Mobile Health and Wellness Project: A binational collaboration of frontline health services to the Latino population in the United States in times of COVID-19.

Hardly reached communities in the United States greatly benefit from collective efforts and partnerships from Community Based Organizations, Health Institutions and Government Agencies, yet the effort to engage in this collaborative effort is minimal and funding to support these projects is lacking. The COVID-19 Pandemic exacerbated on a national scale what many vulnerable communities experience regularly; difficult access to basic medical care, information and support. In an effort to directly engage with community organizations and curb the infection rate of the COVID-19 virus within vulnerable communities, the US Centers for Disease Control and Prevention (CDC) launched its first targeted effort to partner directly with community based organizations. This article will highlight the first pilot year of activities and key results of COVID-19 education and vaccination efforts by the Mobile Health and Wellness project. This is a fleet of 11 Mobile Health Vehicles managed by the Mexico Section US-Mexico Border Health Commission in partnership with Alianza Americas, Latino Commission on AIDS, and the CDC, targeting Latino, Immigrant and rural communities across the US.

The epidemiological follow-up process for suspected and confirmed cases of COVID-19 in migrant shelters on the northern border of Mexico from July to December 2020: Between contagion underestimation and containment.

Background: Elements associated with an increased risk factor for the contagion of COVID-19 in shelters include the turnover and overcrowding of people, time spent in communal areas, daily supply needs, water availability, and sanitation levels. The "Report on the Effects of the COVID-19 Pandemic on Migrants and Refugees," shows that factors such as the shortage of food, supplies, water, sanitizing materials, spaces for healthy distancing, financial resources for rent and essential services, and the lack of medical or psychological care complicated providing care for migrants and applicants seeking international protection. Objective: We describe shelter operations regarding the detection and follow-up of suspected and confirmed COVID-19 cases showing mild symptoms among the migrant population housed in the border cities under study. Methods: We conducted semi-structured, in-depth interviews with study subjects (people in charge, managers, coordinators, shelter directors) from 22 migrant shelters, and 30 with key informants. We studied the cities of Tijuana (Baja California), Nogales (Sonora), Ciudad Juárez (Chihuahua), Piedras Negras (Coahuila), and Heroica Matamoros (Tamaulipas). The research was based on a qualitative methodological design with an ethnographic approach. The information collected was transcribed and systematized into two tables or analytical templates, one for interviews with study subjects, and another for interviews with key actors. Findings: Overall, seventy-eight registered shelters provided accommodation services for migrants in the five cities the study focused on: thirty-seven in Tijuana, five in Nogales, twenty-two in Ciudad Juárez, eight in Piedras Negras, and five plus a camp (six in total) in Matamoros. The major concentration of shelters was in Tijuana (47.4%) and Ciudad Juárez (28.2%). At the beginning of the pandemic, only a few shelter facilities met quarantine and isolation guidelines, such as having separate bathrooms and sufficient space to isolate the "asymptomatic" and "confirmed" from close "contacts". The lack of isolation space and the inability to support the monitoring of patients with COVID-19 posed a challenge for those housed in shelters, forcing many shelters to close or continue operating behind closed doors to avoid becoming a source of infection during the pandemic. Discussion and outlook: Contrary to speculation, during the onset of the pandemic northern border migrant shelters did not become sources of COVID-19 infection. According to the data analyzed from 78 shelters only seven had confirmed cases, and the classification of "outbreak" was applied only in two facilities. Contagion control or containment was successful as the result of following a preventive containment logic, including the isolation of all suspected but unconfirmed cases, without a clear understanding of the human and financial resources required to maintain isolation areas. However, shelters in the study implemented protocols for epidemiological surveillance, control, and prevention with elements that interfered with monitoring spaces, and processes that caused oversights that resulted in underestimating the number of cases. Limitations: Due to travel restrictions imposed to prevent and contain coronavirus infections it was impossible to stay on-site in the cities studied, except for Tijuana, or carry-out recordings of migrants' views in shelters.

