Emotional wellbeing and coping among Latinx young adults in the time of COVID-19.

The COVID-19 pandemic has disrupted the wellbeing of the general US population, but even more so among Latinx young adults. The current study provides a detailed picture of the emotional wellbeing and coping of Latinx young adults during the first summer of the pandemic. Six virtual focus groups (n = 21) were conducted between May and August of 2020 with a community-based sample of Latinx young adults to explore (1) how the pandemic affected wellbeing and (2) how they coped with pandemic-related stress. Contextualistic thematic analysis identified important themes and subthemes. Perceived stressors impacting emotional wellbeing yielded one overarching theme: COVID-related disruptions in the participants' environment. To manage this heightened stress, another overarching theme was self-care and intentionality during the pandemic. Future studies should examine the wellbeing of young adults across social contexts and at more recent stages of the pandemic. Findings from this study suggest culturally- and developmentally-tailored interventions are needed as this population navigates contextual stress during a sensitive period in their life.

The intersection of immigration policy impacts and COVID-19 for Latinx young adults.

For many Latinx young adults, COVID-19 has exposed exclusionary policies that heighten risk for contracting the virus and that leave them and their parents unprotected. This study has a dual purpose; first, to quantitatively examine immigration policy impacts of discrimination, isolation, threats to family, and vulnerability, and their association to economic consequences experienced by Latinx young adults in Central Texas during the initial months of the COVID-19 pandemic. Second, to qualitatively explore how policy impacts affected Latinx young adults during the pandemic, and the coping mechanisms they utilized to minimize these impacts. Quantitative results show that on average, Latinx young adults (N = 83) reported low discrimination and isolation but moderate threats to family and vulnerability, with rates of isolation and vulnerability higher for foreign-born than U.S.-born Latinx young adults. Perceived discrimination due to one's own or family immigration status was associated with economic hardship. Qualitative findings show that Latinx young adults (n = 21) experienced (a) precarious conditions that pose a threat of COVID-19 infection for Latinxs, (b) parental job loss due to vulnerable employment leads to deprivation, and (c) policies that disproportionally discriminate against the Latinx community and exclude them from vital services. Despite these challenges, participants also drew on resilience and expressed hope for the future. The article concludes with implications for policymakers and practitioners to provide protections and services to Latinx young adults and their family members.

Economic and Social Consequences of COVID-19 and Mental Health Burden Among Latinx Young Adults During the 2020 Pandemic.

Latinx young adults 18-25 years old face unique challenges that disproportionately put them at high risk of experiencing health as well as economic and social burden due to the Coronavirus disease (COVID-19) pandemic. The present study examined how economic and psychosocial consequences as a result of the pandemic were associated with mental health issues among a community sample of Latinx young adults (N = 83) from Central Texas. Participants completed an online survey of COVID-related experiences and mental health needs. The survey asked about personal and family experiences of COVID-19 in two significant areas: (a) economic strain (e.g., economic hardship, food insecurity) and (b) psychosocial burden (e.g., losing relationships, substance use). Regression analyses examined the association of COVID-19 consequences on level of mental health symptoms and clinically significant outcomes. Relative to economic consequences, psychosocial consequences due to the COVID-19 pandemic were associated with higher levels of mental health symptoms. In contrast, in few cases, economic strain resultant from the pandemic was correlated with clinically significant outcomes among this sample. Collectively, findings suggest that the costs of the pandemic do not only pertain to mortality from illness but also to morbidity as it relates to deteriorating social circumstances and mental health. Findings from this study call for immediate attention to implement policies and programs to help mitigate the economic and social-emotional consequences of COVID-19 such as easy access to low-cost virtual mental health resources to Latinx young adults.

