...... 02.02.01 Navispare…………………………………………………… ...... 02.02.04 Nifedipine ...... 02.06.02 Nitrazepam ...... 04.01.01 Nitrolingual (spray) ...... 02.06.01 Nizoral antifungal ...... 05.02.00 vagina ...... 07.02.02 scalp ...... 13.09.00 skin ...... 13.10.02 SHS 1998: Coding and Editing Instructions Norethisterone ( as ingredient ) sex hormone ...... 06.04.01 contraception ...... 07.03.01 malignant disease ...... 08.03.02 menstrual disorders ...... 06.04.01 Norethisterone enanthate ...... 07.03.02 Normasol sachet ...... 13.11.01 Nu-Seals Aspirin analgesics ...... 04.07.01 cardiovascular ...... 02.09.00 Nystan - see Nystatin Nystatin antifungal ...... 05.02.00 vaginal and vulval ...... 07.02.02 mouth ...... 12.03.02 skin ...... 13.10.02 Oilatum Emollient ...... 13.02.01 Opticrom (eye drops) ...... 11.04.02 Ortho Dienoestrol ...... 07.02.01 Ortho-Novin 1/50 ...... 07.03.01 Oruvail capsules ...... 10.01.01 gel ...... 10.03.02 Otomize (ear spray) ...... 12.01.01 Otosporin (ear drops) ...... 12.01.01 Ovranette ...... 07.03.01 Oxybutynin ...... 07.04.02 Oxygen acute asthma ...... 03.06.00 anaphylaxis, allergic emergencies ...... 03.04.03 myocardial infarction ...... 02.10.01 Oxytetracycline ...... 05.01.03 Paracetemol analgesics ...... 04.07.01 febrile convulsions ...... 04.08.03 migraine ...... 04.07.04 Paramax ...... 04.07.04 Pavacol-D ...... 03.09.02 Penicillin, Penicillin V or V-K ...... 05.01.01 Phenergan ...... 03.04.01 Phenobarbitone ...... 04.08.01 SHS 1998: Coding and Editing Instructions Phenytoin arrhythmias ...... 02.03.02 epilepsy (control of) ...... 04.08.01 status epilepticus ...... 04.08.02 trigeminal neuralgia ...... 04.07.03 Pholcodine linctus ...... 03.09.01 Phyllocontin Continus ...... 03.01.03 Pilocarpine HCL eye ...... 11.06.00 dry mouth ...... 12.03.05 Piriton ...... 03.04.01 Polytar, Polytar AF, Polytar Plus liquid/shampoo ...... 13.09.00 emollient ...... 13.05.02 Praxilene ...... 02.06.04 Prednesol ...... 06.03.02 Prednisolone glucocorticoid therapy ...... 06.03.02 asthma ...... 03.02.00 Crohn’s disease ...... 01.05.00 haemorrhoids ...... 01.07.02 malignant disease ...... 08.02.02 neuromuscular disorders ...... 10.02.01 eye ...... 11.04.01 rheumatic disease ...... 10.01.02 rectal ...... 01.05.00 Pregaday ...... 09.01.01 Premarin cream ...... 07.02.01 tablets ...... 06.04.01 Prempak-C ...... 06.04.01 Prepulsid ...... 01.02.00 Priadel ...... 04.02.03 Prioderm ...... 13.10.04 Prochlorperazine nausea and vertigo ...... 04.06.00 psychoses ...... 04.02.01 Proctosedyl ...... 01.07.02 Procyclidine ...... 04.09.02 Propine ...... 11.06.00 Propranolol cardiovascular ...... 02.04.00 migraine ...... 04.07.04 thyrotoxicosis ...... 06.02.02 tremor ...... 04.09.03 Proscar ...... 06.04.02 SHS 1998: Coding and Editing Instructions Prothiaden ...... 04.03.01 Provera (sex hormone) ...... 06.04.01 Prozac ...... 04.03.03 Pulmicort (inhaler), Pulmicort Turbohaler, 03.02.00 Pulmicort Respules ...... Pyridoxine vitamin B ...... 09.06.02 anaemia ...... 09.01.03 Quinine malaria ...... 05.04.01 nocturnal cramps/muscle relaxant ...... 10.02.02 Ranitidine ...... 01.03.01 Regulan ...... 01.06.01 Reliflex ...... 10.01.01 Rhinocort Aqua ...... 12.02.01 Salamol ...... 03.01.01 Salazopyrin chronic diarrhoea ...... 01.05.00 rheumatic disease ...... 10.01.03 Salbutamol ...... 03.01.01 Salmeterol ...... 03.01.01 Sanomigran ...... 04.07.04 Schering PC4 ...... 07.03.01 Securon, Securon SR ...... 02.06.02 Senna ...... 01.06.02 Senokot ...... 01.06.02 Serc 16, Serc 8 ...... 04.06.00 Serevent ...... 03.01.01 Seroxat ...... 04.03.03 Simple Linctus ...... 03.09.02 Simvastatin ...... 