|
subjectkey |
GUID |
|
Required |
The NDAR Global Unique Identifier (GUID) for research subject |
NDAR*
|
|
|
|
src_subject_id |
String |
20
|
Required |
Subject ID how it's defined in lab/project |
|
|
bid, catieid, newid, participant_id, prom_id, record_id, subject, subject_id |
|
interview_date |
Date |
|
Required |
Date on which the interview/genetic test/sampling/imaging/biospecimen was completed. MM/DD/YYYY |
|
|
date_of_interview, date_of_rating, pnsdate, prom_date |
|
interview_age |
Integer |
|
Required |
Age in months at the time of the interview/test/sampling/imaging. |
0::1440
|
Age is rounded to chronological month. If the research participant is 15-days-old at time of interview, the appropriate value would be 0 months. If the participant is 16-days-old, the value would be 1 month.
|
age, dema1 |
|
sex |
String |
20
|
Required |
Sex of subject at birth |
M;F; O; NR
|
M = Male; F = Female; O=Other; NR = Not reported
|
dema2, gender, prom_gen |
Query
|
visit |
String |
60
|
Recommended |
Visit name |
|
|
promis_date |
Query
|
promis_1 |
Integer |
|
Recommended |
Are you able to do chores such as vacuuming or yard work? |
|
1=Unable to do; 2=With much difficulty; 3=With some difficulty; 4=With a little difficulty; 5=Without any difficulty; -999 = Missing
|
pfa11 |
Query
|
promis_2 |
Integer |
|
Recommended |
Are you able to go up and down stairs at a normal pace? |
|
1=Unable to do; 2=With much difficulty; 3=With some difficulty; 4=With a little difficulty; 5=Without any difficulty; -999 = Missing
|
pfa21 |
Query
|
promis_3 |
Integer |
|
Recommended |
Are you able to go for a walk of at least 15 minutes? |
|
1=Unable to do; 2=With much difficulty; 3=With some difficulty; 4=With a little difficulty; 5=Without any difficulty; -999 = Missing
|
pfa23 |
Query
|
promis_4 |
Integer |
|
Recommended |
Are you able to run errands and shop? |
|
1=Unable to do; 2=With much difficulty; 3=With some difficulty; 4=With a little difficulty; 5=Without any difficulty; -999 = Missing
|
pfa53 |
Query
|
promis_5 |
Integer |
|
Recommended |
I felt fearful |
|
1=Never; 2=Rarely; 3= Sometimes; 4=Often; 5=Always; -999 = Missing
|
edanx01 |
Query
|
promis_6 |
Integer |
|
Recommended |
I found it hard to focus on anything other than my anxiety |
|
1=Never; 2=Rarely; 3= Sometimes; 4=Often; 5=Always; -999 = Missing
|
edanx40 |
Query
|
promis_7 |
Integer |
|
Recommended |
My worries overwhelmed me |
|
1=Never; 2=Rarely; 3= Sometimes; 4=Often; 5=Always; -999 = Missing
|
edanx41 |
Query
|
promis_8 |
Integer |
|
Recommended |
I felt uneasy |
|
1=Never; 2=Rarely; 3= Sometimes; 4=Often; 5=Always; -999 = Missing
|
edanx53 |
Query
|
promis_9 |
Integer |
|
Recommended |
I felt worthless |
|
1=Never; 2=Rarely; 3= Sometimes; 4=Often; 5=Always; -999 = Missing
|
eddep04 |
Query
|
promis_10 |
Integer |
|
Recommended |
I felt helpless |
|
1=Never; 2=Rarely; 3= Sometimes; 4=Often; 5=Always; -999 = Missing
|
eddep06 |
Query
|
promis_11 |
Integer |
|
Recommended |
I felt depressed |
|
1=Never; 2=Rarely; 3= Sometimes; 4=Often; 5=Always; -999 = Missing
|
eddep29 |
Query
|
promis_12 |
Integer |
|
Recommended |
I felt hopeless |
|
1=Never; 2=Rarely; 3= Sometimes; 4=Often; 5=Always; -999 = Missing
|
eddep41 |
Query
|
promis_13 |
Integer |
|
Recommended |
I feel fatigued |
|
1= Not at all; 2=A little bit; 3=Somewhat; 4=Quite a bit; 5= Very much; -999 = Missing
|
hi7 |
Query
|
promis_14 |
Integer |
|
Recommended |
I have trouble starting things because I am tired |
|
1= Not at all; 2=A little bit; 3=Somewhat; 4=Quite a bit; 5= Very much; -999 = Missing
|
an3 |
Query
|
promis_15 |
Integer |
|
Recommended |
How run-down did you feel on average? |
|
1= Not at all; 2=A little bit; 3=Somewhat; 4=Quite a bit; 5= Very much; -999 = Missing
|
fatexp41 |
Query
|
promis_16 |
Integer |
|
Recommended |
How fatigued were you on average? |
|
1= Not at all; 2=A little bit; 3=Somewhat; 4=Quite a bit; 5= Very much; -999 = Missing
|
fatexp40 |
Query
|
promis_17 |
Integer |
|
Recommended |
My sleep quality was |
|
1=Very good; 2=Good; 3=Fair; 4=Poor; 5=Very poor; -999 = Missing
|
sleep109 |
Query
|
promis_18 |
Integer |
|
Recommended |
My sleep was refreshing |
|
1=Very much; 2=Quite a bit; 3=Somewhat; 4=A little bit; 5=Not at all; -999 = Missing
|
sleep116 |
Query
|
promis_19 |
Integer |
|
Recommended |
I had a problem with my sleep |
|
1= Not at all; 2=A little bit; 3=Somewhat; 4=Quite a bit; 5= Very much; -999 = Missing
|
sleep20 |
Query
|
promis_20 |
Integer |
|
Recommended |
I had difficulty falling asleep |
|
1= Not at all; 2=A little bit; 3=Somewhat; 4=Quite a bit; 5= Very much; -999 = Missing
|
sleep44 |
Query
|
srpsat07 |
Integer |
|
Recommended |
I am satisfied with how much work I can do (include work at home) |
1::5
|
5=Not at all; 4=A little bit; 3=Somewhat; 2=Quite a bit; 1=Very much
