Objective: to investigate the factors associated with the practice of sex under the influence of drugs (chemsex) among Portuguese men who have sex with men during the period of social distancing to prevent the COVID-19. Method: online survey applied in May 2020 to a sample of 1,301 participants living in Portugal, recruited according to Respondent Driven Sampling and via social media Facebook®. Descriptive and bivariate analyses were performed along with logistic regression to calculate adjusted Odds Ratio (ORa). Results: the prevalence of chemsex was 20.2%. The likelihood of practicing chemsex increased with group sex (ORa: 28.4, 95%CI 16.93–47.49); unprotected sex (ORa: 7.1 95%CI 4.57–10.99); the use of pre-exposure prophylaxis (PrEP) to prevent COVID-19 (ORa: 4.2, 95%CI 2.71–6.39) and COVID-19 testing (ORa: 1.9, 95%CI 1.15–3.10). Conclusion: the practice of chemsex among men who have sex with men during the COVID-19 pandemic in Portugal was very frequent and may support greater understanding of the role and impact of sexual behavior on the COVID-19 transmission rates and the current pandemic situation in Portugal.

The narrative of Africa Rising has increasingly been called into scrutiny, not just as a debate for economic growth and development, but also as a possible link to the surge in life expectancy on the continent. Theoretically, an increase in economic development tends to result in an increase in public health spending and subsequent better health outcomes. This paper examines the contribution of economic development and other social determinants to the health status of the African continent and to provide evidence on whether the increase in life expectancy of the past two decades can be largely attributed to the Africa Rising narrative. We estimated an empirical health production function, with life expectancy gains as the output of the health care system, and various socio-economic, environmental and lifestyle factors as contributory factors. We fitted a generalized least squares model, using panel data from 52 African countries for the period 1995-2014. The estimation shows that while increases in health care spending contributed to life expectancy gains, urbanization rates and improved water access were the major drivers of life expectancy gains with substantially larger impacts in the past two decades. Overall, the results provide an evidence base for iterating the need to prioritize increasing funding and examine more critically how to improve the efficiency of health spending. It also illustrates potential gains that can be achieved from an inclusive health policy agenda with a broader range of social and economic development issues.

Background: This study offers a comprehensive approach to precisely analyze the complexly distributed length of stay among HIV admissions in Portugal. Objective: To provide an illustration of statistical techniques for analysing count data using longitudinal predictors of length of stay among HIV hospitalizations in Portugal. Method: Registered discharges in the Portuguese National Health Service (NHS) facilities Between January 2009 and December 2017, a total of 26,505 classified under Major Diagnostic Category (MDC) created for patients with HIV infection, with HIV/AIDS as a main or secondary cause of admission, were used to predict length of stay among HIV hospitalizations in Portugal. Several strategies were applied to select the best count fit model that includes the Poisson regression model, zero-inflated Poisson, the negative binomial regression model, and zero-inflated negative binomial regression model. A random hospital effects term has been incorporated into the negative binomial model to examine the dependence between observations within the same hospital. A multivariable analysis has been performed to assess the effect of covariates on length of stay. Results: The median length of stay in our study was 11 days (interquartile range: 6–22). Statistical comparisons among the count models revealed that the random-effects negative binomial models provided the best fit with observed data. Admissions among males or admissions associated with TB infection, pneumocystis, cytomegalovirus, candidiasis, toxoplasmosis, or mycobacterium disease exhibit a highly significant increase in length of stay. Perfect trends were observed in which a higher number of diagnoses or procedures lead to significantly higher length of stay. The random-effects term included in our model and refers to unexplained factors specific to each hospital revealed obvious differences in quality among the hospitals included in our study. Conclusions: This study provides a comprehensive approach to address unique problems associated with the prediction of length of stay among HIV patients in Portugal.

Highly infectious with the possibility of causing severe respiratory complications, the novel COVID-19 began stretching health systems beyond their capacity all over the world and pushing them to breaking points. Giving the devastating effects caused by this infection, unprecedented measures have to be adopted in order to mitigate its impacts on the health system. This perspective aims to review the epidemic of COVID-19 in Portugal, possible areas of improvement, and potential interventions that can help to mitigate the effect of COVID-19 on the Portuguese health system.

Background: Thirty-day hospital readmission is receiving growing attention as an indicator of the quality of hospital care. Understanding factors associated with 30-day hospital readmission among HIV patients in Portugal is essential given the high burden cost of HIV hospitalizations in Portugal, a country suffering from financial constrains for almost 10 years. Objectives: We aimed to estimate the thirty-day hospital readmission rates among HIV patients in Portugal and to identify its determinants using population based data for Portuguese public hospitals. Study design: A multilevel longitudinal population-based study. Methods: Between January 2009 and December 2014 a total of 37,134 registered discharges in the Portuguese National Health Service (NHS) facilities with HIV/AIDS as a main or secondary cause of admission were analyzed. Logistic regression was used to compare 30-day hospital readmission categories by computing odds ratio (OR) and corresponding 95% confidence intervals (95%CI). A normal random effects model was used to determine unmeasured factors specific to each hospital. Results: A total of 4,914 (13.2%, 95%CI: 12.9%-13.6%) of the hospitalizations had a subsequent 30-day readmission. Hospitalizations that included exit against medical opinion (OR=1.18, 95%CI: 1.01-1.39), scheduled admissions (OR=1.71, 95%CI: 1.58-1.85) and tuberculosis infection (OR=1.20, 95%CI: 1.05-1.38) exhibited a higher risk of hospitalizations with subsequent 30-day readmission. On the contrary, hospitalizations that included females (OR=0.87, 95% CI: 0.81-0.94), a transfer to another facility (OR=0.78, 95%CI: 0.67-0.91) and having a responsible financial institution (OR=0.63, 95%CI: 0.55-0.72) exhibited a lower risk of hospitalizations with subsequent 30-day readmission. Hospitalizations associated with higher number of diagnosis, older ages, or hospitalizations during the economic crisis showed an increasing trend of 30-day readmission, whereas an opposite trend was observed for hospitalizations with higher number of procedures. Significant differences exist between hospitals quality, adjusting for other factors. Conclusion This study analyses the indicators of thirty-day hospital readmission among HIV patients in Portugal and provides useful information for enlightening policymakers and health care providers for developing health policies that can reduce costs associated with HIV hospitalizations.