02.12.00 Sinemet, Sinemet LS, Sinemet-Plus, Sinemet CR .. 04.09.01 Slow-K ...... 09.02.01 Sodium Bicarbonate oral (capsules) ...... 09.02.01 antacid ...... 01.01.02 ear drops ...... 12.01.03 urine alkalinisation ...... 07.04.03 Sofradex ear ...... 12.01.01 eye ...... 11.04.01 Solpadol ...... 04.07.01 Spasmonal ...... 01.02.00 Stemetil ...... 04.06.00 Sudafed tablets, elixir ...... 03.10.00 nasal spray ...... 12.02.02 SHS 1998: Coding and Editing Instructions -Co ( analgesic ) ...... 04.07.01 Sudocrem ...... 13.02.01 Sulpiride antipsychotic ...... 04.02.01 Tourette syndrome ...... 04.09.03 Tamoxifen ...... 08.03.04 Tegretol ...... 04.08.01 Temazepam ...... 04.01.01 Tenoret 50 ...... 02.04.00 Tenoretic ...... 02.04.00 Tenormin ...... 02.04.00 Terfenadine ...... 03.04.01 Thioridazine ...... 04.02.01 Thyroxine ...... 06.02.01 Tilade Mint (inhaler) ...... 03.03.00 Tildiem LA, Tildiem Retard ...... 02.06.02 Timodine ...... 13.04.00 Timoptol, Timoptol LA ...... 11.06.00 Tolbutamide ...... 06.01.02 Transvasin ...... 10.03.02 Traxam ...... 10.03.02 Triludan ...... 03.04.01 Trimethoprim antibacterial ...... 05.01.08 urinary tract ...... 05.01.13 ear ...... 12.01.02 eye ...... 11.03.01 Trimovate ...... 13.04.00 Trinordiol ...... 07.03.01 Tritace ...... 02.05.05 Trusopt ...... 11.06.00 Tylex ...... 04.07.01 Uniphyllin Continus ...... 03.01.03 Velosef ...... 05.01.02 Ventodisks ...... 03.01.01 Ventolin ...... 03.01.01 Verapamil beta-blockers ...... 02.06.02 arrhythmias, hypertension ...... 02.03.02 Viscotears ...... 11.08.01 Vitamin B ...... 09.06.02 Vitamin Capsules ...... 09.06.07 Volmax ...... 03.01.01 Voltarol rheumatic disease and gout ...... 10.01.01 Emulgel ...... 10.03.02 Ophtha ...... 11.08.02 SHS 1998: Coding and Editing Instructions Warfarin ...... 02.08.02 Zantac ...... 01.03.01 Zestril ...... 02.05.05 Zimovane ...... 04.01.01 Zineryt ...... 13.06.01 Zirtek ...... 03.04.01 Zocor ...... 02.12.00 Zopiclone ...... 04.01.01 Zoton ...... 01.03.05 Zovirax infections ...... 05.03.00 cold sore ...... 13.10.03 eye ...... 11.03.03 Zydol, Zydol SR ...... 04.07.02 Unable to code ...... 99.99.99 …………………………………………………… Codes taken from the British National Formulary No. 34 Sept ’97 SHS 1998: Coding and Editing Instructions APPENDIX VII: CODING QUERY RESPONSE FORM P1731 SCOTTISH HEALTH SURVEY 1998 QUERY: RESPONSE: To: Anne McMunn To: Yellow Team c/o Sandra Dowsett Fax: 0171 813 0280 Fax: 01277214117 From: ______From: ______ Date: ______Date: ______ VARIABLE: CVDOth Query details: serial number: ______person no. ______sex: M / F age: ______ Response: CIRCULATION FOR COMPLETED FORM: YELLOW TEAM (B’WOOD) RESEARCHER SHS 1998: Coding and Editing Instructions APPENDIX VIII:VOLUME OF MISCELLANEOUS BOTTLED LAGER/CIDER/BEER BEER TYPE NOTES VOLUME (mls.) VOLUME (pints) Abbot Ale 330 ml. 0.58 Amstel 330 ml. 0.58 Banks Mild only 550 ml. 0.97 Banks Old Ale nips 180 ml. 0.32 Bass pint bottle 568 ml. 1.00 Becks 275 ml. & 330 ml. 0.48 or 0.58 Bishops Finger 500 ml. 0.88 Black Sheep Ale 500 ml. 0.88 Boddingtons Export draught only 330 ml. 0.58 Bombardier 500 ml. 0.88 Brandenburg assume 330 ml* 0.58 Budvar 500 ml. 0.88 Budweiser 330 ml. 0.58 Bulmers 500 ml. 0.88 Carlsberg assume 330ml* 0.58 Castaway 200 ml. 0.35 Coors 330 ml. 0.58 Corona 330 ml. 0.58 Crest Lager Export 250 ml. 0.44 Diamond Blush, White or Zest 275 ml. 0.48 Dragon Stout 284 ml. 0.50 Elephant Lager 330 ml. 0.58 Elephant Lager Beer 275 ml. 0.48 ESB (Fuller's ESB) 500 ml. 0.88 Export 33 250 ml. 0.44 Foster's Ice only 330 ml. 0.58 Fuller's London Pride 550 ml. 0.97 Grolsch two sizes of bottles 330 & 440 ml. 0.58 or 0.77 Guinness Extra Stout 330 ml. 0.58 