|
promis_21 |
Query
|
srpsat24 |
Integer |
|
Recommended |
I am satisfied with my ability to work (include work at home) |
1::5
|
5=Not at all; 4=A little bit; 3=Somewhat; 2=Quite a bit; 1=Very much
|
promis_22 |
Query
|
promis_23 |
Integer |
|
Recommended |
I am satisfied with my ability to do regular personal and household responsibilities |
1::5; -999
|
1= Not at all; 2=A little bit; 3=Somewhat; 4=Quite a bit; 5= Very much; -999 = Missing
|
|
Query
|
srpsat49 |
Integer |
|
Recommended |
I am satisfied with my ability to perform my daily routines |
1::5
|
5=Not at all; 4=A little bit; 3=Somewhat; 2=Quite a bit; 1=Very much
|
promis_24 |
Query
|
promis_25 |
Integer |
|
Recommended |
How much did pain interfere with your day to day activities? |
|
1= Not at all; 2=A little bit; 3=Somewhat; 4=Quite a bit; 5= Very much; -999 = Missing
|
painin9 |
Query
|
promis_26 |
Integer |
|
Recommended |
How much did pain interfere with work around the home? |
|
1= Not at all; 2=A little bit; 3=Somewhat; 4=Quite a bit; 5= Very much; -999 = Missing
|
painin22 |
Query
|
promis_27 |
Integer |
|
Recommended |
How much did pain interfere with your ability to participate in social activities? |
|
1= Not at all; 2=A little bit; 3=Somewhat; 4=Quite a bit; 5= Very much; -999 = Missing
|
painin31 |
Query
|
promis_28 |
Integer |
|
Recommended |
How much did pain interfere with your household chores? |
|
1= Not at all; 2=A little bit; 3=Somewhat; 4=Quite a bit; 5= Very much; -999 = Missing
|
painin34 |
Query
|
promis_pain_intensity |
Integer |
|
Recommended |
How would you rate your pain on
average? |
|
0=No pain; 10=Worst imaginable pain; -999 = Missing
|
global07 |
|
study |
String |
100
|
Recommended |
Study; The code for each individual study |
|
|
|
Query
|
srpper11_caps |
Integer |
|
Recommended |
I have trouble doing all of my regular leisure activities with others |
|
5 = Never; 4= Rarely; 3=Sometimes; 2=Often; 1=Always; -999=missing
|
|
Query
|
srpper18_caps |
Integer |
|
Recommended |
I have trouble doing all of the family activities that I want to |
|
5 = Never; 4= Rarely; 3=Sometimes; 2=Often; 1=Always; -999=missing
|
|
Query
|
srpper23_caps |
Integer |
|
Recommended |
I have trouble doing all of my usual work (include work at home) |
|
5 = Never; 4= Rarely; 3=Sometimes; 2=Often; 1=Always; -999=missing
|
|
Query
|
srpper46_caps |
Integer |
|
Recommended |
I have trouble doing all of the activities with friends that I want to |
|
5 = Never; 4= Rarely; 3=Sometimes; 2=Often; 1=Always; -999=missing
|
|
|
labsample25 |
Integer |
|
Recommended |
Past week: Have you taken any vitamins or other supplements |
0;1
|
0=No; 1=Yes
|
prom_supplement |
|
prom_homemade |
Integer |
|
Recommended |
In an average week, how often do you cook and consume home cooked meals? (Exclude ready-to-eat meals like boxed macaroni and cheese, ramen noodles, lean cuisine) |
1::5
|
1= Never; 2= Rarely (less than once/week); 3= Occasionally (1-2 times/week); 4= Regularly (3-5 times/week); 5= Daily
|
|
|
prom_ready_made_meals |
Integer |
|
Recommended |
In an average week, how often do you consume ready-to-eat meals (i.e macaroni and cheese, ramen noodles, lean cuisine)? |
1::5
|
1= Never; 2= Rarely (less than once/week); 3= Occasionally (1-2 times/week); 4= Regularly (3-5 times/week); 5= Daily
|
|
|
prom_restaurant |
Integer |
|
Recommended |
In an average week, how often do you eat food prepared at a restaurant, including carry-out/take-out? |
1::5
|
1= Never; 2= Rarely (less than once/week); 3= Occasionally (1-2 times/week); 4= Regularly (3-5 times/week); 5= Daily
|
|
|
prom_wheaties |
Integer |
|
Recommended |
In an average week, how often do you eat at least 2 servings of whole grains in a day? |
1::5
|
1= Never; 2= Rarely (less than once per week); 3= Occasionally (1 to 2 times per week); 4= Regularly (3 to 5 times per week); 5= Daily
|
|
|
prom_daily_fruits |
Integer |
|
Recommended |
In an average week, how often to you consume at least 2-3 servings of fruit in a day? |
1::5
|
1= Never; 2= Rarely (less than once/week); 3= Occasionally (1-2 times/week); 4= Regularly (3-5 times/week); 5= Daily
|
|
|
prom_veg_daily |
Integer |
|
Recommended |
In an average week, how often do you consume at least 2-3 servings of vegetables, including potatoes in a day? |
1::5
|
1= Never; 2= Rarely (less than once/week); 3= Occasionally (1-2 times/week); 4= Regularly (3-5 times/week); 5= Daily
|
|
|
prom_diff_plants |
Integer |
|
Recommended |
In an average week, how many different plant species do you eat? |
1::5
|
1= less than 5; 2= 6-10; 3= 11-20; 4= 21-30; 5= greater then 30; e.g. If you consume a can of soup that contains carrots, potatoes and onion, you can count this as 3 different plants; If you consume multi-grain bread, each different grain counts as a plant.
