24.5 Survey

Continuation of National Children's Study Vanguard (Pilot) Study Data Collection: Study Visits through 60-Months and Sibling Birth Enrollment

60M_LungFunctionInstrument

Child-Focused Physical Measures (Postnatal)

OMB: 0925-0593

Document [docx]
Download: docx | pdf

OMB #: 0925-0593

OMB Expiration Date: 8/31/2014

Lung Function Instrument, Phase 2g

OMB Specification


Lung Function Instrument


Event Category:

Time-Based

Event:

60M

Administration:

N/A

Instrument Target:

Child

Instrument Respondent:

Primary Caregiver

Domain:

Physical Measures

Document Category:

Physical Measures

Method:

Data Collector Administered

Mode (for this instrument*):

In-Person, CAI

OMB Approved Modes:

In-Person, CAI

Estimated Administration Time:

12 minutes

Multiple Child/Sibling Consideration:

Per Child

Special Considerations:

N/A

Version:

1.0

MDES Release:

4.0


*This instrument is OMB-approved for multi-mode administration but this version of the instrument is designed for administration in this/these mode(s) only.


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Lung Function Instrument



TABLE OF CONTENTS





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Lung Function Instrument



GENERAL PROGRAMMER INSTRUCTIONS:

WHEN PROGRAMMING INSTRUMENTS, VALIDATE FIELD LENGTHS AND TYPES AGAINST THE MDES TO ENSURE DATA COLLECTION RESPONSES DO NOT EXCEED THOSE OF THE MDES. SOME GENERAL ITEM LIMITS USED ARE AS FOLLOWS:


DATA ELEMENT FIELDS

MAXIMUM CHARACTERS PERMITTED

DATA TYPE

PROGRAMMER INSTRUCTIONS

ADDRESS AND EMAIL FIELDS

100

CHARACTER


UNIT AND PHONE FIELDS

10

CHARACTER


_OTH AND COMMENT FIELDS

255

CHARACTER

  • Limit text to 255 characters

FIRST NAME AND LAST NAME

30

CHARACTER

  • Limit text to 30 characters

ALL ID FIELDS

36

CHARACTER


ZIP CODE

5

NUMERIC


ZIP CODE LAST FOUR

4

NUMERIC


CITY

50

CHARACTER


DOB AND ALL OTHER DATE FIELDS (E.G., DT, DATE, ETC.)

10

NUMERIC


CHARACTER



  • DISPLAY AS MM/DD/YYYY

  • STORE AS YYYY-MM-DD

  • HARD EDITS:

MM MUST EQUAL 01 TO 12

DD MUST EQUAL 01 TO 31

YYYY MUST BE BETWEEN 1900 AND CURRENT YEAR.

TIME VARIABLES

TWO-DIGIT HOUR AND TWO-DIGIT MINUTE, AM/PM DESIGNATION

NUMERIC

  • HARD EDITS:

HOURS MUST BE BETWEEN 00 AND 12;

MINUTES MUST BE BETWEEN 00 AND 59


Instrument Guidelines for Participant and Respondent IDs:

PRENATALLY, THE P_ID IN THE MDES HEADER IS THAT OF THE PARTICIPANT (E.G. THE NON-PREGNANT WOMAN, PREGNANT WOMAN, OR THE FATHER).


POSTNATALLY, A RESPONDENT ID WILL BE USED IN ADDITION TO THE PARTICIPANT ID BECAUSE SOMEBODY OTHER THAN THE PARTICIPANT MAY BE COMPLETING THE INTERVIEW. FOR EXAMPLE, THE PARTICIPANT MAY BE THE CHILD AND THE RESPONDENT MAY BE THE MOTHER, FATHER, OR ANOTHER CAREGIVER. THEREFORE, MDES VERSION 2.2 AND ALL FUTURE VERSIONS CONTAIN A R_P_ID (RESPONDENT PARTICIPANT ID) HEADER FIELD FOR EACH POST-BIRTH INSTRUMENT. THIS WILL ALLOW ROCs TO INDICATE WHETHER THE RESPONDENT IS SOMEBODY OTHER THAN THE PARTICIPANT ABOUT WHOM THE QUESTIONS ARE BEING ASKED.



