Attachment H.
Protocol for Creatinine Phosphokinase (CPK) Study (ages 12+)
National Health and Nutrition Examination Survey (NHANES)
Creatinine Phosphokinase (CPK) Pilot Study
OMB no. 0920-0237
Expires: 12/31/2011
Assurance of confidentiality – All information which would permit identification of an
individual, a practice, or an establishment will be held confidential, will be used for
statistical purposes only by NCHS staff, contractors, and agents only when required and with necessary controls, and will not be disclosed or released to other persons without the consent of the individual or establishment in accordance with section 308(d) of the Public Health Service Act (42 USC 242m) and the Confidential Information Protection and Statistical Efficiency Act (PL-107-347).
Public reporting burden of this collection of information is estimated to average 2 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road, MS D-74, Atlanta, GA 30333. ATTN: PRA (0920-0237).
Creatinine Phosphokinase (CPK) Pilot Study Protocol:
Eligibility: Sample persons aged 12 years or older are eligible for the Creatinine Phosphokinase (CPK) Pilot Study.
Informed Consent: Informed consent will be obtained as a part of standard NHANES consenting procedures.
Exclusion Criteria: There are no overall exclusion criteria for these questions. However respondents, who do not have CPK measured, due to already established exclusion criteria for the NHANES phlebotomy, would not have this component.
Study Design: These Creatinine Phosphokinase (CPK) related questions will be added to the NHANES MEC Questionnaire
Creatine Kinase MEC Questionnaire
(03/22/2010)
Target: 12+ Years
CKQ.010 In the past 3 days, did {you/SP} do any strenuous exercise or heavy
physical work?
PROBE IF NEEDED: Strenuous exercise or heavy physical work is exercise or work that causes large increases in breathing or heart rate if they are done for at least 10 minutes continuously.
YES ............................................................... 1
NO................................................................. 2 (CKQ.030)
REFUSED ..................................................... 7 (CKQ.030)
DON’T KNOW ............................................. 9 (CKQ.030)
CKQ.020 Did it make {your/SPs} muscles sore or painful?
YES ............................................................... 1
NO................................................................. 2
REFUSED ..................................................... 7
DON’T KNOW ............................................. 9
CKQ.030 In the past 3 days, did {you/SP} injure or bruise any muscles?
YES ............................................................... 1
NO................................................................. 2 (CKQ.050)
REFUSED ..................................................... 7 (CKQ.050)
DON’T KNOW ............................................. 9 (CKQ.050)
CKQ.040 Did it make {your/SP's} muscles sore or painful?
YES ............................................................... 1
NO................................................................. 2
REFUSED ..................................................... 7
DON’T KNOW ............................................. 9
BOX 1
CHECK ITEM CKQ.050:
IF CKQ.020=1 or CKQ.040=1, GO TO CKQ.065 OTHERWISE, CONTINUE
CKQ.060 In the last 3 days, have {you/SP} had any muscle pain or soreness?
YES ............................................................... 1 (CKQ.070)
NO................................................................. 2 (END SECTION)
REFUSED ..................................................... 7 (END SECTION)
DON’T KNOW ............................................. 9 (END SECTION)
CKQ.065 In the last 3 days, have {you/SP} had any other muscle pain, aching or
soreness?
YES ............................................................... 1 (CKQ.070)
NO................................................................. 2 (END SECTION)
REFUSED ..................................................... 7 (END SECTION)
CKQ.070 For how long have {you/SP} had this pain, aching or soreness?
|___|___|___|___| ENTER NUMBER (OF DAYS, WEEKS, MONTHS OR YEARS)
REFUSED ..................................................... 777
DON'T KNOW ............................................... 999
ENTER UNIT
DAYS............................................................. 1
WEEKS ......................................................... 2
MONTHS....................................................... 3
YEARS .......................................................... 4
Data Collection: Participants will take the assessment in a private Mobile Examination Center (MEC) interview room.
Report of Findings: The related CPK results are already routinely reported to participants.
Creatine Kinase MEC Questionnaire
(03/22/2010)
Target: 12+ Years
CKQ.010 In the past 3 days, did {you/SP} do any strenuous exercise or heavy
physical work?
PROBE IF NEEDED: Strenuous exercise or heavy physical work is exercise or work that causes large increases in breathing or heart rate if they are done for at least 10 minutes continuously.
YES ............................................................... 1
NO................................................................. 2 (CKQ.030)
REFUSED ..................................................... 7 (CKQ.030)
DON’T KNOW ............................................. 9 (CKQ.030)
CKQ.020 Did it make {your/SPs} muscles sore or painful?
YES ............................................................... 1
NO................................................................. 2
REFUSED ..................................................... 7
DON’T KNOW ............................................. 9
CKQ.030 In the past 3 days, did {you/SP} injure or bruise any muscles?
YES ............................................................... 1
NO................................................................. 2 (CKQ.050)
REFUSED ..................................................... 7 (CKQ.050)
DON’T KNOW ............................................. 9 (CKQ.050)
CKQ.040 Did it make {your/SP's} muscles sore or painful?
YES ............................................................... 1
NO................................................................. 2
REFUSED ..................................................... 7
DON’T KNOW ............................................. 9
BOX 1
CHECK ITEM CKQ.050:
IF CKQ.020=1 or CKQ.040=1, GO TO CKQ.065 OTHERWISE, CONTINUE
CKQ.060 In the last 3 days, have {you/SP} had any muscle pain or soreness?
YES ............................................................... 1 (CKQ.070)
NO................................................................. 2 (END SECTION)
REFUSED ..................................................... 7 (END SECTION)
DON’T KNOW ............................................. 9 (END SECTION)
CKQ.065 In the last 3 days, have {you/SP} had any other muscle pain, aching or
soreness?
YES ............................................................... 1 (CKQ.070)
NO................................................................. 2 (END SECTION)
REFUSED ..................................................... 7 (END SECTION)
CKQ.070 For how long have {you/SP} had this pain, aching or soreness?
|___|___|___|___| ENTER NUMBER (OF DAYS, WEEKS, MONTHS OR YEARS)
REFUSED ..................................................... 777
DON'T KNOW ............................................... 999
ENTER UNIT
DAYS............................................................. 1
WEEKS ......................................................... 2
MONTHS....................................................... 3
YEARS .......................................................... 4
| File Type | application/msword |
| File Title | Attachment A |
| Author | vlb2 |
| Last Modified By | nef1 |
| File Modified | 2010-04-07 |
| File Created | 2010-04-06 |