|
|
|
prom_fermented |
Integer |
|
Recommended |
How often do you consume one or more servings of fermented vegetables in or plant products a day in an average week? |
1::5
|
1= Never; 2= Rarely (less than once/week); 3= Occasionally (1-2 times/week); 4= Regularly (3-5 times/week); 5= Daily
|
|
|
prom_dairy |
Integer |
|
Recommended |
In an average week, how often do you consume at least 2 servings of milk or cheese a day? |
1::5
|
1= Never; 2= Rarely (less than once/week); 3= Occasionally (1-2 times/week); 4= Regularly (3-5 times/week); 5= Daily
|
|
|
prom_dairy_subs |
Integer |
|
Recommended |
In an average week, how often do you consume milk substitutes? |
1::5
|
1= Never; 2= Rarely (less than once/week); 3= Occasionally (1-2 times/week); 4= Regularly (3-5 times/week); 5= Daily
|
|
|
prom_supplement_2 |
String |
100
|
Recommended |
If taking nutritional/herbal supplement.... please specify which ones. |
|
|
|
|
prom_frozen_desserts |
Integer |
|
Recommended |
How often do you eat frozen desserts? |
1::5
|
1= Never; 2= Rarely (less than once/week); 3= Occasionally (1-2 times/week); 4= Regularly (3-5 times/week); 5= Daily
|
|
|
prom_red_meat |
Integer |
|
Recommended |
In an average week, how often do you eat red meat? |
1::5
|
1= Never; 2= Rarely (less than once/week); 3= Occasionally (1-2 times/week); 4= Regularly (3-5 times/week); 5= Daily
|
|
|
prom_high_fat_meat |
Integer |
|
Recommended |
In an average week, how often do you consume higher fat red meats like prime rib, T-bone steak, hamburger, ribs, bacon, etc.? |
1::5
|
1= Never; 2= Rarely (less than once/week); 3= Occasionally (1-2 times/week); 4= Regularly (3-5 times/week); 5= Daily
|
|
|
prom_poultry |
Integer |
|
Recommended |
How many days in an average week do you consume poultry at least once a day? |
1::5
|
1= Never; 2= Rarely (less than once/week); 3= Occasionally (1-2 times/week); 4= Regularly (3-5 times/week); 5= Daily
|
|
|
prom_seafood |
Integer |
|
Recommended |
How many days in an average week do you consume seafood? |
1::5
|
1= Never; 2= Rarely (less than once/week); 3= Occasionally (1-2 times/week); 4= Regularly (3-5 times/week); 5= Daily
|
|
|
prom_salted_snacks |
Integer |
|
Recommended |
How many days in an average week do you consume salted snacks? |
1::5
|
1= Never; 2= Rarely (less than once/week); 3= Occasionally (1-2 times/week); 4= Regularly (3-5 times/week); 5= Daily
|
|
|
prom_sugary_sweets |
Integer |
|
Recommended |
How many days in an average week do you consume sugary sweets? |
1::5
|
1= Never; 2= Rarely (less than once/week); 3= Occasionally (1-2 times/week); 4= Regularly (3-5 times/week); 5= Daily
|
|
|
prom_olive_oil |
Integer |
|
Recommended |
How many days in an average week do you cook with olive oil? |
1::5
|
1= Never; 2= Rarely (less than once/week); 3= Occasionally (1-2 times/week); 4= Regularly (3-5 times/week); 5= Daily
|
|
|
prom_whole_eggs |
Integer |
|
Recommended |
Consume whole eggs. |
1::5
|
1= Never; 2= Rarely (less than once/week); 3= Occasionally (1-2 times/week); 4= Regularly (3-5 times/week); 5= Daily
|
|
|
prom_sweet_beverage |
Integer |
|
Recommended |
Drink 16 ounces or more of a sugar sweetened beverage such as non diet soda or fruit drink or punch in a day? |
1::5
|
1= Never; 2= Rarely (less than once/week); 3= Occasionally (1-2 times/week); 4= Regularly (3-5 times/week); 5= Daily
|
|
|
prom_paleo |
Integer |
|
Recommended |
Do you eat a paleo, modified paleo, primal, FODMAP, Weston-Price, or other low-grain, low processed food diet? |
0;1
|
0= No; 1= Yes
|
|
|
prom_art_sweeteners |
Integer |
|
Recommended |
Consume diet beverages with artificial sweeteners? |
1::5
|