A REMINDER:

ALL RESPONDENTS MUST BE CONSENTED AND HAVE RECORDS IN THE PERSON, PARTICIPANT, PARTICIPANT_CONSENT AND LINK_PERSON_PARTICIPANT TABLES, WHICH CAN BE PRELOADED INTO EACH INSTRUMENT. ADDITIONALLY, IN POST-BIRTH QUESTIONNAIRES WHERE THERE IS THE ABILITY TO LOOP THROUGH A SET OF QUESTIONS FOR MULTIPLE CHILDREN, IT IS IMPORTANT TO CAPTURE AND STORE THE CORRECT CHILD P_ID ALONG WITH THE LOOP INFORMATION. IN THE MDES VARIABLE LABEL/DEFINITION COLUMN, THIS IS INDICATED AS FOLLOWS: EXTERNAL IDENTIFIER: PARTICIPANT ID FOR CHILD DETAIL.





LUNG FUNCTION INSTRUMENT


(TIME_STAMP_LFI_ST).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP

  • PRELOAD PARTICIPANT ID (P_ID) FOR CHILD AND RESPONDENT ID (R_P_ID) FOR ADULT CAREGIVER.

  • PRELOAD FIRST NAME OF CHILD (C_FNAME) FROM INSTRUMENT_ID = XX (PARTICIPANT VERIFICATION, SCHEDULING, & TRACING QUESTIONNAIRE)

  • IF C_FNAME ≠ -1 OR -2, DISPLAY APPROPRIATE NAME IN “C_FNAME” THROUGHOUT THE INSTRUMENT.

  • OTHERWISE, IF C_FNAME = -1 OR -2, DISPLAY “the child” IN APPROPRIATE FIELDS THROUGHOUT THE INSTRUMENT.


LFI01000/(LF_INTRO).


DATA COLLECTOR INSTRUCTIONS

  • EXPLAIN THE LUNG FUNCTION PROTOCOL TO THE ADULT CAREGIVER.

  • IF THE ADULT CAREGIVER REFUSES, SELECT REFUSED. 

  • OTHERWISE, SELECT CONTINUE.


Label

Code

Go To

CONTINUE

1

LF_PAIN

REFUSED

-1



LFI02000/(LF_REF_REASON). I am sorry that you have chosen not to participate in this activity.  Can you please tell me why?


DATA COLLECTOR INSTRUCTIONS

  • SELECT ALL THAT APPLY.


Label

Code

Go To

CONCERN ABOUT DISCOMFORT

1


CHILD SICK

2


CHILD TIRED/UNHAPPY

3


OTHER

-5


NONE GIVEN

-7


REFUSED

-1


DON'T KNOW

-2



SOURCE

National Children’s Study, Vanguard Phase (Child Anthropometry)


PROGRAMMER INSTRUCTIONS

  • IF LF_REF_REASON = ANY COMBINATION OF RESPONSE CODES 1 - 3, GO TO LFI06000.

  • IF LF_REF_REASON = -5, OR ANY COMBINATION OF RESPONSE CODES 1 -3 AND -5, GO TO LF_REF_REASON_OTH.

  • IF LF_REF_REASON = -7, -1 OR -2, DO NOT ALLOW SELECTION OF ADDITIONAL RESPONSE CODES AND GO TO LFI06000


LFI03000/(LF_REF_REASON_OTH). ​SPECIFY:______________________________


SOURCE

National Children’s Study, Vanguard Phase (Child Anthropometry)


LFI06000. ​That’s fine.  Thank you for your time.  


PROGRAMMER INSTRUCTIONS

  • GO TO TIME_STAMP_LFI_ET.


LFI07100/(LF_PAIN). ​Is {C_FNAME/the child} currently experiencing any chest or abdominal pain?


