ALCOHOL-RELATED PROBLEMS SURVEY
This survey is about the health of older people and their use of alcohol.
Your information is valuable in helping us understand how to prevent
This publication was made possible by a grant from the National Institutes of Health. The opinions expressed herein do not necessarily reflect the official position of the National Institutes of Health or any of its Institutes.
Now, please turn to page 1 of this survey.
Arlene Fink, 2002. Please do not reproduce or distribute without permission: [email protected]SECTION 1: HEALTH PROBLEMS This section is about your current health. CHECK (þ)ONE BOX ON EACH LINE 1. Has a doctor or other health care worker ever told you that you have: a. High blood pressure b. Congestive heart failure c. Diabetes d. Osteoporosis e. Cirrhosis or another liver condition f. Cancer of the mouth or throat g. Breast cancer i. Memory disorder or d ementing illness DID YOU CHECK ONE ANSWER ON EACH LINE, EVEN IF YOUR ANSWER IS “DON'T KNOW"?
Arlene Fink, 2002. Please do not reproduce or distribute without permission: [email protected]CHECK (þ) ONE BOX ON EACH LINE 2. In the past twelve months, has a doctor or other health care worker told you that you a. Hepatitis b. Gastritis c. Ulcer of the stomach or small intestine
e. Depression, anxiety or another emotional
3. Do you now use tobacco in any form, including cigarettes, cigars, pipes, chewing tobacco, etc.? CHECK (þ) ONE BOX
θ No, I used tobacco in the past, but I do not use it now.
Arlene Fink, 2002. Please do not reproduce or distribute without permission: [email protected]4. How much of the time during the past 12 months did you have any of the following problems? CHECK (þ) ONE BOX ON EACH LINE A Little Some a. Problems sleeping b. Stomach pains c. Heartburn d. Nausea e. Vomiting f. Diarrhea g. Nervousness h. Memory problems i. Feeling depressed j. Tripping, bumping k. Falling l. Problems with bladder DID YOU CHECK ONE ANSWER ON EACH LINE, EVEN IF YOUR ANSWER IS“NONE OF THE TIME”?
Arlene Fink, 2002. Please do not reproduce or distribute without permission: [email protected]SECTION 2: MEDICATIONS This section is about some medications you may be using. 5. How many different medications do you use at least once a week? Count ALL, even if you get them without a doctor’s prescription. (Do not count eye drops, vitamins, minerals, ointments.) CHECK (þ) ONE BOX 6. Do you now take 2 or more regular or extra strength (325 mg or more) aspirins EVERY DAY or ALMOST EVERY DAY? CHECK (þ)ONE BOX
Arlene Fink, 2002. Please do not reproduce or distribute without permission: [email protected]CHECK (þ) ONE BOX ON EACH LINE 7. Do you now take any of these medications at least ONCE A WEEK? a. Sedatives or sleeping medicines such as
Ambien, Ativan, Halcion, chloral hydrate
b. Tranquilizers such as Thorazine, c. Narcotic medications such as Darvon, DID YOU CHECK ONE ANSWER ON EACH LINE, EVEN IF YOUR ANSWER IS“DON'T KNOW”?
Arlene Fink, 2002. Please do not reproduce or distribute without permission: [email protected]CHECK (þ) ONE BOX ON EACH LINE 8. Do you now take any of these medications EVERY DAY or ALMOST EVERY DAY? a. Ulcer and stomach medicines such as Zantac, b. Arthritis and pain medicines such as Motrin
(Ibuprofen), Voltaren, Clinoril, Naprosyn, Tylenol,
c. Tolinase, Diabinese or Orinase d. Other blood pressure medicines such as Cardizem,
Vasotec, Lotensin, Atenolol, Cozaar, Novasc, water
e. Nitrates such as Isordil, Nitropatch f. Other medicines for the heart such as digoxin, Lasix g. Coumadin (warfarin) h. Seizure medicines such as Tegretol, Dilantin or i. Depression medicines such as Elavil (amitriptyline),
Pamelor (nortriptyline), Paxil, Prozac, Zoloft
j. Prescription antihistamines such as Claritin, Zyrtec, k. Tylenol PM, Benadryl, Chlor-trimeton or other DID YOU CHECK ONE ANSWER ON EACH LINE, EVEN IF YOUR ANSWER IS“DON'T KNOW”?