1= Never; 2= Rarely (less than once/week); 3= Occasionally (1-2 times/week); 4= Regularly (3-5 times/week); 5= Daily
|
|
|
prom_water |
Integer |
|
Recommended |
Consume at least 1L of water in a day? |
1::5
|
1= Never; 2= Rarely (less than once/week); 3= Occasionally (1-2 times/week); 4= Regularly (3-5 times/week); 5= Daily
|
|
|
prom_food_antibiotics |
Integer |
|
Recommended |
Do you eat meat/dairy products from animals treated with antibiotics? |
0::2
|
1= Yes; 0= No; 2= Unsure
|
|
|
prom_diet_restrict |
Integer |
|
Recommended |
Do you follow any other special diet restrictions other than those indicated above? |
0;1
|
0= No; 1= Yes
|
|
|
prom_diet_other |
String |
100
|
Recommended |
If you follow a diet other than those indicated above, please specify: |
|
|
|
|
prom_drinking_source |
Integer |
|
Recommended |
What is your drinking water source at home? |
1::5
|
1= City; 2= Well; 3= Bottled; 4= Filtered; 5= Not sure
|
|
|
prom_current_residence |
Integer |
|
Recommended |
When did you move to your current state of residence? |
1::5
|
1= Within the past month; 2= Within the past 3 months; 3= Within the past 6 months; 4= Within the past year; 5= I have lived in my current state of residence for more than a year
|
|
|
prom_travel |
Integer |
|
Recommended |
I have traveled outside of the United States in the past _________. |
1::5
|
1= Month; 2= 3 months; 3= 6 months; 4= 1 year; 5= I have not been outside of the United States in the past year.
|
|
|
prom_travel_explain |
String |
100
|
Recommended |
If you have traveled outside of the United States in the past 1-6 months, please explain |
|
|
|
|
prom_roommates |
Integer |
|
Recommended |
How many non-family roommates do you have? |
1::5
|
1= None; 2= One; 3= Two; 4= Three; 5= More than three
|
|
|
prom_roommate_participate |
Integer |
|
Recommended |
Are any of your roommates participating in this study? |
1::3
|
1= Yes; 2= No; 3= Not sure
|
|
|
prom_room_participate_2 |
String |
100
|
Recommended |
If your roommates are participating in this study, please explain |
|
|
|
|
prom_related_participants |
Integer |
|
Recommended |
Are you related to or live with any of the other participants in this study? |
1::3
|
1= Yes; 2= No; 3= Not sure
|
|
|
prom_dog |
Integer |
|
Recommended |
Do you have a dog(s)? |
0;1
|
0= No; 1= Yes
|
|
|
prom_dog_explain |
String |
100
|
Recommended |
If you have a dog, please explain |
|
|
|
|
prom_cats |
Integer |
|
Recommended |
Do you have a cat(s)? |
0;1
|
0= No; 1= Yes
|
|
|
prom_cats_explain |
String |
100
|
Recommended |
If you have a cat, please explain |
|
|
|
|
prom_other_pets |
Integer |
|
Recommended |
Do you have any other pet(s)? |
0;1
|
0= No; 1= Yes
|
|
|
prom_other_pets_explain |
String |
100
|
Recommended |
If you have any other pets, please explain |
|
|
|
|
equest30 |
String |
15
|
Recommended |
What is your height? (Please give your best estimate.) |
|
|
prom_ht |
|
prom_dom_hand |
Integer |
|
Recommended |
Which is your dominant hand? |
1::3
|
1= I am right handed; 2= I am left handed; 3= I am ambidextrous
|
|
|
prom_exercise |
Integer |
|
Recommended |
How often do you exercise? |
1::5
|
1= Daily; 2= Regularly (3-5 times/week); 3= Occasionally (1-2 times/week); 4= Rarely (few times/month); 5= Never
|
|
|
prom_indoor_outdoor |
Integer |
|
Recommended |
Do you generally exercise indoors or outdoors? |
1::5
|
1= Indoors; 2= Outdoors; 3= Both; 4= Depends on the season; 5= None of the above
|
|
|
prom_fingernails |
Integer |
|
Recommended |
Do you bite your fingernails? |
0;1
|
0= No; 1= Yes
|
|
|
prom_pool |
Integer |
|
Recommended |
How often do you use a swimming pool/hot tub? |
1::5
|
