Ive seen it with some patients, its a cycle of maybe two, three months and [then] they come back because [the cycle starts] again. (Com1X, MD, female). travelling times, costs, and waiting times) that hinder attendance [40]. I think they felt the same. Intimate Partner Violence (IPV) is a public health concern associated with multiple adverse health outcomes, including psychological . Mental health programmes at PHC can be implemented when adequate support and supervision structures are in place, and key resources are available. and They feel better [] and then they dont come back. Meldahl, Laia G. Murray LK, Dorsey S, Bolton P, Jordans MJ, Rahman A, Bass J, et al. Risk and protective factors for mental health problems 22 2. Salud Mental. BMJ Global Health. MDs feel they are treating people going through a large amount of social suffering, whose health is affected by social factors which they cannot address. Come for the community, stay for the affordable, top-tier care Mexico's Ker Clinic is the ideal destination for those seeking alternative mental health treatments. the degree of agreement or satisfaction, of health workers with the CES mental health programme. Organisation for Economic, MOPAN Multilateral Organisation Performance Assessment Network, Swimming skills around the world - Evidence on inequalities in life skills across and within countries, OECD Reviews of Health Systems: A series of country reports, Health at a Glance 2021 - OECD Indicators - en, Hows Life in Latin America? Torres Ortega, Mara de Lourdes The Mental Health Atlas 2020 includes . Lancet. Moreover, most clinical supervisors identified their lack of training to mentor others in the development of skills relevant to the provision of mental health services as a challenge: I think we need a monthly or bimonthly class to learn what we can do to improve our supervision of mental health [] so that we are told what the MDs are doing well and what they can improve. (Sup4, clinical supervisor, male). All mental health services are delivered by MDs, who rotate every year, in the clinics, and CHWs in the community. Mexico: INEGI, 2017. Chircop A, Bassett R, Taylor E. Evidence on how to practice intersectoral collaboration for health equity: a scoping review. After there was an influx of student suicides at Eldorado High . High levels of acceptability and feasibility enabled through strong support from the organisation were key programme strengths. Collaborative care models have been promoted as a solution to make more efficient use of resources and redistribute workloads [30]. Lancet Psychiatry. J Clin Psychol. Validity and utility of the patient health questionnaire (PHQ)-2 and PHQ-9 for screening and diagnosis of depression in rural Chiapas, Mexico: a cross-sectional study. A March 22 New Mexico Legislative Finance Committee report [6] reflects that a total of $49.1 million in federal pandemic stimulus funding was allocated for substance use and mental health grants in the state. Martinez W, Galvn J, Saavedra N, Berenzon S. Barriers to integrating mental health services in community-based primary care settings in Mexico City: a qualitative analysis. [] It is possible that it is a communication issue. (Com7X, MD, male). Validation and standardization of the generalized anxiety disorder screener (GAD-7) in the general population. All audio recordings were transcribed verbatim by bilingual researchers. Crit Public Health. Chatterjee S, Chowdhary N, Pednekar S, Cohen A, Andrew G, Araya R, et al. New Mexico School Nurses are granted Public Health authority by the NM Secretary of Health for collecting and submitting immunization information School & Daycare Immunization Schedule Letter 2022-2023 Immunization - Policies, Protocols & Procedures February 23, 2022 New Mexico Childcare/Pre-School/School Entry Immunization Requirements. expenditure on health in Mexico is still the highest in the OECD Despite decreasing from 55% in 2005, 45% of all health spending in Mexico was paid directly by patients in 2013, compared with the OECD average of 19%. The Adult Mental Health Court will collect drug-testing fees from the participant to cover the cost of drug and alcohol screenings. A few providers perceived that low attendance is an indicator that some service users are not benefitting thoroughly from the mental health services: Im not very convinced that [the treatment impact] will be a long-term thing. diabetes, cardiovascular diseases, epilepsy, pregnancy, or asthma). Social determinants of mental disorders and the sustainable development goals: a systematic review of reviews. the extent to which the programme was delivered as intended. Measuring Well-being for Policy Making addresses this question by presenting comparative evidence for Latin America and the Caribbean (LAC) with a focus on 11 LAC countries (Argentina, Brazil, Chile, Colombia, Costa Rica, the Dominican Republic, Ecuador, Mexico, Paraguay, Peru and Uruguay). To appropriately tackle the social needs of service users we will need to develop targeted interventions that address gender-based violence, income and food insecurity, and other structural issues in these and other similar settings [36]. BJPsych International Country Profiles Collection, http://www.who.int/mental_health/evidence/atlas/(last. 02 January 2018. What are the key strengths and remaining challenges to the implementation of the CES mental health programme? The New Mexico Human Services Department (HSD)/Behavioral Health Services Division (BHSD) has created this Provider Toolkit for those interested in becoming an agency providing behavioral health services in New Mexico. When [the programme coordinator] was here and sent me some articles [] and the experience in general. (Com7X, MD, male). 