Label

Code

Go To

YES

1

LF_END

NO

2


REFUSED

-1

LF_END

DON'T KNOW

-2

LF_END


SOURCE

Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Enright P, van der Grinten CP, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J. American Thoracic Society/European Respiratory Society (ATS/ERS) Task Force: General Considerations for Lung Function Testing. Eur Respir J; 26 (1): 153-161, 2005. (modified)


LFI07200/(LF_ORAL). Is {C_FNAME/the child} experiencing any oral or facial pain that might be aggravated by a mouthpiece?


Label

Code

Go To

YES

1

LF_END

NO

2


REFUSED

-1

LF_END

DON'T KNOW

-2

LF_END


SOURCE

Miller MR, Crapo R, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, Enright P, van der Grinten CP, Gustafsson P, Jensen R, Johnson DC, MacIntyre N, McKay R, Navajas D, Pedersen OF, Pellegrino R, Viegi G, Wanger J. American Thoracic Society/European Respiratory Society (ATS/ERS) Task Force: General Considerations for Lung Function Testing. Eur Respir J; 26 (1): 153-161, 2005. (modified)


LFI10000/(LF_BRONCHO). Within the past hour, has {C_FNAME/the child} used a bronchodilator, such as an inhaler?


Label

Code

Go To

YES

1

LF_END

NO

2


REFUSED

-1

LF_END

DON'T KNOW

-2

LF_END


SOURCE

National Institute of Occupational Safety and Health (NIOSH). Spirometry Training Guide. December 1, 2003. (modified)


LFI11000/(LF_MEAL). ​Has {C_FNAME/the child} eaten a large meal within the past hour?


Label

Code

Go To

YES

1

LF_END

NO

2


REFUSED

-1

LF_END

DON'T KNOW

-2

LF_END


SOURCE

National Institute of Occupational Safety and Health (NIOSH). Spirometry Training Guide. December 1, 2003.  (modified)


LFI12000/(LF_ILLNESS). Within the past three days, has {C_FNAME/the child} recovered from an illness that lasted less than three weeks?


Label

Code

Go To

YES

1

LF_END

NO

2


REFUSED

-1

LF_END

DON'T KNOW

-2

LF_END


SOURCE

National Institute of Occupational Safety and Health (NIOSH). Spirometry Training Guide. December 1, 2003. (modified)


LFI13000/(LF_INFECTION). Within the past three weeks, has {C_FNAME/the child} had an ear infection or severe respiratory illness?


Label

Code

Go To

YES

1

LF_END

NO

2


REFUSED

-1

LF_END

DON'T KNOW

-2

LF_END


SOURCE

National Institute of Occupational Safety and Health (NIOSH). Spirometry Training Guide. December 1, 2003. (modified)


LFI14000/(LF_SURGERY). Has {C_FNAME/the child} had eye, ear, chest, or abdominal surgery in the past six weeks?


Label

Code

Go To

YES

1

LF_END

NO

2


REFUSED

-1

LF_END

DON'T KNOW

-2

LF_END


SOURCE

National Institute of Occupational Safety and Health (NIOSH). Spirometry Training Guide. December 1, 2003.  (modified)


LFI15000/(LF_EQUIP_ID). RECORD EQUIPMENT ID

 

|___|___||___|___||___|___||___|___||___|___|

EQUIPMENT SERIAL NUMBER


Label

Code

Go To

COULD NOT OBTAIN

-2



SOURCE

New


LFI16000/(LF_CONDITIONS). Does {C_FNAME/the child} have any known obstructive conditions, such as sleep apnea, asthma, or cystic fibrosis?


Label

Code

Go To

YES

1


NO

2

LF_FEV_10_1

REFUSED

-1

LF_FEV_10_1

DON'T KNOW

-2

LF_FEV_10_1


SOURCE

National Institute of Occupational Safety and Health (NIOSH). Spirometry Training Guide. December 1, 2003. (modified)


LFI17000/(LF_CONDITIONS_OTH). LUNG CONDITION OTHER

 

SPECIFY: __________________________________________________


LFI19000/(LF_FEV_10_1). RECORD FORCED EXPIRATORY VOLUME 1.0 (FEV1).