The epidemiological follow-up process for suspected and confirmed cases of COVID-19 in migrant shelters on the northern border of Mexico from July to December 2020: Between contagion underestimation and containment

Background Elements associated with an increased risk factor for the contagion of COVID-19 in shelters include the turnover and overcrowding of people, time spent in communal areas, daily supply needs, water availability, and sanitation levels. The "Report on the Effects of the COVID-19 Pandemic on Migrants and Refugees,” shows that factors such as the shortage of food, supplies, water, sanitizing materials, spaces for healthy distancing, financial resources for rent and essential services, and the lack of medical or psychological care complicated providing care for migrants and applicants seeking international protection. Objective We describe shelter operations regarding the detection and follow-up of suspected and confirmed COVID-19 cases showing mild symptoms among the migrant population housed in the border cities under study. Methods We conducted semi-structured, in-depth interviews with study subjects (people in charge, managers, coordinators, shelter directors) from 22 migrant shelters, and 30 with key informants. We studied the cities of Tijuana (Baja California), Nogales (Sonora), Ciudad Juárez (Chihuahua), Piedras Negras (Coahuila), and Heroica Matamoros (Tamaulipas). The research was based on a qualitative methodological design with an ethnographic approach. The information collected was transcribed and systematized into two tables or analytical templates, one for interviews with study subjects, and another for interviews with key actors. Findings Overall, seventy-eight registered shelters provided accommodation services for migrants in the five cities the study focused on: thirty-seven in Tijuana, five in Nogales, twenty-two in Ciudad Juárez, eight in Piedras Negras, and five plus a camp (six in total) in Matamoros. The major concentration of shelters was in Tijuana (47.4%) and Ciudad Juárez (28.2%). At the beginning of the pandemic, only a few shelter facilities met quarantine and isolation guidelines, such as having separate bathrooms and sufficient space to isolate the "asymptomatic” and "confirmed” from close "contacts”. The lack of isolation space and the inability to support the monitoring of patients with COVID-19 posed a challenge for those housed in shelters, forcing many shelters to close or continue operating behind closed doors to avoid becoming a source of infection during the pandemic. Discussion and outlook Contrary to speculation, during the onset of the pandemic northern border migrant shelters did not become sources of COVID-19 infection. According to the data analyzed from 78 shelters only seven had confirmed cases, and the classification of "outbreak” was applied only in two facilities. Contagion control or containment was successful as the result of following a preventive containment logic, including the isolation of all suspected but unconfirmed cases, without a clear understanding of the human and financial resources required to maintain isolation areas. However, shelters in the study implemented protocols for epidemiological surveillance, control, and prevention with elements that interfered with monitoring spaces, and processes that caused oversights that resulted in underestimating the number of cases. Limitations Due to travel restrictions imposed to prevent and contain coronavirus infections it was impossible to stay on-site in the cities studied, except for Tijuana, or carry-out recordings of migrants' views in shelters.

Mobile Health and Wellness Project: A binational collaboration of frontline health services to the Latino population in the United States in times of COVID-19

Hardly reached communities in the United States greatly benefit from collective efforts and partnerships from Community Based Organizations, Health Institutions and Government Agencies, yet the effort to engage in this collaborative effort is minimal and funding to support these projects is lacking. The COVID-19 Pandemic exacerbated on a national scale what many vulnerable communities experience regularly;difficult access to basic medical care, information and support. In an effort to directly engage with community organizations and curb the infection rate of the COVID-19 virus within vulnerable communities, the US Centers for Disease Control and Prevention (CDC) launched its first targeted effort to partner directly with community based organizations. This article will highlight the first pilot year of activities and key results of COVID-19 education and vaccination efforts by the Mobile Health and Wellness project. This is a fleet of 11 Mobile Health Vehicles managed by the Mexico Section US-Mexico Border Health Commission in partnership with Alianza Americas, Latino Commission on AIDS, and the CDC, targeting Latino, Immigrant and rural communities across the US.