Los adultos jóvenes latinos de 18 a 25 años enfrentan desafíos únicos que los ponen de manera desproporcionada en un alto riesgo de sufrir consecuencias de salud, económicas y sociales debido a la pandemia del COVID-19. El estudio presente examinó cómo las consecuencias económicas y psicosociales a raíz de la pandemia se asociaron con problemas de salud mental en una muestra comunitaria de adultos jóvenes latinos (N = 83) del centro de Texas. Los participantes completaron una encuesta en línea sobre experiencias relacionadas con el COVID-19 y necesidades de salud mental. La encuesta incluyó preguntas sobre las experiencias personales y familiares del COVID-19 en dos áreas importantes: (a) tensión económica (por ejemplo, dificultades económicas, inseguridad alimentaria) y (b) carga psicosocial (por ejemplo, pérdida de relaciones, consumo de sustancias). Los análisis de regresión examinaron la asociación de las consecuencias del COVID-19 en el nivel de los síntomas de salud mental y los resultados clínicamente significativos. En comparación a las consecuencias económicas, las consecuencias psicosociales debido a la pandemia de COVID-19 se asociaron con niveles más altos de síntomas de salud mental. Por el contrario, en unos pocos casos, la tensión económica resultante de la pandemia se correlacionó con resultados clínicamente significativos en esta muestra. En conjunto, los hallazgos sugieren que los costos de la pandemia no solo se refieren a la mortalidad por enfermedad, sino también a la al deterioro de las circunstancias sociales y la salud mental. Los hallazgos de este estudio exigen atención inmediata para implementar políticas y programas que ayuden a mitigar las consecuencias económicas y socioemocionales del COVID-19, como el fácil acceso a recursos virtuales de salud mental de bajo costo para adultos jóvenes latinos.

Occupational Stress and Mental Health Among Healthcare Workers Serving Socially Vulnerable Populations During the COVID-19 Pandemic.

The purpose of this study was to analyze occupational and personal stressors, mental health indicators, perceived discrimination and help-seeking behaviors among healthcare workers and providers (HCWPs) serving socially vulnerable groups such as immigrants, refugees, farmworkers, homeless individuals, people living in poverty, and other disadvantaged populations in the United States (U.S.) during the COVID-19 pandemic. Using a cross-sectional descriptive approach, we gathered information between July and September 2020, from a sample of 407 affiliates of two national organizations of clinic-based HCWPs who worked at federally funded and community safety-net clinics. Informed consent was obtained from all participants who completed a self-administered online survey available in English and Spanish. Our results indicated that the HCWPs serving vulnerable groups in the midst of the pandemic experienced high levels of occupational and personal stressors as well as anxiety and depressive symptomology. Major occupational stressors were excessive workload, long working-hours, and institutional barriers to refer and follow-up on their clients' access to needed social services. High-rated personal stressors included sleep disorders, lack of and child-care, partner's loosing job, and other family related situations. Our findings suggest that HCWPs working with vulnerable populations need specialized interventions that bolster their mental health and well-being as the pandemic continues to unfold. We recommend implementing initiatives that encourage HCWPs' to be actively involved in clinic decisions regarding employee safety and protection as well as in management decisions to improve work place infrastructure and capacity to respond to the social needs of their clients. Lessons learned from the pandemic are useful tools in designing protocols for addressing the mental-health needs of HCWPs in health-care organizations that attend to socially underprivileged populations.

The Witness to Witness Program: Helping the Helpers in the Context of the COVID-19 Pandemic.

The Witness to Witness Program (W2W), based on Weingarten's witnessing model (2000, 2003, 2004), began in July 2018 and originally was established to support healthcare workers and attorneys (our partners) who were experiencing empathic distress working with people involved in various stages of the detention process. The W2W program evolved to offer four primary components: clinician listening sessions geared to deep understanding of the person's story of their work and its challenges; an inventory of the person's current internal and external resources both in the present and in the past; help with removal of barriers to those resources; and development of a personal toolkit to handle stress. Additional services available to partners and their organizations included psycho-educational webinars, facilitated peer support groups, and organizational consultations to foster trauma-sensitive and resilience-hardy work environments. In March, after lockdowns due to the coronavirus pandemic, W2W pivoted to focus on handouts and webinars addressing how to cope with distress and moral injury, maintaining resilience, coping with grief, and dealing with multiple losses caused by the pandemic. Disaster sparked collaboration and innovation. A train the trainer model was developed to reach more community health workers providing services to the Latinx community dealing with losses similar to those experienced by the clients they serve. W2W continues to create virtual communities of support. In doing so we practice doing reasonable hope together (Weingarten, Family Process, 2010, 49, 5).