 

|___|___|.|___|___|

LITERS 


DATA COLLECTOR INSTRUCTIONS

  • OBTAIN FIRST SET OF LUNG FUNCTION MEASUREMENTS.


Label

Code

Go To

REFUSED

-1

LF_REASON_NOT_COLLECT_1

COULD NOT OBTAIN

-8

LF_REASON_NOT_COLLECT_1


SOURCE

New


LFI19100/(LF_FEV_05_1). RECORD FORCED EXPIRATORY VOLUME 0.50 (FEV.5).

 

|___|___|.|___||___|

LITERS


Label

Code

Go To

REFUSED

-1

LF_REASON_NOT_COLLECT_1

COULD NOT OBTAIN

-8

LF_REASON_NOT_COLLECT_1


SOURCE

New


LFI19200/(LF_FEV_75_1). RECORD FORCED EXPIRATORY VOLUME 0.75 (FEV.75).

 

|___|___|.|___||___|

LITERS PER SECOND


Label

Code

Go To

REFUSED

-1

LF_REASON_NOT_COLLECT_1

COULD NOT OBTAIN

-8

LF_REASON_NOT_COLLECT_1


SOURCE

New


LFI20100/(LF_PEF_1). RECORD PEAK EXPIRATORY FLOW (PEF).

 

|___|___|___|

LITERS PER MINUTE


Label

Code

Go To

REFUSED

-1

LF_REASON_NOT_COLLECT_1

COULD NOT OBTAIN

-8

LF_REASON_NOT_COLLECT_1


SOURCE

New


LFI20000/(LF_COLLECT_1). WERE YOU ABLE TO COLLECT ALL OF THE RAW DATA FROM THE PEAK FLOW METER?


Label

Code

Go To

YES

1

LF_ACCEPTABLE_1

NO

2



LFI21000/(LF_REASON_NOT_COLLECT_1).


DATA COLLECTOR INSTRUCTIONS

  • ENTER REASON(S) YOU COULD NOT OBTAIN LUNG FUNCTION MEASUREMENT(S).

  • SELECT ALL THAT APPLY.​


Label

Code

Go To

PARENT/CAREGIVER REFUSAL

1


CHILD REFUSAL

2


COMMUNICATION ISSUES

3


PARENT/CAREGIVER ILL/EMERGENCY

4


CHILD ILL/EMERGENCY

5


NO TIME

6


EQUIPMENT FAILURE

7


SAFETY EXCLUSION

8


PHYSICAL LIMITATION

9


OTHER

-5


NONE GIVEN

-7



PROGRAMMER INSTRUCTIONS

  • IF LF_REASON_NOT_COLLECT_1 = -5 OR -5 AND ANY COMBINATION OF 1-9, GO TO LF_REASON_NOT_COLLECT_1_OTH.

  • OTHERWISE, GO TO LF_COMMENTS_1. 


LFI21100/(LF_REASON_NOT_COLLECT_1_OTH). SPECIFY: __________________________


PROGRAMMER INSTRUCTIONS

  • GO TO LF_COMMENTS_1.


LFI21200/(LF_ACCEPTABLE_1). ​DID THE PARTICIPANT EXERT A FULL EFFORT WITHOUT ERRORS?


Label

Code

Go To

YES

1

LF_COMMENTS_1

NO

2



LFI22000/(LF_ACCEPTABLE_1_REAS). WHY DID THE PARTICIPANT NOT EXERT A FULL EFFORT WITHOUT ERRORS?


Label

Code

Go To

NOT FULL EFFORT

1


COUGH IN FIRST SECOND

2


EARLY TERMINATION

3


GLOTTIS CLOSURE OR BREATH HOLDING

4


OBSTRUCTED MOUTHPIECE

5


INCOMPLETE INHALATION

6


HESITATION

7


EXTRA BREATH

8


OTHER

-5



PROGRAMMER INSTRUCTIONS

  • IF LF_ACCEPTABLE_1_REAS = -5 OR INCLUDES -5, GO TO LF_ACCEPTABLE_1_REAS_OTH.