Guinness Original two sizes of bottles 330 & 500 ml. 0.58 or 0.88 Heineken Export 330 ml. 0.58 SHS 1998: Coding and Editing Instructions Hoegaarden (bier blonde) 330 ml. 0.58 Holsten Pils bottle 330 ml. 0.58 Home made assume 330 ml 0.58 Ice Dragon 275 ml. 0.48 John Smiths 440 ml 0.77 K. Cider 275 ml. 0.48 Kanterbrau assume 330 ml* 0.58 Kronenbourg two sizes of bottle 250 & 330 ml. 0.44 or 0.58 Labatts 330 ml. 0.58 Labatt's Ice 330 ml. 0.58 Lowenbrau 330 ml 0.58 Makeson 500 ml 0.88 Max 275 ml. 0.48 McEwans 80 or 90 shilling 550 ml. 0.97 Merrydowns 330 ml. 0.58 Michelob 330 ml. 0.58 Miller Draught not Pils 330 ml 0.58 Molson 330 ml. 0.58 Murphys 500 ml. 0.88 Newcastle Brown Ale 550 ml. 0.97 Olde English 500 ml. 0.88 Old Speckled Hen 500 ml 0.88 Peroni lager 330 ml. 0.58 Pils (unspecified) assume 330 ml* 0.58 Pivovar Czech Lager 500 ml. 0.88 Red Rock 330 ml. 0.58 Red Stripe 330 ml. 0.58 Rolling Rock 330 ml. 0.58 Royal Dutch 330 ml 0.58 Ruddles assume 330 ml* 0.58 Sam Smiths Old Brewery Strong Ale 550 ml. 0.97 San Miguel 330 ml. 0.58 Shipstones assume 330 ml* 0.58 Skol 330 ml. 0.58 Sol 330 ml. 0.58 Spitfire 500 ml 0.88 Stella Artois dry or regular 250, 275 or 330 .044, 0.48 or 0.58 ml. Stinger assume 330 ml* 0.58 SHS 1998: Coding and Editing Instructions Strongbow (Blackthorn) two sizes of bottles 275 & 330 ml. 0.48 or 0.58 Theakstons 550 ml. 0.97 Vault 330 ml. 0.58 Wadworth Export 500 ml 0.88 Woodpecker 275 ml. 0.48 * unless otherwise stated SHS 1998: Coding and Editing Instructions APPENDIX IX :CIGARETTE BRAND CHECK LIST 18’s 862 Kingsize (LM) [h] 863 Kingsize Lights (L) [lm] Aroma: 783 Aroma Ovals Plain (p) (LM) for Asda - see Madison Balmoral: 695 Filter Mild 100s (L) 833 Gold (LM) [h] 348 King Size (Filter) (LM) [h] 575 King Size Low Tar (L) 561 100s (LM) 784 Kingsize Lights (L) [lm] 785 Superkings Lights (L) [lm] 786 Superkings (LM) [h] 696 Virginia 100s (LM) Beaumont: 697 King Size (LM) [h] 698 King Size Lights (L) [lm] 699 Superkings (LM) [h] 700 Superkings Lights (L) [lm] Belvedere: 531 International (LM) 590 International King Size (LM) 701 Superior Virginia Blend (King Size) (LM) [h] Bennington: 834 King Size (LM) [h] 835 King Size Lights (L) [lm] 849 Superkings (LM) [h] 836 Superkings Lights (L) [lm] Benson & Hedges: 303 Gold Bond Filter (LM) [h] 837 Lights (L) [l] 202 Sovereign Filter (LM) [mh] 203 Sovereign King Size (LM) 204 Sovereign Mild (King Size) (L) [lm] 306 Special Filter (King Size) (LM) [h] 682 Special Mild (King Size) (L) 205 Sterling King Size (LM) 702 Superkings (LM) [h] 703 Superkings Lights (L) [lm] SHS 1998: Coding and Editing Instructions 683 Super Virginia Fi lter (LM) 591 Turkish Filter (M) 838 Ultra Lights (L) [vl] 293 XL (LM) 285 100s (LM) 704 100s Luxury Length (LM) [h] Bentley: 526 King Size (LM) 673 Superkings (LM) Berkeley: 864 Kingsize [h] 522 Special King Size (LM) 272 Superkings (LM) [h] 148 Superkings Mild (L) [lm] 502 Superkings Menthol (L) [lm] 865 Superkings Ultra Mild [vl] Black Cat: 576 King Size (LM) 524 Superkings (LM) Broadway: 684 King Size 25s (LM) 685 Lights King Size 25s (L) Buckingham: 592 King Size (LM) [h] 749 Lights King Size (L) [lm] 705 Superkings (LM) [h] 706 Superkings Lights (L) [lm] Camel: 208 Filters (King Size) (LM) [h] 532 Lights (L) [l] 787 Mild (L) [lm] 750 Camel (P) (M) [vh] Capital: 594 King Size (LM) 595 Superkings American (Blend) (LM) 596 Superkings Medium (M) 597 Superkings Menthol (LM) 598 Superkings Mild (LM) Capstan: 401 Navy Cut Full Strength (P) (M) [vh] 308 Medium (P) SHS 1998: Coding and Editing Instructions Carrolls 209 Number 1 (Virginia) (LM) [mh] Cartier: 600 International Luxury Mild (L) 751 Vendome Lights (L) [lm] Centre 686 King Size (M) Charles House 601 Special Reserve King Size (LM) [vh] 866 Charles House (M) [h] Chess 788 Superkings (LM) [h] Chesterfield 602 (Filter) King Size (LM) [h] Choice: 527 King Size (LM) [h] 789 Lights (Kingsize) (L) [lm] 707 Low Tar King Size (L) 533 100s (LM) 839 Superkings (LM) [h] 790 Superlights (LM) 840 Superlights 100’s (L) [lm] Classic: 503 King Size (LM) [h] 603 100s (LM) [h] Consulate: 104 Menthol (L) 791 Menthol Fresh (L) [lm] 105 No. 2 (L) 515 100s (L) Conway: 752 Deluxe Mild (Special Filter) King Size (L) [lm] 569 King Size Low Tar (L) 708 Lights Superkings (LM) [lm] 709 Special Filter (LM) [h] 570 100s (LM) [h] Craven: 534 100s Superkings (LM) [h] 504 100s Superkings Special Mild (L) Craven “A”: 341 King Size (Filter) (LM) [h] SHS 1998: Coding and Editing Instructions 710 King Size Special Menthol (L) [lm] 133 King Size Special Mild (L) [lm] 106 Luxury Length Special Mild 525 Special Menthol KS 294 Superkings 147 Superkings Special Mild Curzon 692 (King Size) 25s (LM) [h] Davidoff 604 Magnum (LM) [mh] Death: 711 King Size (M) 792 Lights (L) Dickens & Grant: 605 King Size (M) [h] 606 Superkings (LM) [h] 780 Superkings Lights (LM) [lm] 841 Superkings Menthol (L) [lm] Dorchester: 138 Extra Mild (L) 537 Extra Mild King Size (L) [lm] 347 Filter 538 King Size (M) [h] 139 Menthol (LM) [lm] 539 Menthol King Size (L) 516 Superkings (LM) [h] 753 Superkings Extra Mild (L) [mh] 577 Superkings Menthol (L) [lm] 540 Superkings Mild (L) Double Gold: 842 Suuperkings 18’s (LM) [h] Dukes: 867 Kingsize (LM) [h] 868 Kingsize Lights (L) [lm] 869 Superkings (LM) [h] Dunhill: 690 Infinite Lights (L) 213 International (LM) 712 International Filter De Luxe (LM) [h] 214 International Menthol (LM) [mh] 108 International Superior Mild (L) [lm] 215 King Size (Filter) (LM) [h] 109 King Size Superior Mild (L) 658 Lights (L) [l] SHS 1998: Coding and Editing Instructions 568 Light Virginia (L) 216 Luxury Length (LM) 870 Special Reserve (L) [lm] 583 Ultimate Lights (L) [vl] Elan: 713 Mild 100s (LM) 714 King Size Medium (LM) 754 100s Medium (M) Elite: 541 King Size (LM) [h] 715 Superkings (LM) [h] Embassy: 110 Extra Mild 217 Filter (LM) [mh] 542 Mild (King Size) (L) [lm] 111 Number 1 Extra Mild 218 Number 1 King Size (LM) [h] 219 Number 3 Standard Size 220 Regal 113 Ultra Mild King Size 882 Light Kingsize (L) [l] Fine: 716 120 Super Length Menthol (LM) [mh] 717 120 Super Length Virginia Blend (LM) [h] First: 718 De Luxe Length 100s (LM) [h] 505 King Size (LM) [h] 691 Specials (LM) 755 Specials 25s (LM) [h] Five Kings: 675 King Size (LM) [h] 676 King Size Mild (LM) [lm] 677 100s (LM) [h] 798 100’s Mild (L) 871 Superkings Mild (L) [lm] Gallaher’s: 402 De Luxe Blue (P) (LM) 311 De Luxe Green (P) (LM) Gauloises: 610 Blondes (LM) [h] 756 Blondes Legeres King Size (L) [lm] 403 Caporal (P) (M) [h] 224 Caporal Filer (LM) [mh] SHS 1998: Coding and Editing Instructions 225 Disque Blue Caporal (LM) [mh] 145 Legeres (Filter) (L) [lm] Gitanes: 612 Blondes Filter (LM) [h] 613 Blondes Lights (LM) [mh] 404 Caporal (P) (LM) [h] 226 Caporal Filter (LM) [mh] 616 Gitanes (P) (LM) 614 International (LM) [mh] 615 Plain (LM) Globe: 719 Blue King Size (L) 517 King Size (LM) [h] 757 King Size Low Tar (L) 794 Lights (L) [lm] 543 100s (LM) 795 Superlights (L) 796 Superkings (LM) Gold Leaf 313 Filter Virginia (LM) [mh] Gold Mark: 286 King Size (LM) [h] 843 King Size Lights (L) [lm] 506 Superkings (LM) [h] 797 Specials (LM) [h] 228 Guards (LM) Haddows: 678 King Size (LM) [h] 758 King Size Lights (L) [mh] 720 Superkings (LM) [h] Harrods 667 King Size (LM) House of