Changes in mental health problems during the COVID-19 pandemic in Mexican youth: Insights from the Voces-19 study.

BACKGROUND: Previous research suggests that the mental health impacts of the COVID-19 pandemic were stronger during the first months of it. It has also been proposed that those impacts depended on gender and other social determinants. AIMS: We aim to describe the change in prevalence of mental health problems (symptoms of common mental disorders [CMD], alcohol, and drug use) between two time periods during the pandemic, and the association of mental health problems with social determinants, in adolescents and young adults in Mexico. METHODS: We conducted a repeated cross-section analysis of data from VoCes-19, an online survey in November 2020 to February 2021 and November 2021 to March 2022 (combined n = ×224,099). We assessed the change in the prevalence of mental health problems, the differences in prevalence and change in the prevalence by gender, and the association of social determinants and pandemic-related variables with mental health problems, by means of multivariate regression models. RESULTS: The prevalence of CMD decreased (46.0% vs. 42.4%), while the prevalence of alcohol (frequent use 8.4% vs. 10.3%) and drug use (4.6% vs. 7.7%) increased. The three conditions increased more among girls/young women and trans/queer/non-binary participants than among boys/young men. CONCLUSIONS: The results point to the importance of considering the gendered social context of young people. A better understanding of the social circumstances that relate with mental health is required to inform interventions for these age groups.

Access to Health Care for Migrants Along the Mexico-United States Border: Applying a Framework to Assess Barriers to Care in Mexico.

Background: Migrants in Mexico are entitled to care at all levels, independently of their migration status. However, previous studies show that access to care is difficult for this population. As the movement of in-transit migrants and asylum seekers has been interrupted at the Mexico-United States border by migration policies such as the "Remain in Mexico" program, and by border closures due to the COVID-19 pandemic, the Mexican health system has the challenge of providing them with health care. Levesque et al.'s framework, according to which access occurs at the interface of health system characteristics and potential users' abilities to interact with it, is a useful theoretical tool to analyze the barriers faced by migrants. Objective: The objective of this article is to analyze the barriers to access the public Mexican health system, encountered by migrants in cities in Mexican states at the Mexico-United States border during the COVID-19 pandemic. Methods: Data came from a multiple case study of the response of migrant shelters to health care needs during the COVID-19 pandemic. The study consisted of a non-probability survey of migrants with a recent health need, and interviews with persons working in civil society organizations providing services to migrants, governmental actors involved in the response to migration, and academics with expertise in the subject. We analyzed the quantitative and qualitative results according to Levesque et al.'s framework. Results: 36/189 migrants surveyed had sought health care in a public service. The main limitations to access were in the availability and accommodation dimension (administrative barriers decreasing migrants' ability to reach the system), and the affordability dimension (out-of-pocket costs limiting migrants' ability to pay). Civil society organizations were a major source of social support, helping migrants overcome some of the barriers identified. Conclusions: While Mexico's health regulations are inclusive of migrants, in practice there are major barriers to access public health services, which might inhibit migrants from seeking those services. In order to comply with its commitment to guarantee the right to health of all persons, the Mexican health authorities should address the implementation gap between an inclusive policy, and the barriers to access that still remain.

Migrant shelters' response to COVID-19: Comparative case study in four cities close to the Mexico-United States border.

Introduction: In the context of a health contingency such as the current COVID-19 pandemic, some groups may remain invisible, so that their health needs go unnoticed. These groups include migrants, asylum seekers, and refugees (MAR). In Mexico there is a network of migrant shelters (casas del migrante-CM) that provide humanitarian assistance, including access to heath care. Given the major role of the CM in caring for migrants, it was important to identify the main elements of their internal capacities, and of the external resources in the cities in which they are located, that contributed to their role in protecting MRA`s health during the COVID-19 pandemic. Methods: we use a comparative case study approach to understand, explain, and compare how internal capacities and external resources available to four CM in the north of Mexico, influenced the development and implementation of COVID-19 related strategies to protect MRA. The project took place during 2021 in Saltillo and Piedras Negras in Coahuila; Ciudad Juarez, Chihuahua, and in Monterrey, Nuevo Leon. A total of 18 in-depth interviews were performed with key actors from the CM, academia, health care services and international agencies. Results: We found a range from a total closure of one CM, to the continuation of operation of three of them, with differences in the strategies developed to provide services and avoid infections within the facilities. MARs' still face multiple barriers to exercise their right to health, and the response of local governments towards migration and health impacts the response that CM were able to implement. Conclusion: There is a need to strengthening the preparedness and response capacities and coordination mechanisms of local, state and federal authorities to attain their responsibilities in the provision of services directed to MAR, including access to health care.

In-Transit Migrants And Asylum Seekers: Inclusion Gaps In Mexico's COVID-19 Health Policy Response.

During the COVID-19 pandemic, as immigration and asylum processes were delayed or interrupted, migrants and asylum seekers were stranded at Mexico's northern border. In-transit migrants and asylum seekers are an underserved population, and pandemic preparedness has seldom taken their needs into account. In this article we analyze public health policies developed in Mexico in response to the COVID-19 pandemic and describe how these policies have largely overlooked the needs of vulnerable mobile populations. We reviewed eighty publicly available documents issued by federal, state, and municipal authorities in Mexico between January and September 2020. Only seven policy documents explicitly considered in-transit migrants and asylum seekers and their health care needs. In addition, we identified six major gaps in these policies that, if addressed, would promote greater inclusion of persons in mobility in future pandemic response plans, to protect the health of migrant populations.

Macrofollicular Variant of Papillary Thyroid Carcinoma: A Case and Control Analysis.

The planimetric, flow cytometric, and immunohistochemical characteristics of the macrofollicular variant of papillary thyroid carcinoma (MFVPTC) have not been reported before. The clinical, morphological, immunohistochemical, planimetric, and flow cytometric characteristics of six cases of the MFVPTC and six of the follicular variant of papillary thyroid carcinoma (FVPTC) were analyzed. Patients had undergone surgical treatment. The mean age was 38 (range 29-64 yr), and five were women. Tumors had a mean size of 3.2 cm (range 0.3-4.5 cm). Half were originally diagnosed as goiter. Macrofollicles had a mean diameter of 345.5 um, perimeter of 1237 um, and area of 13,779 um(2), with nuclear changes of PTC. Mean follow-up was 107 mo (range 12-277), and neither lymph node metastases nor recurrence were seen. Differences in diameter, perimeter, and area between the macrofollicular and follicular variants were found. Follicular neoplastic cells were thyroglobulin and 5-100 protein positive in macrofollicles and normofollicles. All were negative to cytokeratin and to high-mol-wt keratin. All tumors were diploid. There were no significant differences in follow-up, DNA content, nor immunohistochemical reactivity. Differences in diameter (p < 0.00006), perimeter (p < 0.0001), and area (p < 0.001) were observed. It is important to recognize this variant because it could be misdiagnosed as benign thyroidal lesions.