The impact of COVID-19 and access to health services in the Hispanic/Mexican population living in the United States.

Introduction: The United States is home to 10.5 million undocumented immigrants, of which 5 out of 10 are Mexican or Central American. Their immigration status is an obstacle to secure employment that provides labor benefits such as sick leave and health insurance. Living through the global pandemic in the U.S. had a negative impact on this vulnerable population's mental and physical health. They avoided seeking primary or hospital care fearful that they were undocumented and uninsured. The services provided by the Ventanillas de Salud (VDS) "Health Windows" mitigated this pandemic's negative impact and have become an important source to support and increase access to health services among the immigrant community. Methods: De-identified data from a database system called the Continuous Information System and Health Reports of Mexicans in the United States (SICRESAL-MX) to perform this secondary analysis. The descriptive analysis describes socio-demographic, epidemiological, and situational characteristics of COVID-19. Results: Between January 2020 and July 2021, the VDS and UMS provided 11.5 million individual services to just over 4.3 million people. The main health conditions are overweight and obesity, high blood pressure and elevated cholesterol and glucose levels. Between March 2020 to July 2021 a total of 2,481,834 specific services related to COVID-19 were offered. Discussion: The Mexican migrant community in the United States is in a vulnerable situation, largely due to its immigration status which limits their access to health and human services, including primary health care services. Many of them have suffered from chronic diseases since before the pandemic, generating difficulties in monitoring the ailments and exacerbating their conditions.

The impact of COVID-19 and access to health services in the Hispanic/Mexican population living in the United States

Introduction The United States is home to 10.5 million undocumented immigrants, of which 5 out of 10 are Mexican or Central American. Their immigration status is an obstacle to secure employment that provides labor benefits such as sick leave and health insurance. Living through the global pandemic in the U.S. had a negative impact on this vulnerable population's mental and physical health. They avoided seeking primary or hospital care fearful that they were undocumented and uninsured. The services provided by the Ventanillas de Salud (VDS) "Health Windows” mitigated this pandemic's negative impact and have become an important source to support and increase access to health services among the immigrant community. Methods De-identified data from a database system called the Continuous Information System and Health Reports of Mexicans in the United States (SICRESAL-MX) to perform this secondary analysis. The descriptive analysis describes socio-demographic, epidemiological, and situational characteristics of COVID-19. Results Between January 2020 and July 2021, the VDS and UMS provided 11.5 million individual services to just over 4.3 million people. The main health conditions are overweight and obesity, high blood pressure and elevated cholesterol and glucose levels. Between March 2020 to July 2021 a total of 2,481,834 specific services related to COVID-19 were offered. Discussion The Mexican migrant community in the United States is in a vulnerable situation, largely due to its immigration status which limits their access to health and human services, including primary health care services. Many of them have suffered from chronic diseases since before the pandemic, generating difficulties in monitoring the ailments and exacerbating their conditions.

COVID-19 testing, infection, and vaccination among deported Mexican migrants: Results from a survey on the Mexico-U.S. border.