Commons 659 (King Size) (L) [l] House of Lords 616 (King Size) (L) [l] Hyde Park SHS 1998: Coding and Editing Instructions 281 Superkings (LM) Independent: 287 No.3 King Size (LM) 617 No.3 Superkings (LM) John Player (JP): 872 Lights (L) [l] 231 King Size (LM) 115 King Size Extra Mild (L) 314 Special Filter 352 Special 100s 315 Special King Size (LM) [mh] 578 Special Lights (King Size) (L) [l] 232 Superkings (LM) [h] 134 Superkings (Low Tar) (L) 584 Superkings Lights (L) [lm] 585 Superkings Menthol (L) [lm] 798 Superkings Ultra Light (L) [vl] Kensitas: 544 Club (LM) 316 Club King Size (LM) [h] 873 Club Lights Kingsize (L) [lm] 233 Club Mild (LM) [lm] 234 Club Mild King Size (L) [mh] 318 Corsair (Filter Virginia ) (LM) 319 (Filter Virginia) King Size (LM) 320 Filter Virginia (P) (LM) 320 Kensitas (P) (LM) 799 Kingsize (LM) 235 Mild King Size (LM) 721 Superkings Kent: 618 King Size (LM) [lm] 619 Lights King Size (L) [lm] 620 100s Deluxe (LM) [h] Key: 800 Lights (L) [lm] 801 Kings(ize) (LM) [h] 802 Superkings (LM) [h] 844 Super Lights (L) [lm] King George: 291 King Size (LM) [h] 621 Mild King Size (L) [lm] 571 Superkings (LM) [h] Kings: SHS 1998: Coding and Editing Instructions 508 King Size (M) 349 100s (LM) Kings Royal Filter: 803 Lights (L) [mh] 804 Kingsize (LM) [h] 805 Superkings Lights (L) [lm] 806 Superkings (LM) 845 100’s (LM) [vh] Kingsmen: 344 Filter Virginia 545 King Size (LM) [h] 693 Special King Size (LM) [h] 622 Superkings (LM) [h] Kingston: 660 King Size (LM) 722 King Size Filter Kings (LM) [h] 723 Lights King Size (L) [lm] 759 Superkings (LM) [h] 807 Superlights (LM) [mh] Kingsway 351 King Size (LM) Knights: 509 Low tar (King Size) (L) 510 King Size (LM) [h] 846 King Size Mild (L) [lm] 518 100s (LM) [h] 847 100’s Mild (L) [lm] Knightsbridge: 547 Knightsbridge (LM) 579 Kings (M) 586 King Size (LM) [h] 808 Kingsize Lights (L) [mh] 572 100s (M) 809 Superkings Lights (LM) [mh] 810 Superkings (LM) [h] Kool 623 Filter Kings Menthol (LM) [h] Lambert & Butler: 321 International Size 239 King Size (LM) [h] 549 King Size Low Tar (L) 724 Lights (L) [l] 119 Special Mild King Size SHS 1998: Coding and Editing Instructions 288 100s (LM) Lambeth: 548 King Size (LM) [h] 725 Special Mild King S ize (L) [lm] 565 Superkings (LM) [h] Lark: 625 Filter King Size (LM) 726 Triple Filter (LM) [h] L & M 626 Filter (King Size) (LM) [h] Londis: 811 King Size Lights (L) [mh] 627 King Size (LM) [h] 669 Luxury Length (LM) [h] London: 295 Superkings (M) 874 Filters Lucky Strike 628 (Filters) (King Size) (LM) [h] Mace: 848 Kingsize Lights (L) 511 King Size (LM) [h] 511 Maceline King Size (LM) 629 Superkings (LM) [mh] Madison (Asda’s own) 883 Lights Superkings (LM) [mh] 884 Lights Kingsize (LM) [h] 885 Superkings (LM) [h] 886 Kingsize (M) [vh] Major 528 Extra Size (LM) [h] Marlboro: 242 King Size (LM) [h] 135 Lights King Size (L) [l] 140 Lights 100s (L) [lm] 243 100s (LM) [h] Mayfair: 630 King Size (LM) [mh] 850 Lights (L) [lm] SHS 1998: Coding and Editing Instructions Merit 120 (Filter) Extra Mild (L) [l] Metro: 727 Kings International Filter (LM) [h] 633 100s (LM) [h] 760 100s Mild (L) [lm] More: 812 Classic (LM) 874 Filter (LM) [h] 244 Filter 120s (LM) 245 Menthol (Filter) 120s (LM) [h] 813 Mild Menthol 120’s (LM) [mh] 141 Special Mild 120s (LM) [mh] 142 Special Mild Menthol 120s (L) [mh] 566 Special Mild Menthol Filter120s No.3: 814 Superkings (LM) [h] 815 Kingsize (LM) [h] 875 Kingsize Lights (L) [lm] Oscar: 634 King Size (LM) 851 Superkings Lights (L) [mh] 728 Superkings 100s (LM) [h] Pall Mall 635 (Filter) (King Size) (LM) Park Drive: 325 Special Virginia (P) (LM) [h] 247 Tipped