1= Daily; 2= Regularly (3-5 times/week); 3= Occasionally (1-2 times/week); 4= Rarely (few times/month); 5= Never
|
|
|
prom_cigarettes |
Integer |
|
Recommended |
How often do you smoke cigarettes? |
1::5
|
1= Daily; 2= Regularly (3-5 times/week); 3= Occasionally (1-2 times/week); 4= Rarely (few times/month); 5= Never
|
|
|
prom_alcohol |
Integer |
|
Recommended |
How often do you drink alcohol? |
1::5
|
1= Daily; 2= Regularly (3-5 times/week); 3= Occasionally (1-2 times/week); 4= Rarely (few times/month); 5= Never
|
|
|
prom_drinks_consumed |
Integer |
|
Recommended |
How many drinks do you consume if you do drink alcohol? |
1::4
|
1= None; 2= 1-2 servings; 3= 3-6; 4= More than 6
|
|
|
prom_type_alcohol |
Integer |
|
Recommended |
What type(s) of alcohol do you typically consume (select all that apply)? Beer/ Cider |
0; 1
|
0= No; 1= Yes
|
prom_type_alcohol___1 |
|
prom_type_alcohol_spirits |
String |
100
|
Recommended |
Define different spirit-types: |
|
|
|
|
prom_diet |
Integer |
|
Recommended |
How would you classify your diet? |
1::5
|
1= Omnivore; 2= Omnivore but do not eat red meat; 3= Vegetarian; 4= Vegetarian but eat seafood; 5= Vegan
|
|
|
prom_teeth_brush |
Integer |
|
Recommended |
How often do you brush your teeth? |
1::4
|
1= 2 + times/day; 2= 1-2 times/day; 3= Once a day; 4= Never
|
|
|
prom_floss |
Integer |
|
Recommended |
How often do you floss your teeth? |
1::5
|
1= Daily; 2= Regularly (3-5 times/week); 3= Occasionally (1-2 times/week); 4= Rarely (few times/month); 5= Never
|
|
|
prom_cosmetics |
Integer |
|
Recommended |
How often do you wear facial cosmetics? |
1::4
|
1= Daily; 2= Regularly (3-5 times/week); 3= Occasionally (1-2 times/week); 4= Rarely (few times/month)
|
|
|
prom_deodorant |
Integer |
|
Recommended |
Do you use deodorant or antiperspirant (antiperspirants generally contain aluminum)? |
1::4
|
1= I use deodorant; 2= I use an antiperspirant; 3= Not sure= but I use some form of deodorant/antiperspirant; 4= I do not use deodorant or an antiperspirant
|
|
|
prom_sleep |
Integer |
|
Recommended |
Approximately how many hours of sleep to you get in an average night? |
1::5
|
1= Less than 5 hours; 2= 5-6 hours; 3= 6-7 hours; 4= 7-8 hours; 5= 8 or more hours
|
|
|
prom_fab_softener |
Integer |
|
Recommended |
Do you use fabric softener when drying your clothes? |
0;1
|
0= No; 1= Yes
|
|
|
prom_bowel_day |
Integer |
|
Recommended |
How many times do you have a bowel movement in an average day? |
1::6
|
1= Less than one; 2= One; 3= Two; 4= Three; 5= Four; 6= Five or more
|
|
|
prom_bowel_move |
Integer |
|
Recommended |
Describe the quality of your bowel movements: |
1::3
|
1= I tend to be constipated (have difficulty passing stool) - Type 1 and 2;; 2= I tend to have diarrhea (watery stool) - Type 5= 6 and 7; 3= I tend to have normal formed stool - Type 3 and 4.
|
|
|
prom_antibiotics |
Integer |
|
Recommended |
I have taken antibiotics in the last ____________. (If you answered a or b, please indicate which antibiotic you took and what you were treating in the supplemental answer section |
1::5
|
1= Week; 2= Month; 3= 6 months; 4= Year; 5= I have not taken antibiotics in the past year.
|
|
|
prom_antibiotics_note |
String |
100
|
Recommended |
If you have taken antibiotics in the last week or month, please specify what antibiotics and what they were used to treat: |
|
|
|
|
prom_multivitamin |
Integer |
|
Recommended |
Are you taking a daily multivitamin? |
0;1
|
0= No; 1= Yes
|
|
|
prom_flu |
Integer |
|
Recommended |
I have received a flu vaccine in the last ____________. |
1::5
|
1= Week; 2= Month; 3= 6 months; 4= Year; 5= I have not gotten the flu vaccine in the past year.