  • OTHERWISE, GO TO LF_COMMENTS_1.


LFI22010/(LF_ACCEPTABLE_1_REAS_OTH). SPECIFY: ____________________________


SOURCE

New


LFI22100/(LF_COMMENTS_1). DO YOU HAVE ANY COMMENTS ABOUT THE FIRST LUNG FUNCTION MEASUREMENT?


Label

Code

Go To

YES

1


NO

2



PROGRAMMER INSTRUCTIONS

IF LF_COMMENTS_1 = 2, GO TO PROGRAMMER INSTRUCTIONS AFTER LF_COMMENTS_1_OTH.


LFI23000/(LF_COMMENTS_1_OTH). LUNG FUNCTION COLLECTION COMMENTS

 

SPECIFY:______________________________________________


PROGRAMMER INSTRUCTIONS

  • IF LF_REASON_NOT_COLLECT_1 = ANY COMBINATION INCLUDING 1, 2, 4, 5, 6, 8, OR 9, GO TO LFI74000.


LFI25000/(LF_FEV_10_2). RECORD FEV1 MEASUREMENT 2.

 

|___|___|. |___|___|

LITERS 


DATA COLLECTOR INSTRUCTIONS

  • OBTAIN SECOND SET OF LUNG FUNCTION MEASUREMENTS.​


Label

Code

Go To

REFUSED

-1

LF_REASON_NOT_COLLECT_2

COULD NOT OBTAIN

-8

LF_REASON_NOT_COLLECT_2


SOURCE

New


LFI25100/(LF_FEV_05_2). RECORD FEV.5 MEASUREMENT 2.

 

|___|___|.|___||___|

LITERS


Label

Code

Go To

REFUSED

-1

LF_REASON_NOT_COLLECT_2

COULD NOT OBTAIN

-8

LF_REASON_NOT_COLLECT_2


SOURCE

New


LFI25200/(LF_FEV_75_2).

RECORD FEV.75 MEASUREMENT 2.

 

|___|___|.|___||___|

LITERS PER SECOND


Label

Code

Go To

REFUSED

-1

LF_REASON_NOT_COLLECT_2

COULD NOT OBTAIN

-8

LF_REASON_NOT_COLLECT_2


SOURCE

New


LFI25300/(LF_PEF_2). RECORD PEF MEASUREMENT 2.

 

|___|___|___|

LITERS PER MINUTE


Label

Code

Go To

REFUSED

-1

LF_REASON_NOT_COLLECT_2

COULD NOT OBTAIN

-8

LF_REASON_NOT_COLLECT_2


SOURCE

New


LFI26000/(LF_COLLECT_2). WERE YOU ABLE TO COLLECT ALL OF THE RAW DATA FROM THE PEAK FLOW METER?


Label

Code

Go To

YES

1

LF_ACCEPTABLE_2

NO

2



LFI27000/(LF_REASON_NOT_COLLECT_2).


DATA COLLECTOR INSTRUCTIONS

  • ENTER REASON(S) YOU COULD NOT OBTAIN LUNG FUNCTION MEASUREMENT(S).

  • SELECT ALL THAT APPLY.


Label

Code

Go To

PARENT/CAREGIVER REFUSAL

1


CHILD REFUSAL

2


COMMUNICATION ISSUES

3


PARENT/CAREGIVER ILL/EMERGENCY

4


CHILD ILL/EMERGENCY

5


NO TIME

6


EQUIPMENT FAILURE

7


SAFETY EXCLUSION

8


PHYSICAL LIMITATION

9


OTHER

-5


NONE GIVEN

-7



SOURCE

New


PROGRAMMER INSTRUCTIONS

  • IF LF_REASON_NOT_COLLECT_2 =-5 OR INCLUDES -5, GO TO LF_REASON_NOT_COLLECT_2_OTH.

