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We would like to ask you some questions about participation in social activities. How often, if at all, do you do any of the following activities? |
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Watch television. |
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Go out to films, plays and concerts. |
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Attend classes and lectures. |
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Travel for pleasure. |
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Work in the garden, or your home, or on a car. |
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Read books or magazines for pleasure. |
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Listen to music, radio. |
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Spend time on hobbies or creative activities. |
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Play cards, bingo, games in general. |
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Go to the pub. |
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Eat out of the house. |
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Participate in sport activities or exercise. |
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Visit to or from family or friends, either in person or talking on the phone. |
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Do voluntary work. |
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The next questions are about how you feel about different aspects of your life. For each one, please say how often you feel that wa y. |
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How often do you feel you lack companionship? |
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How often do you feel left out? |
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How often do you feel isolated from others? |
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How often do you feel in tune with the people around you? |
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How often do you feel lonely? |
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We would now like to ask you some questions about your spouse or partner with whom you live. |
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How much does he/she really understand the way you feel about things? |
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How much can you rely on him/her if you have a serious problem? |
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How much can you open up to him/her if you need to talk about your worries? |
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How much does he/she make too many demands on you? |
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How much does he/she criticise you? |
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How much does he/she let you down when you are counting on him/her? |
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How much does he/she get on your nerves? |
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How close is your relationshi p with your spouse or partner with whom you live? |
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We would now like to ask you some questions about your children. |
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How much do they really understand the way you feel about things? |
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How much can you rely on them if you have a serious problem? |
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How much can you open up to them if you need to talk about your worries? |
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How much do they make too many demands on you? |
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How much do they criticise you? |
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How much do they let you down when you are counting on them? |
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How much do they get on your nerves? |
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A part from your spouse/partner and children (if any), do you have any other family members (such as brothers, sisters, parents, cousins, etc.)? |
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We would now like to ask you some questions about THESE FAMILY MEMBERS. |
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How much do they really understand the way you feel about things? |
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How much can you rely on them if you have a serious problem? |
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How much can you open up to them if you need to talk about your worries? |
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How much do they make too many demands on you? |
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How much do they criticise you? |
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How much do they let you down when you are counting on them? |
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How much do they get on your nerves? |
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We would now like to ask you some questions about YOUR FRIENDS. |
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How much do they really understand the way you feel about things? |
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How much can you rely on them if you have a serious problem? |
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How much can you open up to them if you need to talk about your worries? |
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How much do they make too many demands on you? |
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How much do they criticise you? |
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How much do they let you down when you are counting on them? |
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How much do they get on your nerves? |
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This question is about how you have felt in the past month. |
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In the last month, how often have you felt that you were unable to control the important things in your life? |
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In the last month, how often have you felt confident about your ability to handle your personal problems? |
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In the last month, how often have you felt that things were going your way? |
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In the last month, how often have you felt difficulties were piling up so high that you could not overcome them? |
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We would like to ask some questions about how CONCerned YOU Are about the possibility of fallin g. For each of the Following activities, please indicate how concerned YOU are that you might fall if you did this activity. |
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Cleaning the house (e.g. sweep, vacuum, dust). |
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Getting dressed or undressed. |
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Preparing simple meals. |
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Taking a bath or shower. |
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Going to the shop. |
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Getting in or out of a chair. |
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Going up or down stairs. |
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Walking around in the neighbourhood. |
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Reaching for something above your head or on the ground. |
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Going to answer the telephone before it stops ringing. |
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Walking on a slippery surface (e.g. wet or icy). |
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Visiting a friend or relative. |
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Walking in a place with crowds. |
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Walking on an uneven surface (e.g. rocky ground, poorly maintained pavement). |
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Walking up or down a slope. |
