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Silicone breast implants are common but may be associated with a number of complications including implant rupture. This case reports a 38-year-old woman with bilateral breast implants who presented with breast unevenness, triggering a cascade of investigations that identified implant rupture. A computed tomography scan of the thorax showed subpleural enhancing nodules in the left lung of equal density as the implants, repeat computed tomography thorax months later showed no interval changes. In this case, extracapsular rupture causing deposits of silicone via the lymphatic system into the lungs resulted in nodules visible on imaging. Reassuring radiological findings and lack of red flag symptoms led to radiological follow-up and avoided the need for invasive procedures such as biopsy. The authors aim to remind clinicians of the importance of maintaining a high index of clinical suspicion for implant-related pathology and to add to current literature regarding this rare complication.

Background COVID-19 spread globally, including across the Balkans, resulting in different morbidity and mortality outcomes in different countries. The aim of this study was to review the impact of COVID-19 over 17 months with regards to pandemic progression, implemented mitigation strategies, and COVID-19 vaccination programs across the Balkan countries, while identifying any valuable pieces of information acquired serendipitously throughout the pandemic that can be implemented in future action plans. Methods Epidemiological data was obtained from Our World in Data databases, while Ministry of Health websites for each respective country as well as local newspapers were utilized to review COVID-19-related mitigations and vaccination strategies. Case, mortality, and vaccination incidence comparisons were made across neighbouring countries. Results A similar trend in COVID morbidity and mortality outcomes were evident across neighbouring countries. A staggered vaccination rollout was observed, with various rollout speeds, although gradual decline in both morbidity and mortality occurred. Conclusion The COVID-19 outcome for a particular country is not only dependent on the country’s own level of viral transmission, mitigations, and vaccination rates but also on neighbouring countries’ COVID-19 situation. Hence, cross-border governance action and recovery plans are recommended along with targeting vaccination hesitance.

Objectives In this paper, we report the development of the Homeless Health Access to Care Tool. This tool aims to improve the gap in assessing health need and capacity to access healthcare of people experiencing homelessness. Tools exist that prioritise people experiencing homelessness for housing, but none specifically designed to prioritise for healthcare, or that are succinct enough to be easily implemented to emergency department or primary healthcare settings.Design and setting The Homeless Health Access to Care Tool has been adapted from an existing tool, the Vulnerability Index Service Prioritisation Decision Assistance Tool through a five-step process: (1) domain identification, (2) literature review, (3) analysis of hospital admission data, (4) expert judges, and (5) Delphi study.Participants The tool was adapted and developed by homeless health clinicians, academics and people with lived experience of homelessness. The Delphi study (n=9) comprised emergency department and homeless health clinicians.Results Consensus was gained on all but one item, five new items were added, and wording changes were made to six items based on expert feedback. Participants perceived the tool would take between 5 to 11 min to complete, the number of items were appropriate, and the majority agreed it would facilitate the assessment of health needs and capacity to access healthcare.Conclusion Robust development of the Homeless Health Access to Care Tool through the Delphi is the first phase of its development. The Homeless Health Access to Care Tool offers an opportunity to assess both health need and capacity to access healthcare with the aim to improve access to healthcare for people experiencing homelessness. This tool will facilitate standardised data collection to inform service design and data linkage regarding access to healthcare of people experiencing homelessness. The next stages of testing include construct validity, feasibility, usability and inter-rater reliability, and pilot implementation.

A current and pertinent topic is that of gender studies within healthcare students and academic staff of healthcare courses. This commentary explores the feminization of healthcare studies and the extent to which women in Malta hold key roles in academia within the faculties of Health Sciences, Dental Surgery, and Medicine and Surgery at the University of Malta. Data were publicly available from the university website. Gender (male: female ratio) trends were elicited from the data representing each level of qualification as offered by each faculty, while top academic roles within each faculty were noted. As a general trend, the number of students studying healthcare courses has increased, with an increased female-to-male ratio. Yet, in academia, men still occupy top roles. Efforts should be made to cater for all races, ethnicities, genders, sexual orientations, and socioeconomic levels within the healthcare workforce to allow delivery of the best possible service.

BackgroundThe objectives of this scoping review are to investigate the characteristics assessed by existing vulnerability indices and the health outcomes achieved by applying them to people experiencing homelessness. This review forms part of the development and implementation of a novel tool to prioritise people experiencing homelessness for healthcare based on their need and capacity to access healthcare.MethodsIncluded papers were primary research, published in the English language, participants were experiencing homelessness and aged over 18 years at the time of the study, a vulnerability index was used in the study, sample size was greater than 30, and the study had a health focus. Databases searched were MEDLINE, Embase, CINAHL, Scopus, PubMed and Web of Science, between January-April 2020. The Joanna Briggs Appraisal criteria were used to quality appraise the included studies. Results were synthesised narratively.ResultsSix papers were included, a total of 27,509 participants. The reported use of the indices varied; they included screening and profiling homeless populations, comparing homeless populations, and two studies evaluated the predictive capacity, reliability and validity of the indices. One vulnerability index focused on screening for human immunodeficiency virus, one used a 50-item index and four used a nine-item index. No direct health outcomes were reported from applying the vulnerability indices. The studies identified limitations of using vulnerability indices, including the potential bias of relying on self-reported data and two studies highlighted the need for further psychometric testing to ensure validity and reliability of the indices.DiscussionThe sample of included studies was small. Vulnerability indices are reportedly a useful and easily accessible method of gaining valuable data on the health status and health needs of people experiencing homelessness. The variety of characteristics included in the vulnerability indices suggests the importance of tailoring vulnerability indices to the needs of the population to which it is to be applied. Conducting appropriate psychometric testing is critical so that an index can be used to accurately inform decision making and accurately prioritise people experiencing homelessness who are most at risk of mortality and morbidity. A specific tool that prioritises people experiencing homelessness for access to health care is not yet available. The review was funded by a St Vincent's Network Inclusive Health grant.

Climate change and obesity were considered threats to our planet long before the onset of COVID-19. The recent pandemic has enhanced the global burden of both pre-existing crises. The aim of this narrative review is to explore the interaction between the three concurrent crises and the future of our planet should they not be dealt with accordingly. A PubMed and Google Scholar literature search was performed using different combinations of search strategies and using the keywords “obesity”, “climate/temperature change”, “cold/hot temperatures”, and “COVID-19”. High global greenhouse gas (GHG) emissions link obesity and climate change as a result of the interplay between biological and behavioural factors. COVID-19 mitigation measures have indirectly impacted obesity and GHG emissions through the shift in dietary habits, restricted mobility, the impact on healthcare services, and enhanced psychological stress. Furthermore, COVID-19 has a more detrimental effect if acquired by an obese individual, with a higher chance of hospitalization and mechanical ventilation. This leads to higher GHG emissions and negative repercussions on the climate. A tri-directional relationship exists between obesity, climate change, and COVID-19. Various factors contribute to this relationship, but unless urgent global integrated action plans are implemented that target all three calamities, and not just COVID-19, a devastating and unsustainable future may ensue.