LB. Leave-behind Questionnaires (respondent)

Up to survey overview Start of LB. Leave-behind Questionnaires (respondent)   JLB001 Introduction to disability qnaire view item details » BLUE= OTHER THAN THE CONDITIONS EXPLICITLY MENTIONED, YOU SHOULD IMAGINE THE INDIVIDUAL IS IN REASONABLY GOOD HEALTH. RED= OTHER THAN THE CONDITIONS EXPLICITLY MENTIONED, YOU SHOULD IMAGINE THE INDIVIDUAL IS LIKE YOURSELF. 1. Blue introduction 2. Red introduction Blank. Inapplicable   JLB002 Disability qnaire topic order view item details » 1. Affect, pain, cvd 2. Affect, cvd, pain 3. Cvd, affect, pain 4. Cvd, pain, affect 5. Pain, affect, cvd 6. Pain, cvd, affect Blank. Inapplicable   JLB003 AFFECT- GENERALLY ENJOYS WORK view item details » WE WOULD NOW LIKE TO GIVE YOU A NUMBER OF EXAMPLES OF (MEN/WOMEN) WITH SOME HEALTH PROBLEMS. WE WOULD LIKE YOU TO INDICATE THE EXTENT TO WHICH YOU THINK THESE (MEN/WOMEN) WOULD BE LIMITED IN THE KIND OR AMOUNT OF WORK THEY CAN DO. IN TERMS OF THEIR AGE, THEIR EDUCATION, OTHER THAN THE CONDITIONS EXPLICITLY MENTIONED, YOU SHOULD IMAGINE THE INDIVIDUAL IS IN REASONABLY GOOD HEALTH. PLEASE GIVE US YOUR JUDGMENT ON HOW LIMITED THESE PEOPLE ARE IN THE KIND OR AMOUNT OF WORK THEY CAN DO. (TIM/MARY) GENERALLY ENJOYS (HIS/HER) WORK. (HE/SHE) GETS DEPRESSED EVERY THREE WEEKS FOR A DAY OR TWO AND LOSES INTEREST IN WHAT (HE/SHE) USUALLY ENJOYS, BUT IS ABLE TO CARRY ON WITH (HIS/HER) DAY-TO-DAY ACTIVITIES ON THE JOB. 1. Not at all limited 2. Mildly limited 3. Moderately limited 4. Severely limited 5. Cannot do any work Blank. Inapplicable   JLB004 Affect- enjoys work very much view item details » (JIM/ANN) ENJOYS WORK VERY MUCH. (HE/SHE) FEELS THAT (HE/SHE) IS DOING A VERY GOOD JOB AND IS OPTIMISTIC ABOUT THE FUTURE. 1. Not at all limited 2. Mildly limited 3. Moderately limited 4. Severely limited 5. Cannot do any work Blank. Inapplicable   If Affect- enjoys work very much view item details » = 1. Not at all limited »         JLB005 Affect- mood swings on job view item details » (BOB/NANCY) HAS MOOD SWINGS ON THE JOB. WHEN (HE/SHE) GETS DEPRESSED, EVERYTHING (HE/SHE) DOES AT WORK IS AN EFFORT FOR (HIM/HER) AND (HE/SHE) NO LONGER ENJOYS (HIS/HER) USUAL ACTIVITIES AT WORK. THESE MOOD SWINGS ARE NOT PREDICTABLE AND OCCUR TWO OR THREE TIMES DURING A MONTH. 1. Not at all limited 2. Mildly limited 3. Moderately limited 4. Severely limited 5. Cannot do any work Blank. Inapplicable       JLB006 Affect- worried all the time view item details » (FRANK/BARB) FEELS WORRIED ALL THE TIME. (HE/SHE) GETS DEPRESSED ONCE A WEEK AT WORK FOR A COUPLE OF DAYS IN A ROW, THINKING ABOUT WHAT COULD GO WRONG AND THAT (HIS/HER) BOSS WILL DISAPPROVE OF (HIS/HER) CONDITION. BUT (HE/SHE) IS ABLE TO COME OUT OF THIS MOOD IF (HE/SHE) CONCENTRATES ON SOMETHING ELSE. 1. Not at all limited 2. Mildly limited 3. Moderately limited 4. Severely limited 5. Cannot do any work Blank. Inapplicable     JLB007 Affect- depressed most of the time view item details » (GARY/KATHLEEN) FEELS DEPRESSED MOST OF THE TIME. (HE/SHE) WEEPS FREQUENTLY AT WORK AND FEELS HOPELESS ABOUT THE FUTURE. (HE/SHE) FEELS THAT (HE/SHE) HAS BECOME A BURDEN ON (HIS/HER) CO-WORKERS AND THAT (HE/SHE) WOULD BE BETTER DEAD. 1. Not at all limited 2. Mildly limited 3. Moderately limited 4. Severely limited 5. Cannot do any work Blank. Inapplicable   If Affect- depressed most of the time view item details » = 1. Not at all limited »         JLB008 Pain- occasional back pain at work view item details » (MICHAEL/SUE) OCCASIONALLY FEELS BACK PAIN AT WORK, BUT THIS HAS NOT HAPPENED FOR THE LAST SEVERAL MONTHS NOW. IF (HE/SHE) FEELS BACK PAIN, IT TYPICALLY LASTS ONLY FOR A FEW DAYS. 1. Not at all limited 2. Mildly limited 3. Moderately limited 4. Severely limited 5. Cannot do any work Blank. Inapplicable       JLB009 Pain- stiffness in back at work view item details » (CARL/CAROL) SUFFERS FROM BACK PAIN THAT CAUSES STIFFNESS IN (HIS/HER) BACK, ESPECIALLY AT WORK, BUT IS RELIEVED WITH LOW DOSES OF MEDICATION. (HE/SHE) DOES NOT HAVE ANY PAINS OTHER THAN THIS GENERALIZED DISCOMFORT. 1. Not at all limited 2. Mildly limited 3. Moderately limited 4. Severely limited 5. Cannot do any work Blank. Inapplicable       JLB010 Pain- constant back pain view item details » (MATTHEW/RUTH) HAS ALMOST CONSTANT PAIN IN (HIS/HER) BACK AND THIS SOMETIMES PREVENTS (HIM/HER) FROM DOING (HIS/HER) WORK. 1. Not at all limited 2. Mildly limited 3. Moderately limited 4. Severely limited 5. Cannot do any work Blank. Inapplicable     JLB011 Pain-changes in position affect work view item details » (GEORGE/LINDA) HAS BACK PAIN THAT MAKES CHANGES IN BODY POSITION WHILE (HE/SHE) IS WORKING VERY UNCOMFORTABLE. (HE/SHE) IS UNABLE TO STAND OR SIT FOR MORE THAN HALF AN HOUR. MEDICINES DECREASE THE PAIN A LITTLE, BUT IT IS THERE ALL THE TIME AND INTERFERES WITH (HIS/HER) ABILITY TO CARRY OUT EVEN DAY-TO- DAY TASKS AT WORK. 1. Not at all limited 2. Mildly limited 3. Moderately limited 4. Severely limited 5. Cannot do any work Blank. Inapplicable   If Pain-changes in position affect work view item details » = 1. Not at all limited »         JLB012 Pain-back and leg pain almost always view item details » (MARK/JANE) HAS PAIN IN (HIS/HER) BACK AND LEGS, AND THE PAIN IS PRESENT ALMOST ALL THE TIME. IT GETS WORSE WHILE (HE/SHE) IS WORKING. ALTHOUGH MEDICATION HELPS, (HE/SHE) FEELS UNCOMFORTABLE WHEN MOVING AROUND, HOLDING AND LIFTING THINGS AT WORK. 1. Not at all limited 2. Mildly limited 3. Moderately limited 4. Severely limited 