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Going out to a social event (e.g. religious service, family gathering, or club meeting). |
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The following ARE WAYS people react TO VARIOUS DIFFICULT, STRESSFUL, OR UPSETTING SITUATIONS. PLEASE CIRCLE A NUMBER FROM 1 TO 5 ON each line FOR EACH OF THE FOLLOWING ITEMS. |
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Take some time off and get away from the situation. |
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Focus on the problem and see how I can solve it. |
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Blame myself for having gotten into this situation. |
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Treat myself to a favourite food or snack. |
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Feel anxious about not being able to cope. |
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Think about how I solved similar problems. |
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Visit a friend. |
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Determine a course of action and follow it. |
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Buy myself something. |
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Blame myself for being too emotional about the situation. |
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Work to understand the situation. |
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Become very upset. |
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Take corrective action immediately. |
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Blame myself for not knowing what to do. |
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Spend time with a special person. |
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Think about the event and learn from my mistakes. |
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Wish that I could change what had happened or how I felt. |
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Go out for a snack or meal. |
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Analyse the problem before reacting. |
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Focus on my general inadequacies. |
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Phone a friend. |
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Here is a list of statements that people have used to describe their lives or how they feel. How often do you feel like this? |
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My age prevents me from doing the things I would like to. |
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I feel that what happens to me is out of my control. |
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I feel free to plan for the future. |
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I feel left out of things. |
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I feel that I can please myself in what I can do. |
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My health stops me from doing the things I want to do. |
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Shortage of money stops me from doing the things that I want to do. |
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I look forward to each day. |
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I feel that my life has meaning. |
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I enjoy being in the company of others. |
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I feel satisfied with the way my life has turned out. |
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I feel that life is full of opportunities. |
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Have you ever had DRINKS CONTAINING ALCOHOL, e.g. glass of wine, glass of beer, etc.? |
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Have you had DRINKS CONTAINING ALCOHOL OF any kind in the last 6 months? |
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During the last 6 months, how often have you had drinks containing alcohol, like beer, cider, wine, spirits or cocktails ? |
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More recently (i.e. in the last month), would you describe your current alcohol intake as: |
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From the pictures below, please tick the box that represents the drink you would be most likely to drink |
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Thinking about your drink of choice, on average, in the last 6 months on the days that you drank, about how many did you have? |
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THINKING ABOUT YOUR DRINK OF CHOICE, DURING THE LAST 6 MONTHS, APPROXIMATELY WHAT WAS THE LARGEST NUMBER OF DRINKS YOU HAD ON ANY ONE DAY? |
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HOW OFTEN IN THE LAST 6 MONTHS WOULD YOU SAY YOU DRANK THE MAXIMUM NUMBER OF DRINKS YOU INDICATED IN THE LAST QUESTION? |
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Have you ever felt that you should cut down on drinking? |
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Have you reduced your alcohol intake in the last 2 years? |
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Why did you reduce your alcohol intake? |
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Have people ever annoyed you by criticising your drinking? |
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Have you ever felt bad or guilt y about drinking? |
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Have you ever ta ken a drink first thing in the morning to steady your nerves or get rid of a hangover? |
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we would now like to ask some questions about how much you worry about things. please indicate how typical or characteristic each statement is of you. |
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My worries overwhelm me. |
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Many situations make me worry |
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I know I should not worry about things, but I just cannot help it. |
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When I am under pressure, I worry a lot. |
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I am always worrying about something. |
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As soon as I finish one task, I start to worry about everything else I must do. |
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I have been a worrier all my life. |
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I have been worrying about things. |
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Have any of your close friends died in the past TWO years? |
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What is the MAIN way in which you heat your accommodation in the winter (Tick ONE box only) |
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Could you tell me whether you have any of the following problems in your accommodation ? If so, would you say that these are a minor, moderate or major problem for the accommodation ? |
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A leaking roof? |
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Leaking or moisture getting in through walls? |
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Leaking or moisture getting in at door or windows? |
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Leaks from water pipes? |
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Rising damp? |
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Condensation dampness? |
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General dampness from unknown sources? |
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Mould on walls/ceilings etc? |
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Corrosion or rot around any external door(s)? |
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Badly fitting doors? |
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Corrosion or rot around any window(s)? |
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Leaky or draughty windows? |
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Windows that don’t open/close properly? |