King Size (LM) [h] Peter Stuyvesant: 122 Extra Mild (King Size) (L) 249 (Filter) King Size (LM) [h] 250 (Filter) Luxury Length (LM) 816 Lights (L) 123 Luxury Length Extra Mild (L) [lm] 852 100’s (LM) [mh] 853 100’s Extra lights (L) [lm] Piccadilly: 251 Filter De Luxe (LM) [h] 253 Number One (P) (LM) [h] Players: 326 Medium Navy Cut (P) (LM) [h] 256 No.6 King Size (LM) 328 No.10 Filter (LM) 730 Prime King Size (LM) SHS 1998: Coding and Editing Instructions Prime: 881 Kingsize (LM) [h] Prince: 637 Lights (LM) [h] 729 Prince of Blends (M) [vh] Raffles: 274 100s (Special Virginia) (LM) [h] 529 Kings (LM) 670 Lights 100s (L) [lm] 731 Special Virginia Red Band: 289 King Size (LM) [h] 136 King Size Mild (L) 817 Lights Kingsize (L) [lm] 638 Lights Superkings (LM) [mh] 282 Superkings (LM) [h] 876 Specials 25 (LM) [h] Regal: 551 Filter (LM) [mh] 258 King Size (LM) [h] 587 Mild King Size (L) [l] 290 100s Regatta: 530 King Size (M) 877 Kingsize Filter deluxe (LM) 819 Kingsize Super DeLuxe (LM) [h] 818 Superking Filter DeLuxe (LM) [h] 761 Superkings (M) Review 639 King Size (M) Reyno 640 Menthol (Fresh) (M) [vh] Ronson: 345 King Size (LM) 820 Lights Special Mild Virginia (L) [l] 732 Lights Special Mild King Size (L) 733 Special Virginia King Size (LM) [h] 762 Superkings (LM) [mh] 283 100s Rothmans: 259 International (LM) [h] 330 King Size Filter (LM) [h] 680 Lights King Size (L) [l] SHS 1998: Coding and Editing Instructions 734 Royals Lights 25s (L) [l] 260 Royals 120s (LM) [h] 641 Royals 25s (LM) [h] 513 100s (LM) Royal Standard 331 King Size St James 856 King Size 14’s (LM) [h] St. Moritz 261 Luxury Length Menthol (LM)[mh] Salem 642 Menthol (Fresh) (LM) [h] Select: 643 Filter Virginia King Size (LM) [h] 781 No. 2 (Kingsize) (LM) [vh] Senior Service: 262 Cadets King Size (LM) 332 Fine Virginia (P) (LM) [h] 263 Superkings (LM) Silk Cut: 127 Kingsize (L) [l] 143 Silk Cut (L) [l] 275 Extra (L) 137 Extra De Luxe Mild (L) 661 Extra Mild King Size (L) [vl] 662 Extra Mild 100s (L) [vl] 514 King Size Deluxe Mild (L) 588 Menthol (L) 128 No.3 (L) [l] 663 Super Low (King Size) (L) [vl] 580 Ultra (L) [l] 821 Ultra Low 100’s (L) [vl] 130 Ultra Low (King Size) (L) [vl] 664 100s (L) [l] Silver Strand 822 Kingsize (LM) [h] 823 Superkings (LM) [h] 857 Superlights (L) [lm] Sinclair: 735 Superkings (L) 552 100s (L) SHS 1998: Coding and Editing Instructions Special: 858 Kingsize(LM) [h] 859 Superkings (LM) [h] Sky: 824 King Size Lights (L) [lm] 567 King Size (LM) [h] 825 Superkings Lights (L) [lm] 644 Superkings (LM) [h] Sobranie: 645 Black Russian 100’s (LM) [h] 646 Cocktail 100’s (LM) [h] Solo: 292 King Size (LM) [h] 519 King Size Mild (L) 763 Lights King Size (L) [lm] 520 Superkings (LM) [mh] 764 25s King Size (LM) [h] Sovereign 878 Kingsize (LM) [h] Spar: 346 King Size (LM) [h] 647 King Size Extra Mild (L) [lm] 278 Superkings (LM) [h] State Express 555 765 King Size (LM) [h] Special 879 Kingsize (LM) [h] 880 Superkings (LM) [h] Statesmen: 826 Kingsize Lights (L) [mh] 681 King Size (LM) [h] 687 Luxury length (LM) [h] Style: 521 King Size (LM) 694 Special 25s (LM) [h] Sullivan Powell: 671 Private Stock Filter (King Size) (LM) 648 Special Number 1 Turkish Filter (M) Supreme: 736 Mild King Size (L) [lm] 553 King Size (LM) [h] SHS 1998: Coding and Editing Instructions 649 Superkings (LM) [h] Sweet Afton 650 Bank Size Plain (LM) 766 Sweet Afton Virginia (P) (M) [vh] Triumph: 828 Gold Kingsize (LM) [h] 737 King Size Filter (LM) [h] 738 Special Mild King Size (L) [lm] 739 Superkings (LM) [h] 827 Superkings Lights (L) [lm] 860 Superkings Menthol (LM) [mh] Twenties: 564 King Size (LM) 829 Virginia Filter (LM) [h] VG: 284 King Size (LM) 740 Superkings 100s (LM) [h] Victoria Wine: 276 King Size 277 Low tar 554 Special Filter (LM) 555 Special Mild (L) 556 100s (LM) Virginia Star: 741 De Luxe Mild 100s (L) [lm] 767 De Luxe Mild King Size (L) [lm] 742 De Luxe King Size 743 Gold Classic (LM) 744 Special Filter (LM) 573 King Size (LM) [h] 581 100s (LM) [h] Vogue 523 Superslims 100s (L) [l] Warwick: 830 Lights (L) [lm] 831 Kingsize (LM) [h] 832 Superkings (LM) [h] 861 Superkings Lights (L) [mh] Windsor Blue: 558 King Size (LM) [h] 745 King Size Lights (L) [lm] 574 Low Tar (L) 746 Superkings (LM) [h] SHS 1998: Coding and Editing Instructions Windsor Gold: 672 King Size (LM) 747 King Size Special Magnum 782 Special Virginia King Size (LM) Winston 269 King Size (LM) [h] Woodbine 337 (Plain) (P) (LM) [h] York: 666 King Size (LM) [h] 654 King Size Low Tar (L) 769 King Size Mild (L) [lm] 560 Superkings (LM) [h] YSL: 748 Luxury 100s (LM) [h] 656 Menthol (L) 770 Menthol Luxury 100s (L) [lm] SHS 1998: Coding and Editing Instructions APPENDIX X:CODING LIST FOR CODING BUTTER /MARGARINE NB:All brands of butter and hard/block margarine code 1.Olive Gold Light (Sainsbury’s) ...... 2 Anchor Half Fat Spread 2 Olivio...... 1 Anchor Low Fat Spread...... 2 Olivite ...... 2 Asda Country Blend ...... 1 Outline ...... 2 Asda Golden Soft ...... 2 Pact with Omega 3 fatty acids ...... 1 Asda Hi-Life...... 2 Safeway Asda Sunflower low fat spread ...... 2 Golden Low Fat Spread ...... 2 Banquet soft margarine ...... 1 Low Fat Sunflower Spread...... 2 Blue Band soft margarine ...... 1 Meadow...... 1 Blue Leaf soft margarine ...... 1 Olive ...... 1 Butter (any variety)...... 1 Reduced Fat Soft Spread ...... 1 Butterlicious (Sainsbury’s) ...... 1 Soft margarine...... 1 Clover ...... 1 Very Low Fat Spread (Simplese) ...... 2 Clover, lightly salted ...... 1 Sainsbury Clover Extra Lite / Diet ...... 2 Butterlicious ...... 1 Co-op Good Life low fat sunflower spread ...... 2 County Light...... 2 Co-op Red Seal Soft Spread ...... 1 County Spread ...... 1 County Light ...... 2 Half Fat Spread ...... 2 Dairy Crest Willow ...... 1 Luxury Soft Margarine...... 1 Dalesby’s...... 1 Olive Gold ...... 1 Delight ...... 2 Olive Gold Light ...... 2 Delight Extra Low / Diet ...... 2 Soft Spread ...... 1 Echo hard margarine ...... 1 Sunflower Low Fat Spread...... 2 Encore Sol...... 1 Sunflower Very Low Fat Spread ...... 2 Encore Sol Light ...... 2 Shape Sunflower Spread ...... 2 Encore Supersoft Luxury Margarine ...... 1 Slimmers Gold Sunflower Low Fat Spread ...... 2 Flora / Flora Buttery / Flora Reduced Salt ...... 1 Somerfield Low Fat Sunflower ...... 2 Flora Light ...... 2 Somerfield Supersoft ...... 1 Gold (St. Ivel) ...... 2 Soya Margarine (own brands) ...... 1 Gold Extra Light / Lowest (St. Ivel) ...... 2 St Ivel Gold ...... 2 Golden Crown (Kraft) (Golden Churn) ...... 1 St Ivel Gold Lowest ...... 2 Golden Crown Light ...... 1 St Ivel Mono...... 1 Golden Olive ...... 2 Stork / Stork SB ...... 1 Golden Vale ...... 1 Stork Rich Blend ...... 1 Granose...... 1 Stork Light Blend ...... 1 Half Fat Anchor...... 2 Summer County ...... 1 Half Fat butters (own brand) ...... 2 Sunflower margarine (own brands) ...... 1 Hard margarine (own brand) ...... 1 Sunflower low fat spreads (own brands) ...... 2 I can’t believe it’s not butter ...... 1 Sunflower very low fat spreads (own brands) ..... 2 I can’t believe it’s not butter Light ...... 2 Tesco Kerrygold Light ...... 2 Butter Me Up ...... 1 Kraft Special Soft ...... 1 Golden Blend ...... 1 Krona Gold ...... 1 Healthy Eating ½ Fat Sunflower Spread .... 2 Krona Spreadable ...... 