|
|
|
prom_bc |
Integer |
|
Recommended |
Are you currently using some form of hormonal birth control? |
1::6
|
1= Yes, I am taking the pill; 2= Yes, I use an injected contraceptive (DMPA); 3= Yes, I use a contraceptive patch (Ortho-Evra); 4= Yes, I use the NuvaRing; 5= Yes, I use a hormonal IUD (Mirena); 6= No
|
|
|
prom_preg |
Integer |
|
Recommended |
Are you currently pregnant? |
1::3
|
1= Yes; 2= No; 3= Not sure
|
|
|
prom_preg_y_due_date |
String |
100
|
Recommended |
If yes, please indicate your due date: |
|
|
|
|
prom_weight |
Integer |
|
Recommended |
My weight has _________ within the last 6 months. |
1::3
|
1= Increased more than 10 pounds; 2= Decreased more than 10 pounds; 3= Remained stable
|
|
|
prom_tonsil |
Integer |
|
Recommended |
Have you had your tonsils removed? |
1::3
|
1= Yes; 2= No; 3= Not sure
|
|
|
prom_appendix |
Integer |
|
Recommended |
Have you had you appendix removed? |
1::3
|
1= Yes; 2= No; 3= Not sure
|
|
|
prom_chickenpox |
Integer |
|
Recommended |
Have you had chickenpox? |
1::3
|
1= Yes; 2= No; 3= Not sure
|
|
|
prom_rxacne |
Integer |
|
Recommended |
Do you currently take prescription medication for facial acne? |
0;1
|
0= No; 1= Yes
|
|
|
prom_counter_acne |
Integer |
|
Recommended |
Do you use over the counter products to control facial acne? |
0;1
|
0= No; 1= Yes
|
|
|
prom_freq_probiotic |
Integer |
|
Recommended |
How frequently do you take a probiotic? |
1::5
|
1= Never; 2= Rarely (a few times/month); 3= Occasionally (1-2 times/week); 4= Regularly (3-5 times/week); 5= Daily
|
|
|
prom_rx_overcounter |
Integer |
|
Recommended |
Do you currently take over the counter or prescription medication for other conditions? |
0;1
|
0= No; 1= Yes
|
|
|
prom_rx_overcounter_other |
String |
100
|
Recommended |
if you take over the counter prescription medications... |
|
|
|
|
prom_c_section |
Integer |
|
Recommended |
Were you born via caesarean section (C-section)? |
1::3
|
1= Yes; 2= No; 3= Not sure
|
|
|
prom_infant |
Integer |
|
Recommended |
How were you fed as an infant? |
1::4
|
1= Primarily breast milk; 2= Primarily infant formula; 3= A mixture of breast milk and formula; 4= Not sure
|
|
|
prom_add |
Integer |
|
Recommended |
Have you been diagnosed with ADD/ADHD? |
1::4
|
1= I do not have this condition; 2= Diagnosed by a medical professional (doctor= physician assistant); 3= Diagnosed by an alternative medicine practitioner; 4= Self-diagnosed
|
|
|
prom_alzheimers |
Integer |
|
Recommended |
Have you been diagnosed with Alzheimer's Disease/Dementia |
1::4
|
1= I do not have this condition; 2= Diagnosed by a medical professional (doctor= physician assistant); 3= Diagnosed by an alternative medicine practitioner; 4= Self-diagnosed
|
|
|
prom_asthma |
Integer |
|
Recommended |
Have you been diagnosed with Asthma, Cystic fibrosis, or COPD (chronic obstructive pulmonary disease)? |
1::4
|
1= I do not have this condition; 2= Diagnosed by a medical professional (doctor= physician assistant); 3= Diagnosed by an alternative medicine practitioner; 4= Self-diagnosed
|
|
|
prom_asd |
Integer |
|
Recommended |
Have you been diagnosed with Autism or Autism Spectrum Disorder? |
1::4
|
1= I do not have this condition; 2= Diagnosed by a medical professional (doctor= physician assistant); 3= Diagnosed by an alternative medicine practitioner; 4= Self-diagnosed
|
|
|
prom_autoimmune |
Integer |
|
Recommended |
Have you been diagnosed with autoimmune disease such as Lupus (systemic lupus erythematosus), R.A. (rheumatoid arthritis), MS (multiple sclerosis), Hashimoto's thyroiditis |
1::4
|
1= I do not have this condition; 2= Diagnosed by a medical professional (doctor= physician assistant); 3= Diagnosed by an alternative medicine practitioner; 4= Self-diagnosed
|
|
|
prom_candida |
Integer |
|
Recommended |
Have you ever been diagnosed with Candida or fungal overgrowth in the gut? |
1::4
|
1= I do not have this condition; 2= Diagnosed by a medical professional (doctor= physician assistant); 3= Diagnosed by an alternative medicine practitioner; 4= Self-diagnosed
|
|
|
prom_freq_vitb |
Integer |
|
Recommended |
How frequently do you take Vitamin B complex, folate or folic acid? |
1::5
|
1= Never; 2= Rarely (a few times/month); 3= Occasionally (1-2 times/week); 4= Regularly (3-5 times/week); 5= Daily
|
|
|
prom_clostridium |
Integer |
|
Recommended |
Have you ever been diagnosed with Clostridium difficile (C. diff) infection? |
1::4
|
1= I do not have this condition; 2= Diagnosed by a medical professional (doctor= physician assistant); 3= Diagnosed by an alternative medicine practitioner; 4= Self-diagnosed
|
|
|
prom_coronary |
Integer |
|
Recommended |
Have you ever been diagnosed with coronary artery disease, heart disease, or suffered a heart attack and/or stroke? |
1::4
|
1= I do not have this condition; 2= Diagnosed by a medical professional (doctor= physician assistant); 3= Diagnosed by an alternative medicine practitioner; 4= Self-diagnosed