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Rot in timbers other than windows/doors, such as rot in joists, floor boards etc? |
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Structural cracks in internal or external SUPPORT walls? |
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Subsidence in floors? |
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Pests – rats, mice, cockroaches? |
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Noise from neighbouring houses? |
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Difficulty in heating your accommodation? |
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Other problems (tick level of problem and specify below)? |
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Thinking about the food that you eat , we would like you to tell us how often you usually eat the following foods. |
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Beef or Lamb-including roast, steak stew, mince |
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Pork-including roast, chops, slices |
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Ham, Bacon |
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Chicken or Turkey portion –including breast, thigh, leg |
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Chicken products including chicken nuggets or breaded chicken |
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Fresh fish |
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Fish, including breaded, battered, or fish fingers |
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Processed meat - including meat pies, pasties, sausage rolls, burgers, sausages, |
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Lentils, tofu, soya meat, vegeburger |
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White bread |
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Brown bread |
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Porridge, readybrek |
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High fibre cereal e.g Weetabix, all bran branflakes, bran buds, muesli |
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Other cereal e.g. cornflakes, rice crispies |
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Potatoes, including boiled, mashed, baked potatoes, but excluding roast potatoes, chips or potato products eg waffles |
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Chips, roast potatoes, and potato products, eg potato waffles, smiles |
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Rice |
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Pasta |
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PastaYoghurt (carton) |
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Cheese-including cheddar, cheese slices, soft cheese |
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Eggs (one) including boiled, scrambled, poached, fried |
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Cream (tablespoon) |
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Salad dressings (tablespoon) |
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Butter (teaspoon) |
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Low fat spread (teaspoon) |
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Cholesterol lowering spread e.g. benecol, flora pro active |
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Fruit including fresh, frozen, dried, tinned |
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Green vegetables, including cabbage, broccoli, peas, green beans |
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Orange/Yellow vegetables, including carrots, turnips, cauliflower |
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Salad or other vegetables, including leeks, onions, garlic, sweet peppers, mushrooms, sweetcorn, tomatoes, beetroot |
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Plain biscuits |
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Chocolate Biscuits, including wrapped chocolate biscuits, eg Twix, Kit-Kat, Penguin |
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Confectionary, including sweets and chocolate bars |
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Cakes, buns, desserts, eg cheesecakes, apple tart |
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Savoury snacks, eg crisps, tortilla chips |
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Vegetable soup (homemade/carton) |
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Vegetable soup (packet, cup-a-soup) |
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Sauces e.g. white sauce, cheese sauce, gravy (tablespoon) |
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Marmite, bovril |
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Jam, marmalade |
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Water (glass) |
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Tea (cup) |
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Coffee (cup) |
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Cocoa, hot chocolate (cup) |
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Horlicks, Ovaltine (cup) |
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Wine (glass) |
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Beer (half pint) |
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Spirits (single measure) |
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Low Calorie or Diet Fizzy drinks (glass) |
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Fizzy drinks (glass) |
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Pure fruit juice (glass) |
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Fruit squash, diluted orange (glass) |
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What type of milk do you use most often? |
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How much milk do you USE each day? |
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we are interested in your own personal views and experiences about getting older. please indicate how strongly you agree or disagree with the following statements |
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I am always aware of my age. |
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I always classify myself as old. |
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I feel my age in everything that I do. |
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As I get older I get wiser. |
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As I get older I continue to grow as a person. |
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As I get older I appreciate things more. |
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I get depressed when I think about how ageing might affect the things that I can do? |
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Getting older makes me less independent. |
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As I get older I do not cope as well with problems that arise. |
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Slowing down with age is not something I can control. |
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How mobile I am in later life is not up to me. |
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I have no control over the effects which getting older has on my social life. |
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I get depressed when I think about getting older. |
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I go through cycles in which my experience of ageing gets better and worse. |
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I feel angry when I think about getting older. |
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I go through phases of feeling old. |
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I go through phases of viewing myself as old. |
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In our study we are interested in looking at the migration patterns of people throughout their lifetime both within ireland and to and from ireland. we also want to investigate the possible effect of water supply on health . |
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If there is anything you would like to tell us, please write in the space below. FEEL FREE TO ADD A PAGE IF this space is insufficient. We shall be very interested to read what you have to say. |