Introduction:To examine racial variations in access to postacute care (PAC) and rehabilitation (Rehab) services following elective total knee arthroplasty and whether where patients go after surgery for PAC/Rehab is associated with 30-day readmission to acute care facility.Materials and Methods:Sample consisted of 129 522 patients discharged from 169 hospitals in the State of Pennsylvania between fiscal years 2008 and 2012. We used multinomial regression models to assess the relationship between patient race and discharge destination after surgery, for patients aged 18 to 64 years and for those aged 65 and older. We used multivariable (MV) regression and propensity score (PS) approaches to examine the relationship between patient discharge destination after surgery for PAC/Rehab and 30-day readmission, controlling for key individual- and facility-level factors.Results:Lower proportions of younger patients compared to those older than 65 were discharged to inpatient rehabilitation facilities (IRFs; 5.8% vs 12.6%, respectively) and skilled nursing facilities (SNFs; 15.2% vs 32.7%, respectively) compared to home-based Rehab (self-care; 23.3% vs 14.2%, respectively). Compared to whites, African American patients had significantly higher odds of discharge to IRF (age < 65, odds ratio = 2.04; age ≥ 65, odds ratio = 1.64) and to SNF (age < 65, odds ratio = 2.86; age ≥ 65, odds ratio = 2.19) and discharge to home care in patients younger than 65 years (odds ratio = 1.31). The odds of 30-day readmission among patients discharged to an IRF (MV odds ratio = 7.76; PS odds ratio = 8.34) and SNF (MV odds ratio = 2.01; PS odds ratio = 1.83) were significantly higher in comparison to patients discharged home with self-care.Conclusion:African American patients with knee replacement are more likely to be discharged to inpatient Rehab settings following surgery. Inpatient Rehab is significantly associated with 30-day readmission to acute care facility.

Purpose Unintentional weight loss is important and predicts long-term outcomes in rheumatoid arthritis (RA). This study assessed how primary RA therapies influence changes in body mass index (BMI) in a large administrative database. Methods Unique dispensing episodes of methotrexate, prednisone, leflunomide and tumor necrosis factor inhibitors (TNFi) administered to RA patients were identified from national Veterans Affairs pharmacy databases. The closest values for C-reactive protein (CRP) and BMI within 30 days of the course start date and follow-up time-points were linked. Missing laboratory values were imputed. Weight loss was defined as a decrease in BMI of >1 kg/m2. Regression models evaluated changes in BMI with use of each drug compared to methotrexate. Propensity scores were incorporated in analyses using matched-weighting techniques to assess the impact of confounding by indication. Results There were 52,662 treatment courses in 32,859 patients. Weight gain was seen at 6 months among users of methotrexate, prednisone, and TNFi. On average, prednisone-treated patients had significantly more weight gain, while leflunomide-treated patients demonstrated weight loss. In multivariable models, there was more weight loss among leflunomide users [β: −0.41 kg/m2 (95% CI −0.46, −0.36) p<0.001] compared to methotrexate and a greater risk of weight loss [OR 1.73 (95% CI 1.55, 1.79) p<0.001]. Prednisone was associated with greater weight gain [β: 0.072 kg/m2 (95% CI 0.042, 0.10) p<0.001]. These associations persisted with propensity-adjustment and in sensitivity analyses. Conclusions Leflunomide is associated with significant but modest weight loss compared to other RA therapies, while prednisone is associated with greater weight gain.

Objective Rheumatoid arthritis (RA) is associated with muscle loss, osteoporosis, and fracture. We examined associations between skeletal muscle mass, strength, and quality and trabecular and cortical bone deficits in patients with RA and healthy controls. Methods Participants, ages 18–75 years, completed whole-body DXA and peripheral quantitative CT of the tibia to quantify appendicular lean mass and fat mass indices (ALMI, FMI),, muscle density at the lower leg, trabecular bone density, and cortical bone thickness. Age-, sex-, and race-specific Z-Scores were calculated based on distributions in controls. Associations between body composition and pQCT bone outcomes were assessed in RA and controls. Linear regression analyses assessed differences in bone outcomes after considering differences in body mass index (BMI) and body composition. Results The sample consisted of 112 RA patients (55 men) and 412 controls (194 men). Compared to controls, RA patients had greater BMI (p=0.004), lower ALMI after adjustment for FMI (p=0.02), lower muscle strength (p=0.006), and lower muscle density (p<0.0001). Among RA, ALMI Z-Scores were positively associated with trabecular density [β: 0.29 (0.062,0.52) p=0.01] and cortical thickness [β: 0.32 (0.13,0.53) p=0.002]. Associations were similar in controls. Bone outcomes were inferior in RA patients after adjusting for BMI but similar to controls when adjusting for body composition. Radiographic damage and higher adiponectin levels were independently associated with inferior bone outcomes. Conclusions Patients with RA exhibit deficits in cortical bone structure and trabecular density at the tibia and a preserved functional muscle-bone unit. A loss of mechanical loading may contribute to bone deficits.

Compared to other high income nations, the US reports high rates of household firearm ownership and firearm-related injuries and deaths. Though a growing body of evidence suggests that firearm access increases the risk of violent injury, the current literature is limited in its assessment of the injury prevention potential of protective firearm use in violent crime scenarios.PurposeThe purpose of our study is to examine associations between armed self-protective strategies and victim injury outcomes in the context of violent crime using a large, nationally representative and multi-year sample of US crime victimizations.MethodsWe assembled a comprehensive panel of all available National Crime Victimisation Survey (NCVS) data, spanning collection years 1973–2015. A penalised logistic regression approach was used to estimate the effects of defensive weapon use (DWU) on five injury types, including: (1) gunshot/knife wounds, (2) internal injuries/knocked out, (3) broken bones/teeth, (4) minor injuries, and (5) any injuries. Findings. Relative to victimizations that involved the defensive use of verbal threats and arguments, the risk of gunshot injuries to the victim was increased when DWU (OR=2.02; 95% CI, 1.14 ‘“ 3.52) was employed by crime victims. Risk of broken bone injuries was also increased in DWU cases compared to non-DWU victimizations (OR=1.68; 95% CI, 1.10–2.47).ContributionOur findings suggest that armed self-protective strategies serve to increase the odds of victim injury, in particular by gunfire.