|
|
|
prom_mental_health |
Integer |
|
Recommended |
Have you ever been diagnosed mental health illness? |
0;1
|
0= No; 1= Yes
|
|
|
prom_mental_health_2 |
Integer |
|
Recommended |
If you responded yes to question please select which disorder/s from the following list: Depression |
0; 1
|
0= No; 1= Yes
|
prom_mental_health_2___1 |
|
prom_diabetes |
Integer |
|
Recommended |
Have you ever been diagnosed with diabetes? |
1::4
|
1= I do not have this condition; 2= Diagnosed by a medical professional (doctor= physician assistant); 3= Diagnosed by an alternative medicine practitioner; 4= Self-diagnosed
|
|
|
prom_diabetes_type |
Integer |
|
Recommended |
If you responded yes to question 40), which type of diabetes? |
1::4
|
1= Prediabetes; 2= Type I diabetes; 3= Type II diabetes; 4= Gestational diabetes
|
|
|
prom_epilepsy |
Integer |
|
Recommended |
Have you ever been diagnosed with epilepsy or seizure disorder? |
1::4
|
1= I do not have this condition; 2= Diagnosed by a medical professional (doctor= physician assistant); 3= Diagnosed by an alternative medicine practitioner; 4= Self-diagnosed
|
|
|
prom_ibs |
Integer |
|
Recommended |
Have you ever been diagnosed with irritable bowel syndrome (IBS)? |
1::4
|
1= I do not have this condition; 2= Diagnosed by a medical professional (doctor= physician assistant); 3= Diagnosed by an alternative medicine practitioner; 4= Self-diagnosed
|
|
|
prom_ibd |
Integer |
|
Recommended |
Have you ever been diagnosed with inflammatory bowel disease (IBD)? |
1::4
|
1= I do not have this condition; 2= Diagnosed by a medical professional (doctor= physician assistant); 3= Diagnosed by an alternative medicine practitioner; 4= Self-diagnosed
|
|
|
prom_migranes |
Integer |
|
Recommended |
Have you ever been diagnosed with migraines? |
1::4
|
1= I do not have this condition; 2= Diagnosed by a medical professional (doctor= physician assistant); 3= Diagnosed by an alternative medicine practitioner; 4= Self-diagnosed
|
|
|
prom_vitd |
Integer |
|
Recommended |
How frequently do you take a Vitamin D supplement? |
1::5
|
1= Never; 2= Rarely (a few times/month); 3= Occasionally (1-2 times/week); 4= Regularly (3-5 times/week); 5= Daily
|
|
|
prom_kidney_disease |
Integer |
|
Recommended |
Have you ever been diagnosed with kidney disease? |
1::4
|
1= I do not have this condition; 2= Diagnosed by a medical professional (doctor= physician assistant); 3= Diagnosed by an alternative medicine practitioner; 4= Self-diagnosed
|
|
|
prom_liver |
Integer |
|
Recommended |
Have you ever been diagnosed with liver disease? |
1::4
|
1= I do not have this condition; 2= Diagnosed by a medical professional (doctor= physician assistant); 3= Diagnosed by an alternative medicine practitioner; 4= Self-diagnosed
|
|
|
prom_phenylketonuria |
Integer |
|
Recommended |
Have you ever been diagnosed with phenylketonuria? |
1::4
|
1= I do not have this condition; 2= Diagnosed by a medical professional (doctor= physician assistant); 3= Diagnosed by an alternative medicine practitioner; 4= Self-diagnosed
|
|
|
prom_sibo |
Integer |
|
Recommended |
Have you ever been diagnosed with small intestinal bacterial overgrowth (SIBO)? |
1::4
|
1= I do not have this condition; 2= Diagnosed by a medical professional (doctor= physician assistant); 3= Diagnosed by an alternative medicine practitioner; 4= Self-diagnosed
|
|
|
prom_skin |
Integer |
|
Recommended |
Have you ever been diagnosed with a skin condition? |
1::4
|
1= I do not have this condition; 2= Diagnosed by a medical professional (doctor= physician assistant); 3= Diagnosed by an alternative medicine practitioner; 4= Self-diagnosed
|
|
|
prom_throid |
Integer |
|
Recommended |
Have you ever been diagnosed with thyroid disease? |
1::4
|
1= I do not have this condition; 2= Diagnosed by a medical professional (doctor= physician assistant); 3= Diagnosed by an alternative medicine practitioner; 4= Self-diagnosed
|
|
|
prom_cancer |
Integer |
|
Recommended |
Have you ever been diagnosed with cancer? |
1::4
|
1= I do not have this condition; 2= Diagnosed by a medical professional (doctor= physician assistant); 3= Diagnosed by an alternative medicine practitioner; 4= Self-diagnosed
|
|
|
prom_cancer_treat |
Integer |
|
Recommended |
If you have been diagnosed with cancer, how was it treated? |
1::4
|
1= No treatment; 2= Surgery only; 3= Chemotherapy; 4= Radiation therapy
|
|
|
prom_gerd |
Integer |
|
Recommended |
Have you ever been diagnosed with acid reflux or GERD (gastro-esophageal reflux disease? |
1::4
|
1= I do not have this condition; 2= Diagnosed by a medical professional (doctor= physician assistant); 3= Diagnosed by an alternative medicine practitioner; 4= Self-diagnosed
|
|
|
prom_thyroid |
Integer |
|
Recommended |
Have you ever been diagnosed with thyroid disease? |
1::4
|
1= I do not have this condition; 2= Diagnosed by a medical professional (doctor= physician assistant); 3= Diagnosed by an alternative medicine practitioner; 4= Self-diagnosed