  • OTHERWISE, GO TO LF_COMMENTS_2.


LFI27100/(LF_REASON_NOT_COLLECT_2_OTH). SPECIFY:  _____________________


PROGRAMMER INSTRUCTIONS

  • GO TO LF_COMMENTS_2.


LFI27200/(LF_ACCEPTABLE_2). ​DID THE PARTICIPANT EXERT A FULL EFFORT WITHOUT ERRORS?


Label

Code

Go To

YES

1

LF_COMMENTS_2

NO

2



LFI28000/(LF_ACCEPTABLE_2_NO_REAS). WHY DID THE PARTICIPANT NOT EXERT A FULL EFFORT WITHOUT ERRORS?


Label

Code

Go To

NOT FULL EFFORT

1


COUGH IN FIRST SECOND

2


EARLY TERMINATION

3


GLOTTIS CLOSURE OR BREATH HOLDING

4


OBSTRUCTED MOUTHPIECE

5


INCOMPLETE INHALATION

6


HESITATION

7


EXTRA BREATH

8


OTHER

-5



PROGRAMMER INSTRUCTIONS

  • IF LF_ACCEPTABLE_2_REAS = -5 OR INCLUDES -5, GO TO LF_ACCEPTABLE_2_REAS_OTH.

  • OTHERWISE, GO TO LF_COMMENTS_2.


LFI28010/(LF_ACCEPTABLE_2_REAS_OTH). SPECIFY: ______________________________


SOURCE

New


LFI28100/(LF_COMMENTS_2). DO YOU HAVE ANY COMMENTS ABOUT THE SECOND LUNG FUNCTION MEASUREMENT?


Label

Code

Go To

YES

1


NO

2



PROGRAMMER INSTRUCTIONS

  • IF LF_COMMENTS_2 = 2, GO TO PROGRAMMER INSTRUCTIONS AFTER LF_COMMENTS_2_OTH.


LFI29000/(LF_COMMENTS_2_OTH). LUNG FUNCTION COLLECTION COMMENTS

 

SPECIFY: _________________________________________________


PROGRAMMER INSTRUCTIONS

  • IF LF_REASON_NOT_COLLECT_2 = ANY COMBINATION INCLUDING 1, 2, 4, 5, 6, 8, OR 9, GO TO LFI74000


LFI31000/(LF_FEV_10_3). RECORD FEV1 MEASUREMENT 3.

 

|___|___|.|___|___|

LITERS 


DATA COLLECTOR INSTRUCTIONS

  • OBTAIN THIRD SET OF LUNG FUNCTION MEASUREMENTS.


Label

Code

Go To

REFUSED

-1


COULD NOT OBTAIN

-8



SOURCE

New


LFI31100/(LF_FEV_05_3).

RECORD FEV.5 MEASUREMENT 3.

 

|___|___|.|___||___|

LITERS


Label

Code

Go To

REFUSED

-1

LF_REASON_NOT_COLLECT_3

COULD NOT OBTAIN

-8

LF_REASON_NOT_COLLECT_3


SOURCE

New


LFI31200/(LF_FEV_75_3).

RECORD FEV.75 MEASUREMENT 3.

 

|___|___|.|___||___|


Label

Code

Go To

REFUSED

-1

LF_REASON_NOT_COLLECT_3

COULD NOT OBTAIN

-8

LF_REASON_NOT_COLLECT_3


SOURCE

New


LFI31300/(LF_PEF_3). RECORD PEF MEASUREMENT 3.

 

|___||___|___|

LITERS PER MINUTE


Label

Code

Go To

REFUSED

-1

LF_REASON_NOT_COLLECT_3

COULD NOT OBTAIN

-8

LF_REASON_NOT_COLLECT_3


SOURCE

New


LFI32000/(LF_COLLECT_3). WERE YOU ABLE TO COLLECT ALL OF THE RAW DATA FROM THE PEAK FLOW METER?


Label

Code

Go To

YES

1

LF_ACCEPTABLE_3

NO

2



LFI33000/(LF_REASON_NOT_COLLECT_3).