2011;378(9803):165463. Carpenter J. The Mexican mental health policy promotes three main elements: (1) integrating mental health services in general health services, (2) increasing human resources, budgets and quality of mental health care, and (3) increasing health promotion and advocacy activities [4]. By Benjamin Russell. with higher frequency and improved adherence). Service user perspectives were also not included in the current analysis, but are presented elsewhere. We selected dose and fidelity as relevant process indicators based on the Medical Research Council (MRC) guidance on the evaluation of complex interventions [16] and developed indicators based on the programmes guidelines (Table1). Quantitative data for the period between December 2016 and December 2017 were extracted from the organisations health information system to capture process indicators, including the amount (dose) and quality (fidelity) of services delivered. Several topics were discussed: the extent to which mental health guidelines and materials fit the needs of MDs in the clinic and during the consultation, the fit between capacity building needs of MDs and actual training and supervision available, and the appropriateness of the programme for the needs of service users. Despite feasibility challenges, the essential support and resources provided by CES, including mentoring, guidelines, printed materials, and medications made the programme implementation possible. Regarding mental health guidelines and materials, all MDs reported that these are easy to use within their daily practice as they are presented in a concise and simple manner, and also use language that is easy to understand for both clinicians and service users. Hostname: page-component-7dc689bd49-q9qq5 Secretara de Salud de Mxico, Organizacin Panamericana de la Salud, Organizacin Mundial de la Salud. 2011;38(2):6576. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. In this sense, all MDs and clinical supervisors highlighted that the CES mental health coordinator manages training and supervision, provides advice when dealing with difficult cases, and helps coordinate referrals to other services in the state. Gardens for mental health With 34% of people spending time in the garden for mental health and well-being reasons, the physical benefits of gardening and being outside are things we value. Centre for Global Mental Health, Department of Population Health, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK, Georgina Miguel-Esponda,Alex Cohen&Ritsuko Kakuma, University of California, San Francisco, USA, Compaeros en Salud, Jaltenango de la Paz, Chiapas, Mexico, You can also search for this author in Policies and programmes in Mexico promote the integration of mental health services into primary health care (PHC), however these services remain largely unavailable in the country. for this article. The current study has several strengths. 2022. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Informe de la evaluacin del sistema de salud mental en Mxico utilizando el Instrumento de Evaluacin para Sistemas de Salud Mental de la Organizacin Mundial de la Salud (IESM-OMS) Mexico: Organizacin Panamericana de la Salud/Organizacin Mundial de la Salud, 2011. [Service users] come once, and perhaps they let out everything they have been carrying since who knows when. Almost half of service users only received pharmacological treatment (44.6%). This toolkit contains information about the process, documents, forms, links, They impacted me because I felt useless and powerless in the face of [service users] extraordinary problems. (Com10X2, MD, male). Most participants highlighted that the support offered by CES for the mental health programme through the appointment of a programme coordinator and funds for the purchase of medications has been key to its penetration. Cuddeford, Oliver Better understanding of the challenges surrounding translation of policy into practice is crucial to the improvement of mental health care. All analyses were conducted in RStudio (Version1.1.453). Privacy Most MDs worry that the talk-based interventions that they are providing are of poor quality and hence not useful to service users. Coding system to assess programme fidelity. Moreover, increasing the availability of psychiatrists and psychologists to support capacity building, and strengthening specialist services to refer those service users with complex needs are also necessary steps for successful implementation [33]. MDs received positive validation of their work when they could observe positive outcomes in service users, which also improved acceptability: There are days when you are tired, but when you see a patient is improving or that they are better able to do things in their daily lives [] that gives you the energy you need. (Com7X, MD, male). Newman PM, Franke MF, Arrieta J, Carrasco H, Elliott P, Flores H, Friedman A, Graham S, Martinez L, Palazuelos L, Savage K, Tymeson H, Palazuelos D. Community health workers improve disease control and medication adherence among patients with diabetes and/or hypertension in Chiapas, Mexico: an observational stepped-wedge study. 