Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial: Design and rationale.

BACKGROUND: Acute decompensated heart failure (ADHF) is a leading cause of hospitalization in older persons in the United States. Reduced physical function and frailty are major determinants of adverse outcomes in older patients with hospitalized ADHF. However, these are not addressed by current heart failure (HF) management strategies and there has been little study of exercise training in older, frail HF patients with recent ADHF. HYPOTHESIS: Targeting physical frailty with a multi-domain structured physical rehabilitation intervention will improve physical function and reduce adverse outcomes among older patients experiencing a HF hospitalization. STUDY DESIGN: REHAB-HF is a multi-center clinical trial in which 360 patients ≥60 years hospitalized with ADHF will be randomized either to a novel 12-week multi-domain physical rehabilitation intervention or to attention control. The goal of the intervention is to improve balance, mobility, strength and endurance utilizing reproducible, targeted exercises administered by a multi-disciplinary team with specific milestones for progression. The primary study aim is to assess the efficacy of the REHAB-HF intervention on physical function measured by total Short Physical Performance Battery score. The secondary outcome is 6-month all-cause rehospitalization. Additional outcome measures include quality of life and costs. CONCLUSIONS: REHAB-HF is the first randomized trial of a physical function intervention in older patients with hospitalized ADHF designed to determine if addressing deficits in balance, mobility, strength and endurance improves physical function and reduces rehospitalizations. It will address key evidence gaps concerning the role of physical rehabilitation in the care of older patients, those with ADHF, frailty, and multiple comorbidities

Cohabitation and Exchanges of Support* Cohabitation and Exchanges of Support

Abstract This paper examines the relationship between nonmarital cohabitation and routine exchanges of support between American adults aged 19-30 (N = 3,809

Father’s Presence and Young Children’s Behavioral and Cognitive Adjustment

The impact of fathers on the development and well-being of their children has been the focus of much recent research and debate (e.g., Furstenberg, 1988; Hawkins & Eggebeen, 1991; Lamb, 1987). Traditionally, fathers have been assumed to play an important role in the socialization of their children and, consequently, father-absence has been hypothesized to result in a variety of cognitive and psychosocial vulnerabilities. The need to understand the influence of fathers becomes especially acute at a time when high rates of divorce and nonmarital childbearing lead to the prediction that the majority of children will experience some period of father-absence (Bumpass, 1984; Bumpass & Sweet, 1989)

American Children in Multiracial Households

This study provides a demographic portrait of multiracial households, using children as the units of analysis. The authors conceptualize 3 dimensions for understanding multiracial qualities: 1) the racial composition of a household overall, 2) where in the household a racial difference exists relative to the household head, and 3) where in the household a racial difference exists relative to each child. Using microdata from the 1980 US census, the authors explore the 1st 2 of these dimensions and test 2 propositions about the links between racial diversity and other nonracial attributes of children's household environments. The finding is made, among other things, that the largest proportion of children live in Asian-white households, and that about 60% live in households headed by mixed-race couples. Support for the notion that attributes of multiracial households fall between those of their same-race counterparts was mixed. Nonetheless, there appears to be a link between location of diversity and some nonracial characteristics of household

Sibling-based tests of linkage and association for quantitative traits.

The transmission/disequilibrium test (TDT) developed by Spielman et al. can be a powerful family-based test of linkage and, in some cases, a test of association as well as linkage. It has recently been extended in several ways; these include allowance for implementation with quantitative traits, allowance for multiple alleles, and, in the case of dichotomous traits, allowance for testing in the absence of parental data. In this article, these three extensions are combined, and two procedures are developed that offer valid joint tests of linkage and (in the case of certain sibling configurations) association with quantitative traits, with use of data from siblings only, and that can accommodate biallelic or multiallelic loci. The first procedure uses a mixed-effects (i.e., random and fixed effects) analysis of variance in which sibship is the random factor, marker genotype is the fixed factor, and the continuous phenotype is the dependent variable. Covariates can easily be accommodated, and the procedure can be implemented in commonly available statistical software. The second procedure is a permutation-based procedure. Selected power studies are conducted to illustrate the relative power of each test under a variety of circumstances