Arlene Fink, 2002. Please do not reproduce or distribute without permission: [email protected]SECTION 3: RECENT ALCOHOL USE This section is about alcohol use during the past 12 months. The next questions ask you to count drinks. When you answer, please count one drink of alcohol as equal to one of the following: or or or or
9. During the past 12 months, how often did you have a drink containing alcohol? CHECK (þ) ONE BOX
ð Please go to page 12.
Arlene Fink, 2002. Please do not reproduce or distribute without permission: [email protected]10. On days that you drank alcohol during the past 12 months, how many drinks of alcohol (beer, wine, and/or hard liquor) did you usually drink? CHECK (þ) ONE BOX 11. During the past 12 months, how often did you have three or more drinks of alcohol at one sitting? CHECK (þ) ONE BOX
Arlene Fink, 2002. Please do not reproduce or distribute without permission: [email protected]
12. During the past 12 months, how often did you have four or more drinks of alcohol at one sitting? CHECK (þ) ONE BOX 13. Because of your alcohol use, how often in the past 12 months did you fail to do what you were supposed to do? CHECK (þ) ONE BOX
At least once a week, but less than daily
At least once a month, but less than weekly
Arlene Fink, 2002. Please do not reproduce or distribute without permission: [email protected]14. Because of your alcohol use, how often in the past 12 months were you unable to stop drinking once you started? CHECK (þ) ONE BOX
At least once a week, but less than daily
At least once a month, but less than weekly
At least once a month, but less than weekly
15. Because of your alcohol use, how often in the past 12 months did you feel guilty or sorry for something you did? CHECK (þ) ONE BOX
At least once a week, but less than daily
At least once a month, but less than weekly
At least once a month, but less than weekly
Arlene Fink, 2002. Please do not reproduce or distribute without permission: [email protected]16. In the past 12 months, on how many days did you drive a car, truck, or other vehicle within 2 hours of having three or more drinks? CHECK (þ) ONE BOX
I did not drive in the past 12 months17. Has a doctor, other medical person, relative, friend, or anyone else ever been concerned about your drinking or suggested that you should cut down? CHECK (þ) ONE BOX
Arlene Fink, 2002. Please do not reproduce or distribute without permission: [email protected]SECTION 4: The following question is about you in general.
18. The following are physical activities you might do during a typical day. How much are you limited in these activities because of your health? CHECK (þ) ONE BOX ON EACH LINE Not limited Limited a lot a. Climbing one flight of stairs b. Walking one block c. Bathing or dressing 19. How would you describe your current health status? Excellent Ο Very good Ο
20. Are you male or female? Female Ο
Arlene Fink, 2002. Please do not reproduce or distribute without permission: [email protected]21. What is your date of birth?
(Write in the date below. Example: 01 01 1935) 22. Which of the following best describes you? White, not of Hispanic origin Black, not of Hispanic origin Hispanic Asian or Pacific Islander American Indian or Alaskan Native Other, specify:_______________ 23. What was the highest grade or year of education you completed and got credit for? Circle one only of the numbers below. Grade School, Jr. High, High, High School College or Vocational School Graduate or Professional
Arlene Fink, 2002. Please do not reproduce or distribute without permission: [email protected]
Chapter – 7 Geostationary Satellite A geostationary orbit (GEO) is a geosynchronous orbit directly above the Earth's equator (0° latitude), with a period equal to the Earth's rotational period and an orbital eccentricity of approximately zero. From locations on the surface of the Earth, geostationary objects appear motionless in the sky, making the GEO an orbit of great interest to