|
|
|
prom_vitd_iu |
String |
100
|
Recommended |
If takes a vitamin D supplement.... How many IUs(i.e. 1000, 2000, etc)? |
|
|
|
|
prom_critical_condition |
String |
100
|
Recommended |
Have you ever been diagnosed with any other relevant clinical condition? |
|
|
|
|
prom_allergies |
Integer |
|
Recommended |
Do you have seasonal allergies? |
0;1
|
0= No; 1= Yes
|
|
|
prom_non_allergies |
Integer |
|
Recommended |
Do you have any of the following non-food allergies? (check all that apply) Drug (Penicillin) |
0; 1
|
0= No; 1= Yes
|
prom_non_allergies___1 |
|
prom_lactose |
Integer |
|
Recommended |
Are you lactose intolerant? |
0;1
|
0= No; 1= Yes
|
|
|
prom_gluten |
Integer |
|
Recommended |
Are you gluten intolerant? |
1::4
|
1= I was diagnosed with celiac disease; 2= I was diagnosed with gluten allergy (anti-gluten IgG)= but not celiac disease; 3= I do not eat gluten because it makes me feel bad; 4= No
|
|
|
prom_allergies_food |
Integer |
|
Recommended |
I am allergic to (mark all that apply) Peanuts |
0; 1
|
0= No; 1= Yes
|
prom_allergies_food___1 |
|
prom_allergies_food_other |
String |
100
|
Recommended |
If other, please specify: |
|
|
|
|
prom_dreams |
Integer |
|
Recommended |
Do you have vivid and/or frightening dreams? |
1::5
|
1= Never; 2= Rarely (less than once/week); 3= Occasionally (1-2 times/week); 4= Regularly (3-5 times/week); 5= Daily
|
|
|
prom_ensure |
Integer |
|
Recommended |
Are you an adult who receives most (more than 75% of daily calories) of their nutrition from adult nutritional shakes (i.e. Ensure)? |
0;1
|
0= No; 1= Yes
|
|
|
prom_meat_eggs |
Integer |
|
Recommended |
In an average week, how often do you consume meat/eggs? |
1::5
|
1= Never; 2= Rarely (less than once/week); 3= Occasionally (1-2 times/week); 4= Regularly (3-5 times/week); 5= Daily
|
|
|
prom_mental_health_2___5 |
Integer |
|
Recommended |
If you responded yes to question please select which disorder/s from the following list: Anorexia nervosa |
0; 1
|
0= No; 1= Yes
|
|
|
prom_mental_health_2___6 |
Integer |
|
Recommended |
If you responded yes to question please select which disorder/s from the following list: Bulimia nervosa |
0; 1
|
0= No; 1= Yes
|
|
|
prom_mental_health_2___7 |
Integer |
|
Recommended |
If you responded yes to question please select which disorder/s from the following list: Substance abuse |
0; 1
|
0= No; 1= Yes
|
|
|
prom_non_allergies___2 |
Integer |
|
Recommended |
Do you have any of the following non-food allergies? (check all that apply) Pet dander |
0; 1
|
0= No; 1= Yes
|
|
|
prom_non_allergies___3 |
Integer |
|
Recommended |
Do you have any of the following non-food allergies? (check all that apply) Bee stings |
0; 1
|
0= No; 1= Yes
|
|
|
prom_non_allergies___4 |
Integer |
|
Recommended |
Do you have any of the following non-food allergies? (check all that apply) Poison ivy or oak |
0; 1
|
0= No; 1= Yes
|
|
|
prom_non_allergies___5 |
Integer |
|
Recommended |
Do you have any of the following non-food allergies? (check all that apply) Sun |
0; 1
|
0= No; 1= Yes
|
|
|
prom_allergies_food___2 |
Integer |
|
Recommended |
I am allergic to (mark all that apply) Tree nuts |
0; 1
|
0= No; 1= Yes
|
|
|
prom_allergies_food___3 |
Integer |
|
Recommended |
I am allergic to (mark all that apply) Shellfish |
0; 1
|
0= No; 1= Yes
|
|
|
prom_allergies_food___4 |
Integer |
|
Recommended |
I am allergic to (mark all that apply) Other |
0; 1
|
0= No; 1= Yes
|
|
|
prom_allergies_food___5 |
Integer |
|
Recommended |
I am allergic to (mark all that apply) I have no food allergies that I know of |
0; 1
|
0= No; 1= Yes
|
|
|
prom_type_alcohol___2 |
Integer |
|
Recommended |
What type(s) of alcohol do you typically consume (select all that apply)? Sour beers |
0; 1
|
0= No; 1= Yes
|
|
|
prom_type_alcohol___3 |
Integer |
|
Recommended |
What type(s) of alcohol do you typically consume (select all that apply)? White Wine |
0; 1
|
0= No; 1= Yes
|
|
|
prom_type_alcohol___4 |
Integer |
|
Recommended |
What type(s) of alcohol do you typically consume (select all that apply)? Red Wine |
0; 1
|
0= No; 1= Yes
|
|
|
prom_type_alcohol___5 |
Integer |
|
Recommended |
What type(s) of alcohol do you typically consume (select all that apply)? Spirits/ hard alcohol |
0; 1
|
0= No; 1= Yes
|
|
|
prom_mental_health_2___2 |
Integer |
|
Recommended |
If you responded yes to question please select which disorder/s from the following list: Bipolar disorder |
0; 1
|
0= No; 1= Yes
|
|
|
prom_mental_health_2___3 |
Integer |
|
Recommended |
If you responded yes to question please select which disorder/s from the following list: PTSD (post-traumatic stress disorder) |
0; 1
|
0= No; 1= Yes
|
|
|
prom_mental_health_2___4 |
Integer |
|
Recommended |
If you responded yes to question please select which disorder/s from the following list: Schizophrenia |
0; 1
|
0= No; 1= Yes
|
|
|
site |
String |
101
|
Recommended |
Site |
|
Study Site
|
|