This form structure is an organized set of data definitions for a form that has not been copyrighted

 General Details

Title:
National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire
Short Name:
NHANESCSQ
Description:
The National Health and Nutrition Examination Survey (NHANES) is a program of studies designed to assess the health and nutritional status of adults and children in the United States. The NHANES is a major part of the National Center for Health Statistics (NCHS) which is part of the Center for Disease Control (CDC). The NHANES interview includes demographic, socioeconomic, dietary, and health-related questions. The examination component consists of medical, dental, and physiological measurements, as well as laboratory tests administered by highly trained medical personnel.References: Centers for Disease Control and Prevention (CDC) 2013-2014. https://www.cdc.gov/nchs/data/nhanes/nhanes_13_14/CSQ_H.pdf
Disease:
Traumatic Brain Injury , General (For all diseases)
Organization:
FITBIR
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-10-24
Owner:
Number of Data Elements:
45
eForms:
N

 Documentation


 Groups & Attached Data Elements

Logically grouped data elements with defined frequency at which they repeat.

# Title Short Description Variable Name Required? Type
1 GUID   Global Unique ID which uniquely identifies a subject GUID Required CDE
2 Subject identifier number   An identification number assigned to the participant/subject within a given protocol or a study. SubjectIDNum Optional CDE
3 Age in years   Value for participant's subject age recorded in years. AgeYrs Recommended CDE
4 Vital status   Status of participant/subject as alive or dead VitStatus Optional CDE
5 Visit date   Actual interview or visit date VisitDate Recommended CDE
6 Site name   The name of the site for the study SiteName Recommended CDE
7 Days since baseline   The number of days since baseline DaysSinceBaseline Optional CDE
8 Case control indicator   Indicator of whether subject is in the case or control arm of the study CaseContrlInd Optional CDE
9 General notes text   General notes GeneralNotesTxt Optional CDE

Additional Element Groups

Listed below are your additional element groups.

Form Administration (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Language form administration ISO code  Code (ISO 639-2) for the language that was used for CRF/instrument/scale/etc. administration LangCRFAdministratISOCode Recommended CDE
2 Language form administration ISO code other text  The free-text field related to 'Language used for CRF/instrument/scale/etc. administration ISO code' specifying other text. LangCRFAdministratISOCodeOTH Recommended CDE
3 Context type  The context to which the questions were answered ContextType Recommended CDE
4 Context type other text  The free-text related to ContextType specifying other text ContextTypeOTH Recommended CDE
5 Data source  Source of the data provided on the case report form DataSource Recommended CDE
6 Data source other text  The free-text field related to Data source specifying other text. Source of the data provided on the case report form DataSourceOTH Recommended CDE