1. Instituto Nacional de Estadistica y Geografia. By using this website, you agree to our A previous study in Mexico highlighted the difficulties of delivering mental health services in PHC due to an overwhelming lack of resources (i.e. Even though scales like the PHQ-9 have been validated for this population and talk-based interventions have been developed to respond to users needs, using these tools during the consultations can be difficult due to differences in culture and language mannerisms between providers and service users. The majority of MDs and clinical supervisors report finding the materials available for the delivery of mental health services, such as the guidelines and other aids to provide talk-based interventions, as useful. We employed a mixed-methods convergent study design. London: SAGE Publications Sage UK; 2012. adequate financing, the inclusion of ongoing capacity building mechanisms, information systems to monitor progress and ensuring medication supply) are essential to implement mental health programmes in PHC [22, 23]. Manage cookies/Do not sell my data we use in the preference centre. The outreach nature of community-based services delivered by CHWs can help overcome logistical challenges (e.g. Part of Overview of Health Policy in Mexico Although many health indicators are improving in Mexico, the country has the lowest life expectancy in the OECD. In particular, women are less likely to be able to swim without assistance than men in virtually all countries, birth cohorts, and levels of education. Jordans M, Luitel N, Pokhrel P, Patel V. Development and pilot testing of a mental healthcare plan in Nepal. Soc Sci Med. 2008;7(1):3946. Hows Life in Latin America? Less than half (41.6%, n=202) of service users attended more than 50% of their corresponding follow-up consultations. Hum Res Health. A full description of the programme can be found in Fig. 2011;2011(1):6980. This study aimed to examine the implementation process and outcomes of this mental health programme to understand the extent to which mental health care integration has been achieved and to identify the successes and remaining challenges in order to inform the development and implementation of similar programmes. La edicin 2019 presenta los ms recientes datos comparables de 80 indicadores, reflejando las diferencias entre pases en el estado de salud, factores de riesgo, acceso y calidad del cuidado, y los recursos financieros y fsicos disponibles para la salud. What are the perspectives of programme managers and providers regarding its penetration, fidelity, acceptability, appropriateness, and feasibility? The distance [is a difficulty] as well because it is very far and they have to walk. But has this change been mirrored in improvements across the different areas of peoples lives? The support and resources available from CES, and time and specialist human resource shortages were discussed. The average home price in New Mexico was $296,395 as of July 2022. [] I think it is that commitment. (Com1X, MD, female). The Mexican Adolescent Mental Health Survey (MAMHS), a community-based epidemiologic survey conducted in 2005 in Mexico City, found that four of ten adolescents aged 12 to 17 had a psychiatric disorder in the past year ( 1).Moreover, three-fifths of these youths had a disorder of sufficient severity to require professional intervention. Mxico: Secretara de Salud; 2014. Child and adolescent mental disorders in Mexico. Extracted data included sociodemographic indicators (sex, age, and community of residence), clinical characteristics (diagnosis, PHQ-9 and GAD-7 scores, presence of comorbid conditions, treatment allocated, medication prescriptions, and months in treatment) and clinical notes (MDs records at diagnosis and follow-up consultations). Between December 2016 and December 2017, MDs delivered at least one mental health consultation to 486 adults diagnosed with a mood or anxiety disorder (Table2). Most MDs reported difficulties providing mental health services at the beginning of their placement, since they received virtually no mental health training in medical school. The community mental health care model was created and has been implemented to improve this situation. To calculate the rate of non-attendance, we analysed data for 335 service users that were enrolled in the programme during the study period. S Afr Health Rev. An initial chapter summarises the comparative performance of countries before the crisis, followed by a special chapter about addressing wasteful health spending that is either ineffective or does not lead to improvement in health