1 Healthy Eating Very Low Fat Spread ...... 2 Latta...... 2 Healthy Eating Lowest Ever Soft Spread .. 2 Marks and Spencer Tomor hard margarine...... 1 English Churn ...... 1 Utterly Butterly ...... 1 Sunglow ...... 2 Vitalite ...... 1 Sunflower Lite ...... 2 Vitalite Light ...... 2 Meadowcup...... 1 Vitaquelle ...... 2 Mello...... 1 Weight Watchers...... 2 Mono (St Ivel)...... 1 Willow (Dairy Crest) ...... 1 Olive Gold (Sainsbury’s) ...... 1 SHS 1998: Coding and Editing Instructions Oat and Bran flakes (any brand) APPENDIX XI: CODING LIST FOR Oat Bran flakes (any brand) CODING BREAKFAST CEREALS Oat Bran flakes with added fruit (any brand) NB: All the cereals listed on this card are high in Oat Krunchies fibre and should be coded 1 or 2 as indicated. Oat and wheat bran (any brand) e.g. Weetabix For any cereal not on the list with bran, oats Organically grown oat flakes (Sainsbury’s) or wheat in the name, code 3 and enter the Porridge Oats (any brand) name at OthCer. Porridge with Bran (any brand) BRAN CEREALS CODE 1 Puffed Wheat (any brand) All Bran (any brand) Quaker Harvest Oat Krunchies Bran Breakfast (Tesco’s) Quaker Oat Bran Bran Buds Quaker Oat Bran Crispies Branflakes (any brand) Quaker Oats Branflakes with sultanas (any brand) Raisin Splitz High Fibre Bran (Sainsbury’s) Raisin Wheats (Sainsbury’s) Nabisco Team Ready Brek (any variety / brand) Natural Bran Ryvita Cornflakes - High Fibre only Sultana Bran (any brand) Scottish Oatflakes with wheatbran (Sainsbury’s) Team (Nabisco) Shredded Wheat (includes Bite Size) OAT OR WHEAT CEREALS CODE 2 Shredded Malt Wheats (Tesco) Allinson’s Tropical Break Wholeflakes Shreddies (any brand) Alpen Squared Malt Bites (Safeway) Alpen with Tropical Fruit Start Apricot Wheats (Sainsbury’s) Strawberry Wheats (Sainsbury’s) Balance (Sainsbury’s) Strike Billington’s Organic Muesli Sustain Cherry Wheats (Sainsbury’s) Swiss Style Muesli (any brand) Cheshire Natural Muesli Toppas Cheshire Fruit and Fibre Muesli Weetabix Clusters Weetaflakes Coco Shreddies Wheatflakes (any brand) Common Sense (Kellogg’s) Wheatflakes with fruit (any brand) Country Store muesli Wholewheat biscuits (e.g Weetabix) Crunchy Oat Cereal (Sainsbury’s) Wholewheat Mini-Flakes Crunchy muesli Wholewheat Muesli (any brand) Cubs (mini Shreddies) Deeside Apricot and Yoghurt Cereal Frosted Shreddies Fruit and Fibre (any brand) Fruit filled mini shredded wheat Harvest Crunch muesli Instant hot oat cereal (any brand) Instant porridge (any brand) Jordan’s Crispy Muesli Jordan’s Oat Bran Hearts Jordan’s Original Crunchy Muesli Jordan’s Porridge Oats Jordan’s Special Recipe Muesli Malties Maple and Nut Flakes (Sainsbury’s) Mini Shredded Wheat Mini Wheats Mornflakes Chocolate Fruit and Nut Crunch Muesli (any brand/variety) Nut Feast (Kellogg’s) Nutri-Grain SHS 1998: Coding and Editing Instructions APPENDIX XII: Coding Frame for Heart Trouble Coding Medical Term Lay Term Category Heart Bruit Heart Murmur Heart Murmur Valvular Heart Disease Damaged Heart Valves (most commonly called mitral and aortic) Rheumatic Heart Disease Rheumatic Fever (affecting the heart) Palpitations (heart arrhythmias) Palpitations Tachycardia Rapid Heart Abnormal Heart Rhythm Bradycardia (heart block) Slow Heart Heart Fibrillation Flutter Congestive Cardiac Failure Right Sided Heart Failure Heart Failure Weakening Heart Other Heart Left Sided Heart Failure Trouble Congenital Heart Disease Born with Heart Problem Other Various This is a list of conditions which might come up in the Diagnosis & Treatment section of the CVD module, and/or in the Parental History section of the ‘Other Classification’ module