DATA COLLECTOR INSTRUCTIONS

  • ENTER REASON(S) YOU COULD NOT OBTAIN LUNG FUNCTION MEASUREMENT(S).

  • SELECT ALL THAT APPLY.


Label

Code

Go To

PARENT/CAREGIVER REFUSAL

1


CHILD REFUSAL

2


COMMUNICATION ISSUES

3


PARENT/CAREGIVER ILL/EMERGENCY

4


CHILD ILL/EMERGENCY

5


NO TIME

6


EQUIPMENT FAILURE

7


SAFETY EXCLUSION

8


PHYSICAL LIMITATION

9


OTHER

-5


NONE GIVEN

-7



PROGRAMMER INSTRUCTIONS

  • IF LF_REASON_NOT_COLLECT_3 =-5 OR INCLUDES -5, GO TO LF_REASON_NOT_COLLECT_3_OTH.

  • OTHERWISE, GO TO LF_COMMENTS_3.


LFI33100/(LF_REASON_NOT_COLLECT_3_OTH). SPECIFY: ____________________________________


PROGRAMMER INSTRUCTIONS

  • GO TO LF_COMMENTS_3.


LFI33200/(LF_ACCEPTABLE_3). ​DID THE PARTICIPANT EXERT A FULL EFFORT WITHOUT ERRORS?


Label

Code

Go To

YES

1

LF_COMMENTS_3

NO

2



LFI34000/(LF_ACCEPTABLE_3_NO_REAS). WHY DID THE PARTICIPANT NOT EXERT A FULL EFFORT WITHOUT ERRORS?


Label

Code

Go To

NOT FULL EFFORT

1


COUGH IN FIRST SECOND

2


EARLY TERMINATION

3


GLOTTIS CLOSURE OR BREATH HOLDING

4


OBSTRUCTED MOUTHPIECE

5


INCOMPLETE INHALATION

6


HESITATION

7


EXTRA BREATH

8


OTHER

-5



PROGRAMMER INSTRUCTIONS

  • IF LF_ACCEPTABLE_3_NO_REAS = -5 OR INCLUDES -5, GO TO LF_ACCEPTABLE_3_NO_REAS_OTH.  

  • OTHERWISE, GO TO ​LF_COMMENTS_3


LFI34010/(LF_ACCEPTABLE_3_NO_REAS_OTH). SPECIFY: ________________________


SOURCE

New


LFI34100/(LF_COMMENTS_3). DO YOU HAVE COMMENTS ABOUT THE THIRD LUNG FUNCTION MEASUREMENT?


Label

Code

Go To

YES

1


NO

2

LFI74000


LFI38000/(LF_COMMENTS_3_OTH). LUNG FUNCTION COLLECTION COMMENTS

 

SPECIFY: __________________________________________________


SOURCE

New


LFI74000. ​Thank you for having {C_FNAME/the child} complete these lung function measures. 


PROGRAMMER INSTRUCTIONS

  • GO TO TIME_STAMP_LFI_ET


LFI75000/(LF_END). Thank you for answering these questions.  


DATA COLLECTOR INSTRUCTIONS

  • ENTER REASON CHILD WAS EXCLUDED FROM LUNG FUNCTION MEASUREMENT(S)


Label

Code

Go To

CHEST OR ABDOMINAL PAIN

1


ORAL OR FACIAL PAIN

2


BRONCHODILATOR USE IN PAST HOUR

3


LARGE MEAL IN PAST HOUR

4


ILLNESS IN PAST THREE DAYS

5


EAR INFECTION OR SEVERE RESPIRATORY ILLNESS IN PAST THREE WEEKS

6


EYE, EAR, CHEST, OR ABDOMINAL SURGERY IN PAST SIX WEEKS

7



(TIME_STAMP_LFI_ET).


PROGRAMMER INSTRUCTIONS

  • INSERT DATE/TIME STAMP


Public reporting burden for this collection of information is estimated to average 12 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: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0593*).  Do not return the completed form to this address.

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