Gender differences in horizontal strabismus: Systematic review and meta-analysis shows no difference in prevalence, but gender bias towards females in the clinic.

Background: Strabismus is a misalignment of the visual axis that affects 2-3% of the population and can lead to loss of binocular vision. It is currently controversial whether there is a gender difference in the most common form of visual misalignment: horizontal strabismus. Some studies claimed that more females than males have an outward deviation (exotropia), while others concluded that there is no significant gender difference. No previous work has systematically explored gender differences in horizontal strabismus or has compared the results of population-based studies with those of clinic-based studies. Methods: We conducted a systematic review and meta-analysis of studies reporting the prevalence of horizontal strabismus. We included 73 population-based studies and compared their disclosed gender population with that in 141 comparable clinical-based studies. We analysed the data according to gender, strabismus type (esotropia, exotropia), and geographic region/ethnicity. Results: Summary statistics showed a nearly identical prevalence of horizontal strabismus (2.558% for males, 2.582% for females), esotropia (1.386% males vs. 1.377% females), and of exotropia (1.035% males vs. 1.043% females). Meta-analysis results showed that these differences between males and females were not statistically significant (odds ratio (OR) = 1.01; 95% confidence interval (CI) = 0.97-1.10), but that females were significantly more frequent (by 7.50%) in clinic-based studies than males, with 5.00% more females for esotropia, and 12.20% more females for exotropia when adjusted for the population's sex ratio. The extent of the female gender bias differed between geographic regions/societies, with Asians having the lowest bias towards females and Latin American countries having the strongest bias. Conclusions: Males and females have the same prevalence of horizontal strabismus, including exotropia. Females with strabismus seek health care or are brought to clinics significantly more often than males. This is an example of gender bias in health care in favour of females rather than males, apparently because parents - erroneously fearing only cosmetic consequences - are more concerned about strabismus in their daughters than their sons. Societal attitudes towards females, as well as economic factors (insurance status), appear to be relevant factors that determine the magnitude of the gender bias in horizontal strabismus.

High school health education: The impact of medical student led instruction in northern Nevada high schools.

Health education is an important topic in high school given its lasting effect on learners. Medical students are in a unique position to deliver this curriculum as they can provide information from a relatable standpoint. Ten medical students created a health education program, The Healthier Nevada Project (HNVP), designed for high school students using four modules focused on adolescent public health concerns: substance use and addiction, exercise, personal relationships, and stress and mental health. The curriculum was administered to over 700 health class students at three schools in Reno, Nevada, U.S.A., from August 2019-March 2020. This cross-sectional study measured whether the modules increased students' comfort level, familiarity, and likelihood of discussing each topic with a healthcare provider. The method of evaluation was pre- and post-Likert scale surveys with 7-10 questions regarding students' understanding of each topic, knowledge of related resources, and likelihood of future discussions with healthcare providers. Linear regression analysis showed significant increases in mean scores (in all cases p < 0.0001) for all four modules after the training. The modules were adjusted for the cluster effect of School and showed no significant two-way interaction between pre- and post-survey, although overall differences between schools were present. These findings indicate that HNVP significantly increased students' knowledge, comfort, and likelihood of discussing each topic with a healthcare professional following module administration. Future efforts will aim to evaluate the long-term impact of HNVP on student behavior and evaluate if presenter type influences program success among adolescents.