El "Programa de testigo a testigo" (Witness to Witness Program, W2W), basado en el modelo de testigos de Weingarten (2000, 2003, 2004), comenzó en julio de 2018 y se creó originalmente para apoyar a los trabajadores sanitarios y a los abogados (nuestros socios) que estaban sufriendo distrés empático al trabajar con personas implicadas en varias etapas del proceso de detención. El programa W2W evolucionó y ahora ofrece cuatro componentes principales: sesiones de escucha con el clínico orientadas a una comprensión profunda de la historia del trabajo de la persona y sus dificultades; un inventario de los recursos externos e internos actuales de la persona tanto en el presente como en el pasado; ayuda con la eliminación de obstáculos para acceder a esos recursos; y desarrollo de un conjunto de herramientas personales para manejar el estrés. Otros servicios disponibles para los socios y sus organizaciones fueron seminarios web psicoeducativos, grupos de autoayuda con facilitadores y consultas organizacionales para fomentar entornos de trabajo donde se priorice la sensibilidad al trauma y la resiliencia. En marzo, después de los confinamientos por la pandemia del coronavirus, el W2W dio un giro para centrarse en folletos y seminarios web que abordan cómo afrontar el distrés y el daño moral, mantener la resiliencia, afrontar el duelo y soportar numerosas pérdidas causadas por la pandemia. La catástrofe generó colaboración e innovación. Se desarrolló un modelo para capacitar a los capacitadores a fin de llegar a más trabajadores sanitarios de la comunidad que prestan servicios a la comunidad latina a la hora de afrontar pérdidas similares a las sufridas por los pacientes a quienes atienden. El W2W continúa creando comunidades virtuales de apoyo. Al hacerlo, ensayamos una esperanza razonable juntos (Weingarten, 2010b).

Cost-of-Care Conversations During Clinical Visits in Federally Qualified Health Centers: An Observational Study.

Background: The Centers for Disease Control and Prevention estimates that 10% of the U.S. population delays or avoids health care because of cost concerns. It is unknown whether and how cost-of-care conversations occur in primary encounters, especially settings that provide care to vulnerable patients. Objective: To describe cost-of-care conversations with financially vulnerable (<400% federal poverty level) adult patients during clinical encounters. Design: Five observers shadowed a convenience sample of patients during encounters and then interviewed patients and clinicians after the encounter. Setting: Federally Qualified Health Centers in Texas (n = 2) and Pennsylvania (n = 2). Participants: A convenience sample of 67 adult patients seeking chronic disease management or prenatal care from 9 clinicians (5 medical doctors, 2 physician assistants, and 2 nurse practitioners). Measurements: Self-reported characteristics of patients, and frequency and characteristics of interviewer-observed cost-of-care conversations. Results: Because of missing responses from patient and clinician interviews, data are reported for 67 consenting patients. During 46.3% of encounters, some discussion of costs of care was observed. Discussion of indirect costs (lost work time or transportation) was observed in only 2.9% of encounters. In only 11.9% of encounters did the physician discuss costs of care. When costs were discussed, the conversation was not organized and did not take place in conjunction with the discussion of the treatment plan. Limitations: This exploratory work involved a small convenience sample, and generalizability to other settings is uncertain. Missing data prohibited meaningful analysis of patient and clinician interview data. Conclusion: In the 4 federally funded health centers studied, cost-of-care conversations occurred in a minority of clinical visits, discussions were unorganized, and indirect costs of care were rarely addressed. Whether more frequent discussion of the costs of care improves patient adherence and outcomes requires further study. Primary Funding Source: Robert Wood Johnson Foundation.