Background: Migrants detained and held in immigration and other detention settings in the U.S. have faced increased risk of COVID-19 infection, but data on this population is scarce. This study sought to estimate rates of COVID-19 testing, infection, care seeking, and vaccination among Mexican migrants detained by U.S. immigration authorities and forcibly returned to Mexico. Methods: We conducted a cross-sectional probability survey of Mexican migrants deported from the U.S. to three Mexican border cities: Tijuana, Ciudad Juárez, and Matamoros (N = 306). Deported migrants were recruited at Mexican migration facilities after being processed and cleared for departure. A two-stage sampling strategy was used. Within each city, a selection of days and shifts were selected during the operating hours of these deportation facilities. The probability of selection was proportional to the volume of migrants deported on each day of the month and during each time period. During the selected survey shifts, migrants were consecutively approached, screened for eligibility, and invited to participate in the survey. Survey measures included self-reported history of COVID-19 testing, infection, care seeking, vaccination, intentions to vaccinate, and other prevention and risk factors. Weighted data were used to estimate population-level prevalence rates. Bivariate tests and adjusted logistic regression models were estimated to identify associations between these COVID-19 outcomes and demographic, migration, and contextual factors. Results: About 84.1% of migrants were tested for COVID-19, close to a third were estimated to have been infected, and, among them, 63% had sought care for COVID-19. An estimated 70.1% had been vaccinated against COVID-19 and, among those not yet vaccinated, 32.5% intended to get vaccinated. Close to half (44.3%) of respondents had experienced crowdedness while in detention in the U.S. Socio-demographic (e.g. age, education, English fluency) and migration-related (e.g. type of detention facility and time in detention) variables were significantly associated with COVID-19 testing, infection, care seeking, and vaccination history. Age, English fluency, and length of detention were positively associated with testing and vaccination history, whereas detention in an immigration center and length of time living in the U.S. were negatively related to testing, infection, and vaccination history. Survey city and survey quarter also showed adjusted associations with testing, infection, and vaccination history, reflecting potential variations in access to services across geographic regions and over time as the pandemic unfolded. Conclusion: These findings are evidence of increased risk of COVID-19 infection, insufficient access to testing and treatment, and missed opportunities for vaccination among Mexican migrants detained in and deported from the U.S. Deportee receiving stations can be leveraged to reduce disparities in testing and vaccination for deported migrants. In addition, decarceration of migrants and other measures informed by public health principles must be implemented to reduce COVID-19 risk and increase access to prevention, diagnostic, and treatment services among this underserved population.

Screening Tool for Mental Health Problems During COVID-19 Pandemic: Psychometrics and Associations With Sex, Grieving, Contagion, and Seeking Psychological Care.

Background: The COVID-19 pandemic has created a public mental health crisis. Brief, valid electronic tools are required to evaluate mental health status, identify specific risk factors, and offer treatment when needed. Objective: To determine the construct validity, reliability, and measurement invariance of a brief screening tool for mental health symptoms by sex, loss of loved ones, personal COVID-19 status, and psychological care-seeking during the COVID-19 pandemic. Furthermore, the aim involved establishing a predictive pattern between the mental health variables. Method: A total sample of 27,320 Mexican participants, with a mean age of 32 years (SD = 12.24, range = 18-80), 67% women (n = 18,308), 23.10% with a loss of loved ones (n = 6,308), 18.3% with COVID-19 status (n = 5,005), and 18.40% seeking psychological care (n = 5,026), completed a questionnaire through a WebApp, containing socio-demographic data (sex, loss of loved ones, COVID-19 status, and psychological care-seeking) and the dimensions from the Posttraumatic Checklist, Depression-Generalized Anxiety Questionnaires, and Health Anxiety-Somatization scales. We used the confirmatory factor analysis (CFA: through maximum likelihood to continuous variable data, as an estimation method), the invariance measurement, and the structural equational modeling (SEM) to provide evidence of the construct validity of the scale and the valid path between variables. We analyzed the measurement invariance for each dimension by comparison groups to examine the extent to which the items showed comparable psychometric properties. Findings: The tool included eight dimensions: four posttraumatic stress symptoms -intrusion, avoidance, hyperactivation, and numbing, as well as depression, generalized anxiety, health anxiety, and somatization The tool's multidimensionality, was confirmed through the CFA and SEM. The participants' characteristics made it possible to describe the measurement invariance of scales because of the participants' attributes. Additionally, our findings indicated that women reported high generalized anxiety, hyperactivation, and depression. Those who lost loved ones reported elevated levels of intrusion and health anxiety symptoms. Participants who reported having COVID-19 presented with high levels of generalized anxiety symptoms. Those who sought psychological care reported high levels of generalized anxiety, intrusion, hyperactivation, and health anxiety symptoms. Our findings also show that intrusion was predicted by the avoidance dimension, while health anxiety was predicted by the intrusion dimension. Generalized anxiety was predicted by the health anxiety and hyperactivation dimensions, and hyperactivation was predicted by the depression one. Depression and somatization were predicted by the health anxiety dimension. Last, numbing was predicted by the depression and avoidance dimensions. Discussion and Outlook: Our findings indicate that it was possible to validate the factor structure of posttraumatic stress symptoms and their relationship with depression, anxiety, and somatization, describing the specific bias as a function of sociodemographic COVID-19-related variables. We also describe the predictive pattern between the mental health variables. These mental health problems were identified in the community and primary health care scenarios through the CFA and the SEM, considering the PCL, depression, generalized anxiety, health anxiety, and somatization scales adapted during the COVID-19 pandemic. Therefore, future studies should describe the diagnosis of mental health disorders, assessing the cut-off points in the tool to discriminate between the presence and absence of conditions and mental health cut-off points. Community and primary care screening will lead to effective early interventions to reduce the mental health risks associated with the current pandemic. Limitations: Future studies should follow up on the results of this study and assess consistency with diagnoses of mental health disorders and evaluate the effect of remote psychological help. Moreover, in the future, researchers should monitor the process and the time that has elapsed between the occurrence of traumatic events and the development of posttraumatic stress and other mental health risks through brief electronic measurement tools such as those used in this study.

