Frequency and patient attributes associated with emergency department visits after discharge: Retrospective cohort study.

BACKGROUND: The utilization of emergency department (ED) during the post-discharge period may provide relevant insights to reduce fragmentation of care, particularly in a context of general intense use. We aimed to describe frequency and patient attributes associated with emergency department (ED) visits within 30 days of inpatient discharge in a Portuguese health region-Algarve. METHODS: Secondary data on inpatient and emergency care, for adult patients discharged in 2016. To analyse the association between outcome-ED visit within 30 days of discharge-and selected variables (admission type and groups of or individual illnesses/conditions), we used age- and sex-adjusted odds ratios (aOR). We included all adult patients (aged ≥18 years) discharged during 2016 from the region's public hospital inpatient departments. The period for ED visits also included January 2017. RESULTS: For 21,744 adults discharged in 2016 (mean age: 58 years; 60% female), 23 percent visited ED at least once within 30 days of discharge. Seventy-five percent of those visits were triaged with high clinical priority. Patients with more comorbidities or specific groups of illnesses/conditions had a significant increased risk of returning ED (aOR and 95% confidence intervals-endocrine: 1.566; 1.256-1.951; mental illness: 1.421; 1.180-1.713; respiratory: 1.308; 1.136-1.505). CONCLUSION: Patients returned ED after inpatient discharge frequently and for severe reasons. Patients with more comorbidities or specific groups of illnesses/conditions (endocrine, mental illness or respiratory) had an increased risk of returning ED, so these groups may be prioritized in further research and health system initiatives to improve care before and after discharge.

A Novel, Low-Cost Coconut Fiber Larval Diet for Mass Rearing Anastrepha (Diptera: Tephritidae).

Mass rearing fruit flies of the genus Anastrepha for the sterile insect technique involves the use of artificial larval diets that commonly contain corn cob powder as a bulking agent. Corn cob powder varies in quality, and larval diets that contain it can be reaching at high temperatures (>34°C), which subsequently has a negative effect on pupal weight and adult survival. In addition, corn cob powder is susceptible to contamination by mycotoxins, which can inhibit larval development and cause high larval mortality. The objective of this work was to develop a low-cost artificial larval diet for mass rearing Anastrepha spp. fruit flies using coconut fiber, a nonconventional bulking agent, and to evaluate its effects on the quality parameters for A. ludens wild-type, A. ludens Tap-7 GS-strain, A. obliqua, A. serpentina, and A. striata. The coconut fiber diet resulted in an increase in the larval and pupal weight of A. ludens Tap-7 GS-strain and A. obliqua, an increase in the larval weight of A. ludens wild-type, an increase in the flight ability of A. obliqua and A. serpentina and an increase in adult eclosion in A. ludens Tap-7 GS-strain. The coconut fiber diet resulted in increased production and quality of the mass-reared flies, reduced the cost of the diet by 15 and 20% for A. ludens and A. obliqua, respectively, and led to further cost savings through reduced labor processes.