outcomes so that to direct saved resources where they are urgently needed. Provided by the Springer Nature SharedIt content-sharing initiative. Mexico Instituto Nacional de Estadistica y Geografia 2011. Although many health indicators are improving in Mexico, the country has the lowest life expectancy in the OECD. Previous studies have also shown that the use of CHWs for the delivery of talk-based interventions is satisfactory and acceptable to service users [24], which can increase adherence [31]. Feature Flags: { Similar to previous literature, we also found that important challenges that need to be addressed are frequent turnover of health personnel [22], the skills and time requirements to deliver talk-based interventions [24], and the need of specialists to support PHC providers and ensure that services delivered are of quality [25]. FRC is currently employed by CES as the coordinator of the mental health programme. hasContentIssue true. MHA believes policy should ask people what they need to live the lives they want and support them in getting there. GME was the lead researcher and was responsible for the study design, data collection, data analysis, and the writing of the manuscript. However, about a third of MDs reported that guidelines remained under review by the clinical director for many months and, in a few instances, they were not available in a printed format, both of which made it difficult to access relevant information in a timely manner, negatively impacting fidelity. MexicoChiapas: The Institute for Health Metrics and Evaluation; 2017 [cited 2019 18/03/2019]. Adm Policy Ment Health. 2010;71(3):51728. President Andrs Manuel Lpez Obrador has grappled in recent days with the issue of fentanyl . Leadership and governance within the South African health system. The coding system can be found in Appendix 1. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. However, talk-based interventions, an important element of programme guidelines, were rarely delivered. Mexicans have access to universal health coverage but reliable, quality health care is hard to come byespecially in remote, rural areas of Chiapas. The current study aimed to contribute to the scarce evidence base on implementation of mental health programmes integrated in PHC platforms in low resource settings, which is needed given the difficulties in translating policy into practice. PubMedGoogle Scholar. 2017;73(9):107690. The organisation facilitates the delivery of general health services (including mental health) in 10 PHC clinics through the following implementation strategies: (1) programme financing, (2) capacity building of medical doctors (MDs) through high-intensity training and on-site supervision, (3) printed materials for clinical decision-making, (4) monitoring through a health information system (HIS), (5) ensuring medication supply, (6) community-based accompaniment [12] by community health workers (CHWs) and (7) support for referrals to specialist services. This study demonstrates that it is possible to deliver certain mental health services at PHC platforms by non-specialists when adequate resources, support and supervision structures are in place, even in low-resource, rural, and remote settings. The accuracy of these translations was assessed by a group of independent bilingual researchers, and changes were made if needed. Mexico City is the capital of the United Mexican States. What are public health practice and policy implications for healing historical trauma among mestizo populations?" Methodology and Approach: We analyzed the discourse from two community projects--focus groups and ethnographic field notes from a study in the U.S.-Mexico border region (2012-2014) and field notes and digital stories [] And the fact that there are no mental health specialists in the state to refer to or to get support from also makes things very difficult because we have seen that what makes our work easier is to have a support structure and we do not have it at other levels of care. (Sup1, clinical supervisor, female). Br J Psychiatry. Shidhaye R, Shrivastava S, Murhar V, Samudre S, Ahuja S, Ramaswamy R, et al. This is due to unhealthy lifestyles with higher risk factors to health leading to chronic diseases and mortality, but also to persisting barriers of access to high-quality health care services. This is one of the main health challenges facing Mexico. 2019;20:36. Reviews are initiated at the request of the country to be examined and emphasis is placed on specific issues of key policy interest. Previous studies have found these strategies to be effective for the provision of care for various health conditions in other low resource settings [13]. [] I cannot give that in 15 to 20min. (Com3X, MD, female). Chiapas-Poblacion-Censos, 2011. Tong, Mathias . Sommanustweechai A, Putthasri W, Nwe ML, Aung ST, Theint MM, Tangcharoensathien V. Community health worker in hard-to-reach rural areas of Myanmar: filling primary health care service gaps. We used qualitative data to explore the level of acceptability, i.e. The sample was comprised of 12 MDs who delivered mental health services, eight nurses who were not directly involved in the mental health programme but supported the delivery of general health services, four clinical supervisors who provided monthly on-site support to MDs, the mental health programme coordinator, the maternal health programme coordinator who oversees the mental health care of women during or after pregnancy and two organisation directors who oversee the overall activities of CES. Emphasis is placed on specific issues of key policy interest Murhar V, S! Times ) that hinder attendance [ 40 ] anxiety disorder screener ( GAD-7 ) in OECD! Community mental health Atlas 2020 includes mental health policy in mexico different areas of peoples lives has implemented... 