Questionnaires

Carolina Lupus Study (CLS)

For more information about the Carolina Lupus Study questionnaires, contact Dale P. Sandler, Ph.D.

Baseline Study Questionnaires

Systemic Lupus Erythematosus Risk Factor Questionnaire (clu_riskfactor_v4.pdf)   (692K)

• Section A: Demographics
• Section B: Symptoms
• Section C: Reproductive History
• Section D: Early Environment
• Section E: Occupational History
• Section F: Farming Experience
• Section G: Hobbies and Leisure
• Section H: Diet
• Section I: Smoking History
• Section J: Hair Treatments
• Section K: Medical History
• Section L: Family History
• Section M: Closing
• Section N: Interviewer Remarks

Medical Records Abstract (clu_medrecord.pdf)   (50K)

• SLE Eligibility Criteria

Follow-up Study Questionnaires

Carolina Lupus Study Questionnaire Follow-Up 2001 (Cases) (clu_fu_cases_v2.pdf)   (547K)

• Section A: Medical History Update
• Section B: Depression
• Section C: Occupation
• Section D: Work/Health Disability
• Section E: Demographics/Insurance/Income
• Section F: Stress/Racism
• Section G: Reproductive History
• Section H: Helplessness Scale
• Section I: Quality of Social Support Scale
• Section J: Smoking and Alcohol
• Section K: Cognitive Symptoms
• Section L: SLE Activity Questionnaire
• Section M: Quality of Life
• Section N: Closing
• Section O: Interviewer Remarks

Carolina Lupus Study Questionnaire Follow-Up 2001 (Controls) (clu_fu_controls_v3.pdf)   (274K)
The questionnaire covers recent health, jobs and personal habits as well as events from around the time of the first interview.

SLE Cumulative Damage Index (clu_fu_damage.pdf)   (130K) 
The total damage in a patient may result from SLE itself or from other pathologic processes  such as atherosclerosis, hypercoagulability, hypertension, therapy for SLE and other comorbid (existing simultaneously with and usually independently of another illness) conditions. This Cumulative Damage Index summarizes the total of all damage that has occurred from any mechanism.

Cause of Death Form (cfu_fu_death.pdf)   (25K)
Form for patients who died since enrollment in the Carolina Lupus Study

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