Mental Health Symptoms, Binge Drinking, and the Experience of Abuse During the COVID-19 Lockdown in Mexico.

Background: The health crisis associated with the COVID-19 pandemic is causally linked to negative mental health symptoms in the same way as other diseases such as Ebola. Objective: The purpose of this paper is to describe the relationship between mental health symptoms, binge drinking, and the experience of abuse during the COVID-19 lockdown. Method: We surveyed 9,361 participants, all Mexican, with an average age of 33 years old (SD = 10.86). In this group of people, we found out that 59% were single (5,523), 71% were women (6,693). Forty-six percentage were complying with lockdown procedures (4,286), 50% were partially complying (4,682), and 4% were not complying at all (393). The invitation to participate was open from April 24th to April 30th during the second stage of the pandemic in Mexico, in 2020, characterized by voluntary complete lockdown staying at home. Thus, we used a cross-sectional online survey design to assess mental health risk factors related to the COVID-19 pandemic. The survey was available on a WebApp designed by Linux®, PHP®, HTML®, CSS®, and JavaScript®. We calculated descriptive and inferential analysis to describe the mental health average distribution as a function of the lockdown, binge drinking, and experience of abuse. To calculate the reliability and validation of the subscales, we used Cronbach's Alpha and Factor Loading. We run the confirmatory factor loading analysis, and we described the relationship between each latent variable and its item factor load, obtained through structural modeling equations, derived from 179 iterations and 207 parameters (t[1,171] = 28,079.418, p < 0.001). We got a CFI of 0.947, a TLC of 0.940, an RMSEA of 0.049 (0.049-0.050), and an SRMR of 0.048. Findings: The results indicated that reported attitudes such as avoidance, sadness, withdrawal, anger, and anxiety were associated with acute stress, which was linked to an anxiety condition caused by uncertainty about achieving or maintaining overall good health. Discussion and Prospects: People in lockdown mentioned a sudden increase in alcohol consumption. They lived episodes of physical and emotional abuse, in contrast with those who stated that they did not go into lockdown or consume alcohol, or experienced abuse. Limitations: Further studies should diagnose mental health conditions as part of the impact of COVID-19, ensure their follow-up, and assess the effect of providing remote psychological care. There is a need to explore methods to curb the increase in the number of people affected by post-traumatic stress disorder.