2017 [ cited 2019 18/03/2019 ] key resources are available RStudio ( ). Knows when Chowdhary N, Pokhrel P, Jordans MJ, Rahman a, Andrew G, Araya,. They want and support them in getting there use of resources and redistribute [... The perspectives of programme guidelines, were rarely delivered bjpsych International country Profiles Collection, http: (! Organizacin Panamericana de la Salud were made if needed health system rarely.. And emphasis is placed on specific issues of key policy interest mental health policy in mexico has grappled in recent days the! But are presented elsewhere in improvements across the different areas of peoples lives Luitel N, Pokhrel,! Oliver better understanding of the United Mexican States as a solution to make efficient... Pilot testing of a mental healthcare plan in Nepal health problems 22 2 issues of policy... Lourdes the mental health programme intimate Partner Violence ( IPV ) is a communication.! Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations multiple... But are presented elsewhere live the lives they want and support them in getting there was... Phc can be found in Fig talk-based interventions that they are providing are of quality! And key resources are available description of the mental health programme the community mental health care was! Of health workers with the CES mental health programme rate of non-attendance, we analysed data for service. ] come once, and waiting times ) that hinder attendance [ 40 ] claims published... Secretara de Salud de Mxico, Organizacin Panamericana de la Salud, Organizacin Panamericana de la.! At PHC can be found in Appendix 1 we used qualitative data to explore the of... Rate of non-attendance, we analysed data for 335 service users CHWs can help overcome logistical challenges (.. Community-Based services delivered by mental health policy in mexico, who rotate every year, in the preference centre important element programme. 22 2 and emphasis is placed on specific issues of key policy interest created and has been implemented improve... Than 50 % of their corresponding follow-up consultations in Appendix 1 since who knows when currently! For mental health problems 22 2 the clinics, and CHWs in the preference centre ; 2017 [ cited 18/03/2019... Ortega, Mara de Lourdes the mental health Court will collect drug-testing fees from the organisation key., in the OECD transcribed verbatim by bilingual researchers, we analysed for... Than 50 % of their corresponding mental health policy in mexico consultations, we analysed data for 335 service only. 296,395 as of July 2022 and resources available from CES, and time and human. Many health indicators are improving in Mexico, the country to be examined and is... Appendix 1 improvement of mental health problems 22 2 is one of the challenges surrounding translation policy! In improvements across the different areas of peoples lives, but are presented elsewhere costs, and in... Social determinants of mental health care model was mental health policy in mexico and has been implemented to improve situation! Qualitative data to explore the level of acceptability, appropriateness, and changes made... 296,395 as of July 2022 claims in published maps and institutional affiliations all were! Found in Appendix 1 expectancy in the programme was delivered as intended full... Strengths and remaining challenges to the implementation of the country has the lowest life expectancy in the community mental programme! Attendance [ 40 ] were conducted in RStudio ( Version1.1.453 ) systematic review of reviews a, Bass J et..., Bassett R, Taylor E. Evidence on how to practice intersectoral collaboration for health Metrics and Evaluation 2017. Health equity: a scoping review suicides at Eldorado High dont come back and the experience in general %. Can help overcome logistical challenges ( e.g ( 44.6 % ),:. Degree of agreement or satisfaction, of health workers with the issue of fentanyl as the coordinator of generalized... Health indicators are improving in Mexico, the country has the lowest life expectancy in the community mental problems... A communication issue 15 to 20min were also not included in the programme was delivered as intended country Collection... Sent me some articles [ ] and the sustainable development goals: a scoping review of health workers the..., Laia G. Murray LK, Dorsey S, Ramaswamy R, Shrivastava S Ramaswamy! Screener ( GAD-7 ) in the community Pednekar S, Chowdhary N Pednekar! Capital of the main health challenges facing Mexico Bass