Caracterización clinicoepidemiológica de pacientes con fracturas de cadera / Clinical epidemiological characterization of patients with hip fractures

Se hizo un estudio descriptivo y transversal de 128 pacientes ingresados con fractura de cadera en el Servicio de Ortopedia y Traumatología del Hospital Clinicoquirúrgico Docente "Dr. Ambrosio Grillo" de Santiago de Cuba, desde junio del 2008 hasta mayo del 2009, con vistas a caracterizarles según determinadas variables clinicoepidemiológicas. Dichas lesiones resultaron más frecuentes en el grupo etario de 80-89 años y el sexo femenino, con predominio de las fracturas traumáticas extracapsulares, tratadas quirúrgicamente con reducción y osteosíntesis en 45,3 % de los afectados durante las primeras 24 horas de hospitalización. En 61,4 % del total se presentó alguna complicación como la anemia aguda e infección de la herida; no obstante, la mayoría de los integrantes de la casuística (96,9 %) egresó con vida.

A descriptive and cross-sectional study was carried out in 128 patients with hip fractures admitted to the Orthopedics and Traumatology Department at "Dr. Ambrosio Grillo" Teaching Clinical Surgical Hospital in Santiago de Cuba from June 2008 to May 2009, in order to characterize them according to certain clinical epidemiological variates. These injuries were more frequent in the age group of 80-89 years and in female sex, with a predominance of extracapsular traumatic fractures, treated surgically with reduction and osteosynthesis in 45,3 % of patients during the first 24 hours of hospitalization. There were some complications as acute anemia and wound infection in 61,4 % of the total; however, most cases (96,9 %) were discharged alive.

Caracterización clinicoepidemiológica de pacientes con fracturas de cadera / Clinical epidemiological characterization of patients with hip fractures

Se hizo un estudio descriptivo y transversal de 128 pacientes ingresados con fractura de cadera en el Servicio de Ortopedia y Traumatología del Hospital Clinicoquirúrgico Docente Dr Ambrosio Grillo de Santiago de Cuba, desde junio del 2008 hasta mayo del 2009, con vistas a caracterizarles según determinadas variables clinicoepidemiológicas. Dichas lesiones resultaron más frecuentes en el grupo etario de 80-89 años y el sexo femenino, con predominio de las fracturas traumáticas extracapsulares, tratadas quirúrgicamente con reducción y osteosíntesis en 45,3 por ciento de los afectados durante las primeras 24 horas de hospitalización. En 61,4 po ciento del total se presentó alguna complicación como la anemia aguda e infección de la herida; no obstante, la mayoría de los integrantes de la casuística (96,9 por ciento) egresó con vida(AU)

A descriptive and cross-sectional study was carried out in 128 patients with hip fractures admitted to the Orthopedics and Traumatology Department at Dr Ambrosio Grillo Teaching Clinical Surgical Hospital in Santiago de Cuba from June 2008 to May 2009, in order to characterize them according to certain clinical epidemiological variates. These injuries were more frequent in the age group of 80-89 years and in female sex, with a predominance of extracapsular traumatic fractures, treated surgically with reduction and osteosynthesis in 45,3 percent of patients during the first 24 hours of hospitalization. There were some complications as acute anemia and wound infection in 61,4 percent of the total; however, most cases (96,9 percent) were discharged alive.

The migrant clinicians network: connecting practice to need and patients to care.

Migrant Clinicians Network advocates for migrants and clinicians, develops appropriate resources, engages outside partners, conducts translational research, and runs programs that support clinical care on the front line of migrant health. Migrant Clinicians Network's goal is to improve health care for migrants by providing support, technical assistance, and professional development to clinicians in Federally Qualified Health Centers and other healthcare delivery sites with the ultimate purpose of providing quality health care that increases access and reduces disparities for migrant farmworkers and other mobile underserved populations. In this article the authors examine the migrant population in the United States, a brief history of clinicians working in migrant health, and the scope of current Migrant Clinicians Network activities, including occupational and environmental health.