NHANES CSQ (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system smell difficulty indicator  Indicator that the participant has had a problem, including loss of smell and things not smelling the way they should, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). NHANESCSQChemoSysSmeDiffInd Recommended CDE
2 National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system smell comparison difficulty condition type  Type of condition of the participant's smelling abilities compared to his or her smelling abilities when he or she was 25 years old, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). NHANESCSQCheSmeCompDiffCondTyp Recommended CDE
3 National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system non unpleasant smell bother indicator  Indicates that certain smells bother the participant even though these smells do not seem to bother other people, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). NHANESCSQCheSysNUnpSmeBothInd Recommended CDE
4 National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system absent smell bother indicator  Indicates that the participant smells unpleasant, bad, or burning smells/odors when there are no such smells present, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). NHANESCSQCheSysAbsSmeBothInd Recommended CDE
5 National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system smell first notice problem code  Code representing the time at which the participant first noticed a problem in his or her ability to smell, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). NHANESCSQCheSysSme1stNoProCode Recommended CDE
6 National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system smell problem constant type  The type of problem the participant has with smell, whether it is constant or comes and goes, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). NHANESCSQCheSysSmeProbConsTyp Recommended CDE
7 National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system taste difficulty indicator  Indicates whether or not the participant has had a problem with his or her ability to taste certain flavors or items within the last 12 months, as a part of the NHANES-CSQ NHANESCSQCheSysTasteDiffInd Recommended CDE
8 National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system taste comparison difficulty type  Type of response for the participant's tasting abilities compared to his or her tasting abilities when he or she was 25 years old, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). NHANESCSQCheSysTasCompDiffTyp Recommended CDE
9 National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system taste comparison salt difficulty status  Type of condition of the participant's tasting abilities compared to his or her tasting abilities when he or she was 25 years old in question a, as a part of the NHANES-CSQ NHANESCSQCheTasCoSalDifCondTyp Recommended CDE
10 National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system taste comparison sour difficulty condition type  Type of condition of the participant's tasting abilities compared to when he or she was 25 years old in question b, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). NHANESCSQCheTasCoSouDifCondTyp Recommended CDE
11 National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system taste comparison sweet difficulty condition type  Type of condition of the participant's tasting abilities compared to when he or she was 25 years old in question c, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). NHANESCSQCheTasCoSweDifConTyp Recommended CDE
12 National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system taste comparison bitter difficulty condition type  Type of condition of the participant's tasting abilities compared to when he or she was 25 years old in question d, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). NHANESCSQCheSysTasCoBitCondTyp Recommended CDE
13 National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system taste flavor difficulty indicator  Indicates whether or not the participant can taste chocolate, vanilla, or strawberry is currently as good as it was 25 years ago, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). NHANESCSQCheSysTasFlavDiffInd Recommended CDE
14 National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system taste persistence indicator  Indicates whether or not the participant has had a taste or other sensation in his or her mouth that would not go away, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). NHANESCSQCheSysTastePersInd Recommended CDE
15 National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system taste persistence description code  Describes the taste or sensation that would not go away, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). NHANESCSQCheSysTasPersDescCode Recommended CDE
16 National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system taste first notice problem type  Denotes how long ago the participant first noticed the problem with his or her taste, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). NHANESCSQCheSysTas1stNotProTyp Recommended CDE
17 National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system taste smell discuss problem indicator  Indicates whether or not the participant has ever discussed the problem or change in his or her smell or taste with some sort of health care provider, as a part of the NHANES-CSQ NHANESCSQCheSysTasSmeDisProInd Recommended CDE
18 National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system taste smell problem last discuss type  Denotes how long ago was the last time that the participant discussed the problem or change in his or her smell or taste with a health care provider, as a part of the NHANES-CSQ NHANESCSQCheSysTasSmeProDisTyp Recommended CDE
19 National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system taste smell treatment indicator  Indicates whether or not the participant has tried to improve his or her ability to smell or taste within the last 12 months, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). NHANESCSQCheSysTasSmeTreInd Recommended CDE
20 National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system taste smell affect life indicator  Indicates whether or not a problem with the participants smell or taste has affected his or her general life, work life, or enjoyment of life within the last 12 months, as a part of the NHANES-CSQ. NHANESCSQCheSysTasSmeAffLifInd Recommended CDE
21 National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system head cold indicator  Denotes whether or not, in the past 12 months, the participant has experienced a head cold or flu for longer than a month, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). NHANESCSQCheSysHeadColdInd Recommended CDE
22 National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system dry mouth indicator  Denotes whether or not, in the past 12 months, the participant has experienced persistent dry mouth, or lack or saliva, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). NHANESCSQCheSysDryMouInd Recommended CDE
23 National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system nasal congestion indicator  Denotes whether or not, in the past 12 months, the participant has experienced frequent nasal congestion from allergies, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). NHANESCSQCheSysNasConInd Recommended CDE
24 National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system ear infection indicator  Indicates whether or not the participant has experienced 3 or more ear infection in his or her entire life, including childhood, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). NHANESCSQCheSysEarInfInd Recommended CDE
25 National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system drain ear fluid indicator  Indicates whether or not the participant has ever had a tube placed in his or her ear in order to drain fluid from it, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). NHANESCSQCheSysDraEarFluInd Recommended CDE
26 National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system procedure injury wisdom teeth indicator  Indicates whether or not the participant has ever had his or her wisdom teeth removed, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). NHANESCSQCheSysProInjWTeeInd Recommended CDE
27 National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system procedure injury tonsil indicator  Indicates whether or not the participant has ever had his or her tonsils removed, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). NHANESCSQCheSysProcInjTonsInd Recommended CDE
28 National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system procedure injury head injury indicator  Indicates whether or not the participant has ever experienced a loss of consciousness because of a head injury, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). NHANESCSQCheSysProInjHeaInjInd Recommended CDE
29 National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system procedure injury face skull injury indicator  Indicates whether or not the participant has ever experienced a broken nose or other serious injury to the face or skull, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). NHANESCSQCheSysProInjFSInjInd Recommended CDE
30 National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ) - Chemosensory system procedure injury sinus infection indicator  Indicates whether or not the participant has ever had two or more sinus infections, as a part of the National Health and Nutrition Examination Chemical Senses-Taste and Smell Questionnaire (NHANES-CSQ). NHANESCSQCheSysProInjSinInfInd Recommended CDE

 Change History

 Administrative Change History