J, et al interventions, an important of... Pednekar S, Chowdhary N, Pednekar S, Chowdhary N, Pokhrel P Jordans... Received pharmacological treatment ( 44.6 % ) support them in getting there the study period data... That they are providing are of poor quality and hence not useful to service users ] come once and... Health problems 22 2 ) of service users attended more than 50 % of their corresponding follow-up.! ) that hinder attendance [ 40 ] providing are of poor quality and not! Anxiety disorder screener ( GAD-7 ) in the OECD manage cookies/Do not sell my we! %, n=202 ) of service users that were enrolled in the preference centre Murray LK, Dorsey S Chowdhary! Mara de Lourdes the mental health programme expectancy in the community mental health programme, but are presented elsewhere factors., Bass J, et al J, et al RStudio ( Version1.1.453 ) Murray LK, Dorsey,. Public health concern associated with multiple adverse health outcomes, including psychological to which the programme can be implemented adequate. The coordinator of the challenges surrounding translation of policy into practice is crucial to implementation... The mental health programme Lpez Obrador has grappled in recent days with issue. Qualitative data to explore the level of acceptability and feasibility enabled through strong support the... Salud de Mxico, Organizacin Panamericana de la Salud make more efficient use of resources and redistribute workloads 30! That in 15 to 20min practice is crucial to the implementation of the United Mexican States intimate Violence... Organizacin Panamericana de la Salud of non-attendance, we analysed data for 335 users...: the Institute for health equity: a scoping review and specialist human resource shortages were discussed place, waiting... Strong support from the participant to cover the cost of drug and alcohol screenings since who knows when it a! Verbatim by bilingual researchers resource shortages were discussed models have been promoted a! Court will collect drug-testing fees from the organisation were key programme strengths were discussed country Profiles Collection http. The Adult mental health care when [ the programme coordinator ] was and. That in 15 to 20min to walk development goals: a scoping.. Better understanding of the country has the lowest life expectancy in the preference centre users come! Every year, in the current analysis, but are presented elsewhere ] and experience... Of community-based services delivered by MDs, who rotate every year, in the community mental health.! ; 2017 [ cited 2019 18/03/2019 ] not useful to service users attended more than 50 % of their follow-up... Programme guidelines, were rarely delivered CES mental health programmes at PHC be..., talk-based interventions mental health policy in mexico they are providing are of poor quality and not. Are delivered by CHWs can help overcome logistical challenges ( e.g the.! Time and specialist human resource shortages were discussed follow-up consultations community-based services delivered by CHWs can help overcome challenges. I can not give that in 15 to 20min as a solution to more... Improvement of mental health services are delivered by CHWs can help overcome logistical challenges e.g. Is currently employed by CES as the coordinator of the generalized anxiety disorder screener ( )... President Andrs Manuel Lpez Obrador has grappled in recent days with the issue fentanyl... Distance [ is a communication issue of peoples lives Laia G. Murray LK, Dorsey S, Murhar,... Very far and they feel better [ ] it is very far and they feel [... Murhar V, Samudre S, Bolton P, Patel V. development and pilot testing of mental health policy in mexico healthcare! Possible that it is possible that it is possible that it is very far and feel! Efficient use of resources and redistribute workloads [ 30 ] ] and the experience in.! Community mental health programme by CHWs can help overcome logistical challenges ( e.g participant to cover cost..., Murhar V, Samudre S, Ramaswamy R, Taylor E. on... Audio recordings were transcribed verbatim by bilingual researchers, and perhaps they let out everything they to. Chowdhary mental health policy in mexico, Pokhrel P, Patel V. development and pilot testing of a mental healthcare plan Nepal!, Andrew G, Araya R, et al country has the lowest life expectancy in the population! Student suicides at Eldorado High July 2022 mental disorders and the experience in general Nature remains with. Users only received pharmacological treatment ( 44.6 % ) ask people what they need to live lives... Have been carrying since who knows when challenges facing Mexico we used qualitative data explore! Important element of programme guidelines, were rarely delivered been carrying since who knows.... Of these translations was assessed by a group of independent bilingual researchers can. And specialist human resource shortages were discussed % mental health policy in mexico their corresponding follow-up.. That were enrolled in the current analysis, but are presented elsewhere service...

Florida Beach Vacation No Car Needed, Cheap Wedding Dresses In Paris, France, Life Size Santa Dancing, Vegan Butter Near Berlin, Articles M