CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
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Emergency department visits as a first point of contact for people with mental illness may reflect poor access to timely outpatient mental health care. We sought to determine the extent to which immigrants use the emergency department as an entryway into mental health services. ⋯ Immigrant youth are more likely to present with a first mental health crisis to the emergency department than non-immigrants, with variability by region of origin and time since migration. Immigrants may face barriers to access and use of outpatient mental health services from a physician. Efforts are needed to reduce stigma and identify mental health problems early, before crisis, among immigrant populations.
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Understanding how socioeconomic events influence cause-specific mortality is essential for optimizing disease-control strategies. We characterized long-term trends in cause-specific mortality in a stable population from a very large urban centre. ⋯ Birth cohorts exposed to extreme starvation in early life had increased premature cause-specific mortality in later life. Decreased cause-specific mortality followed improvements in public health, medical infrastructure and pollution control, but not for cancer or diabetes, likely because of exposure to new risk factors.