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Objectives We investigated whether perceived social support among adolescent students moderated the association between violence exposure and internalising symptoms in São Paulo city, Brazil. Methods We tested the stress-buffering model using data from the cross-sectional school-based, survey São Paulo Project on the Social Development of Children and Adolescents. Internalising symptoms were measured using an adapted version of the Social Behaviour Questionnaire; serious victimisation, being bullied once/week, school violence and community violence, friend and teacher support were scales adapted by the research team; the Alabama Parenting Questionnaire measured parenting style. Linear mixed-effects models were used to quantify moderation effects of (i) social support between violence exposure and internalising symptoms and (ii) gender between violence exposure and internalising symptoms across schools. Results Across schools, being bullied once/week, school violence, and community violence were associated with a significant (p<0.001) increase in internalising symptoms (e.g., bullied b = 5.76, 95% CI 2.26, 9.26; school violence b = 0.48, 95% CI 0.30, 0.67; community violence b = 0.36; 95% CI 0.22, 0.50). Males exposed to all types of violence had significantly lower (p<0.01) internalising symptoms compared to females (e.g., serious victimisation: b = -1.45; 95% CI -2.60, -0.29; school violence b = -0.27; 95% CI -0.30, -0.24; community violence b = -0.23; 95% CI -0.25, -0.20). As a main effect, social support was associated with a significant (p<0.01) decrease in internalising symptoms across schools (e.g., positive parenting b = -2.42; 95% CI -3.12, -1.72; parent involvement b = -2.75; 95% CI -3.32, -2.17; friend support b = -1.05; 95% CI -1.74, -0.34; teacher support b = -0.90; 95% CI -1.58, -0.22). Social support did not moderate the association between violence exposure and internalising symptoms. Conclusions Adolescent students in São Paulo exposed to violence have a higher likelihood of internalising symptoms, compared to those who are not. Support from parents, friends, and teachers, independent of violence, appear to be protective against internalising symptoms, pointing to potential programmes that could improve adolescent mental health.

Conflict-related sexual violence (CRSV) against women and girls has been the subject of increasing research and scholarship. Less is known about the health of men, boys and lesbian, gay, bisexual, transgender (LGBT) and other gender non-binary persons who survive CRSV. This paper is the first systematic realist review on medical, mental health and psychosocial support (MHPSS) interventions that focusses on male and LGBT survivors of CRSV. The review explores the gender differences in context, mechanisms and outcomes that underpin interventions addressing the health and psychosocial wellbeing of male and LGBT survivors. The aim is to contribute to the design and delivery of gender-sensitive and, when needed, gender-specific approaches for interventions that respond to specific needs of different groups of all survivors. We conducted a systematic search of academic and grey literature to identify medical and MHPSS interventions that included men, boys and LGBT survivors. We identified interventions specifically targeting women and girls that we used as comparators. We then purposively sampled studies from the fields of gender and health, and sexual abuse against men and LGBT people for theory building and testing. We identified 26 evaluations of interventions for survivors of CRSV. Nine studies included male survivors, twelve studies focussed exclusively on female survivors and one study targeted children and adolescents. No intervention evaluation focussed on LGBT survivors of CRSV. The interventions that included male survivors did not describe specific components for this population. Results of intervention evaluations that included male survivors were not disaggregated by gender, and some studies did not report the gender composition. Although some mental health and psychosocial consequences of sexual violence against men and boys may be similar among male and female survivors, the way each process trauma, display symptoms, seek help, adhere to treatment and improve their mental health differ by gender. Initiatives targeting male and LGBT survivors of CRSV need to be designed to actively address specific gender differences in access, adherence and response to MHPSS interventions. Models of care that are gender-sensitive and integrated to local resources are promising avenues to promote the health of male and LGBT survivors of CRSV.

Purpose To examine suicide mortality trends among young people (10–24 years of age 1 ) in selected countries and territories of the Americas. Methods An ecological study was conducted using a time series of suicide mortality data from 19 countries and one territory in the Region of the Americas from 2001 to 2008, comprising 90.3% of the regional population. The analyses included age-adjusted suicide mortality rates, average annual variation in suicide mortality rates, and relative risks for suicide, by age and sex. Results The mean suicide rate for the selected study period and countries/territory was 5.7/100,000 young people (10–24 years), with suicide rates higher among males (7.7/100,000) than females (2.4/100,000). Countries with the highest total suicide mortality rates among young people (10–24 years) were Guyana, Suriname, Nicaragua, El Salvador, Chile, and Ecuador; countries with the lowest total suicide mortality rates included Mexico, Venezuela, Cuba, and Brazil, and the U.S. territory of Puerto Rico. During this period, there was a significant increase in suicide mortality rates among young people in the following countries: Argentina, Chile, Ecuador, Mexico, and Suriname; countries with significant decreases in suicide mortality rates included Canada, Colombia, Cuba, El Salvador, and Venezuela. The three leading suicide methods in the Americas were hanging, firearms, and poisoning. Conclusions Some countries of the Americas have experienced a rise in adolescent and youth suicide during the study period, with males at a higher risk of committing suicide than females. Adolescent and youth suicide policies and programs are recommended, to curb this problem. Methodological limitations are discussed.

Background: Although male breast cancer (MBC) is a rare disease, important geographic differences may help elucidate its etiology. For example, MBC in Europe and the U.S. accounts for less than 1% of all breast cancers, whereas incidence in Africa is estimated to be both higher overall and more variable amongst regions. Research from Egypt during the 1970s and 1980s showed higher incidence of MBC than the current incidence of the disease in Egypt. Preliminary studies showed that the proportion of MBC in Morocco as 3% of all breast cancers, which would suggest the possibility of MBC being more common in certain regions of Africa. Little knowledge exists, however, about the actual proportion, risk factors, and clinical characteristics of MBC in Egypt and Morocco. The goals of the current study were to explore the demographic and clinical characteristics of MBC in Egypt and Morocco with a particular focus on place of residence, age at diagnosis, previous medical history including: family history of breast cancer, treatment seeking patterns, and BRCA2 germline and tumor status. Materials and Methods: We analyzed data from Egypt (National Cancer Institute of Cairo University and the Gharbiah population-based cancer registry) for years 1999-2008 and Morocco (Casablanca and Rabat hospital cancer registries) for years 2002-2008. Information was abstracted from medical records and pathology reports (Egypt: N=191; Morocco: N=131) and tissue samples were collected for analysis of BRCA2 expression, as described previously. Results: The 1999-2006 age-adjusted incidence rate for the Gharbiah province in Egypt is 1.79/105. Frequency of MBC, out of all breast cancer cases in Morocco is 2.6%. The median age is 58 years (+/− 15.2) and 66 years (+/− 14.4) for Egypt and Morocco, respectively. At both sites, a majority of patients presented with grade II cancer (Egypt: 78.4%, Morocco: 81.0%). The most common type of cancer was invasive ductal carcinoma (Egypt: 86.5%, Morocco: 68.5%), and both countries presented with a majority of ER positive (Egypt: 81.1%, Morocco: 85.5%) cases. In both countries, most cases came from urban areas (Egypt: 66.0%; Morocco: 67.9%) and were without a family history of any breast cancer (Egypt: 2.0%; Morocco: 3.9%). Immunohistochemical analysis showed BRCA2 protein truncation in 23.1% of Egyptian cases and 26.3% of Moroccan cases. Conclusion: Although the molecular pattern of MBC in North Africa resembles MBC in the US, the higher incidence suggests studies of the CAG repeat polymorphism of the androgen receptor gene, which are ongoing in cases and normal controls to help explain the potential higher risk of MBC in North Africa. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 1813.