5. Cannot do any work Blank. Inapplicable       JLB013 Cvd- active and fit view item details » (PETER/KAREN) IS VERY ACTIVE AND FIT. (HE/SHE) TAKES AEROBIC CLASSES 3 TIMES A WEEK. 1. Not at all limited 2. Mildly limited 3. Moderately limited 4. Severely limited 5. Cannot do any work Blank. Inapplicable       JLB014 Cvd- heart problems in the past view item details » (JACOB/LORI) HAS HAD HEART PROBLEMS IN THE PAST AND (HE/SHE) HAS BEEN TOLD TO WATCH (HIS/HER) CHOLESTEROL LEVEL. SOMETIMES IF (HE/SHE) FEELS STRESSED AT WORK (HE/SHE) FEELS PAIN IN (HIS/HER) CHEST AND OCCASIONALLY IN (HIS/HER) ARMS. 1. Not at all limited 2. Mildly limited 3. Moderately limited 4. Severely limited 5. Cannot do any work Blank. Inapplicable     JLB015 Cvd- history of heart problems view item details » (PAUL/BETH)'S FAMILY HAS A HISTORY OF HEART PROBLEMS. (HIS/HER) FATHER DIED OF A HEART ATTACK WHEN (PAUL/BETH) WAS STILL VERY YOUNG. THE DOCTORS HAVE TOLD (PAUL/BETH) THAT (HE/SHE) IS AT SEVERE RISK OF HAVING A SERIOUS HEART ATTACK (HIMSELF/HERSELF) AND THAT (HE/SHE) SHOULD AVOID STRENUOUS PHYSICAL ACTIVITY OR STRESS. (HE/SHE) SOMETIMES FEELS SEVERE PAIN IN (HIS/HER) CHEST AND ARMS, AND SUFFERS FROM DIZZINESS, FAINTING, SWEATING, NAUSEA OR SHORTNESS OF BREATH. 1. Not at all limited 2. Mildly limited 3. Moderately limited 4. Severely limited 5. Cannot do any work Blank. Inapplicable   If Cvd- history of heart problems view item details » = 1. Not at all limited »         JLB016 Cvd- diagnosed high blood pressure view item details » (TOM/DIANE) HAS BEEN DIAGNOSED WITH HIGH BLOOD PRESSURE. (HIS/HER) BLOOD PRESSURE GOES UP QUICKLY IF (HE/SHE) FEELS UNDER STRESS. (TOM/DIANE) DOES NOT EXERCISE MUCH AND IS OVERWEIGHT. LIFE CAN SOMETIMES CAN BE HECTIC FOR (HIM/HER). (HE/SHE) DOES NOT GET ALONG WITH (HIS/HER) BOSS VERY WELL. 1. Not at all limited 2. Mildly limited 3. Moderately limited 4. Severely limited 5. Cannot do any work Blank. Inapplicable       JLB017 Cvd- triple bypass heart surgery view item details » (DAN/JUDY) HAS UNDERGONE TRIPLE BYPASS HEART SURGERY. (HE/SHE) IS A HEAVY SMOKER AND STILL EXPERIENCES SEVERE CHEST PAIN SOMETIMES. 1. Not at all limited 2. Mildly limited 3. Moderately limited 4. Severely limited 5. Cannot do any work Blank. Inapplicable       JLB018 Who answered disability qnaire view item details » WERE THE QUESTIONS IN THIS BOOKLET ANSWERED BY THE PERSON WHOSE INITIALS ARE WRITTEN ON THE FRONT COVER, OR DID SOMEONE ELSE PROVIDE THEIR OWN ANSWERS? (CHECK ONE.) 1. The questions were answered by the person whose initials are written on the front cover. 2. Someone else provided their own answers. Blank. Inapplicable     End of LB. Leave-behind Questionnaires (respondent)

Start of LB. Leave-behind Questionnaires (respondent)