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Background Vitamin D levels have been shown to be associated with diabetic retinopathy, however to date, no review has examined the relationship between vitamin D and sight threatening diabetic retinopathy (STDR) and non-sight threatening diabetic retinopathy (NSTDR). The aim of this review, therefore, was to pool associations between vitamin D deficiency (25(OH)D Methods A systematic review of major databases was undertaken for studies published from inception to 22/04/2022, using a pre-published protocol. Studies reporting prevalence of STDR or NSTDR versus a control group with diabetes and no DR or DME and either (a) vitamin D deficiency prevalence, or (b) circulating 25(OH)D levels, were included. A random effects meta-analysis was undertaken. Results Following screening, 12 studies (n = 9057) were included in the meta-analysis. STDR was significantly associated with vitamin D deficiency (OR = 1.80 95%CI 1.40–2.30; p = p = 0.48). Both conclusions were graded as low credibility of evidence. Furthermore, circulating 25(OH)D levels were significantly associated with both NSTDR (SMD = -0.27 95%CI -0.50; −0.04; p = 0.02) and STDR (SMD = −0.49 95%CI -0.90; −0.07; p = 0.02), although these were graded as low credibility of evidence. Conclusion Vitamin D deficiency is significantly associated with STDR (including DME), but not with NSTDR. Given the well-reported associations between vitamin D deficiency and other unfavourable outcomes, it is important that vitamin D deficiency is managed appropriately and in a timely manner to reduce the risk of blindness in people with diabetes.

Background Inappropriate and injudicious use of antimicrobials in broiler and layer farms has become a common practice in lower and middle-income countries including Bangladesh. This study aimed to assess poultry farmers’ knowledge, attitude, and practices regarding antimicrobial usage (AMU), and their beliefs in factors that affect antimicrobial resistance (AMR) spread and emergence in humans through commercial poultry farms in Bangladesh. Methods A cross-sectional study was conducted among 204 farmers (95.6% male; meanage = 35.14 ± 10.25 years) in the Rajshahi district of Bangladesh who were recruited from three upazilas (sub-districts) through a multistage sampling technique. Data were collected from June to November 2021 via face-to-face interviews using a semi-structured questionnaire. Results The proportion of farmers who reported having received information regarding AMU from veterinarians was higher in layer compared to broiler farms (65.9% vs. 44.9%, p < 0.001). A higher proportion of layer compared to broiler farmers believed that antimicrobial residues and pathogens in poultry can pass to humans through the consumption of contaminated eggs (28.1% vs. 5.8%, p < 0.05). The mean score of the farmers’ attitude towards addressing AMU was 4.49 (SD = 1.37) out of 7, with the higher score indicating a better attitude. The mean score of better attitudes towards addressing AMU was significantly higher among educated participants (bachelor’s or higher levels of education (p = 0.006). A higher proportion of layer (56.3%) farmers did not keep a record of AMU when compared to broiler farmers (37.7%) (p = 0.012). More broiler (50.7%) compared to layer (38.5%) farmers continued using the full dose of antimicrobials (p = 0.042). The most frequently used antimicrobials in broiler and layer poultry farms were Colistin (broiler vs layer: 73.9% vs. 86.75%; p = 0.024), and Ciprofloxacin (broiler vs. layer: 95.7% vs. 84.4%; p = 0.021). Farmers’ beliefs were significantly associated with the spread of AMR pathogens from contaminated eggs to humans (p < 0.001). Conclusions The findings reflected that majority of farmers had inadequate knowledge of AMU, less knowledgeable beliefs aboutAMU, and inappropriate AMU (e.g., poor record keeping, incomplete doses) in chicken production systems. The government should ensure education or advisory services for poultry farmers on proper AMU, enforce current veterinary laws and regulations on antimicrobials, and implement AMU surveillance systems.

Aims-\ud \ud Several modifiable risk factors have been meta-analysed for diabetic retinopathy (DR), such as physical activity and vitamin D status. To date, these factors have not been systematically aggregated and the credibility of evidence assessed. Therefore, the aim of this umbrella review was to aggregate all modifiable risks of DR and assess the credibility of the evidence.\ud \ud Methods-\ud \ud An umbrella review of meta-analyses was undertaken. For each meta-analytic association, random-effects effect size, 95% confidence intervals (CIs), heterogeneity, small-study effects, excess significance bias and 95% prediction intervals were calculated. The credibility of significant evidence (p < 0.05) was graded from I to IV, using pre-defined criteria.\ud \ud Results-\ud \ud After initial searches, 13 studies were included covering 34 independent outcomes (total participants = 824,372). Positive associations were found between insulin usage and diabetic macular oedema (RR = 4.5; 95% CI 3.1–6.6), and DR risk (RR = 2.3; 95% CI 1.4–3.9) in people with type 2 diabetes. Vitamin D deficiency was associated with DR risk (OR = 2.8; 95% CI 1.1–7.1), as was obesity (RR = 1.34; 95% CI 1.06–1.68) and sedentary behaviour (RR = 1.22; 95%CI 1.03–1.44). Intensive blood pressure targets (RR = 0.8 95%CI 0.8–1.0), and moderate physical activity (RR = 0.69; 95%CI 0.53–0.91) yielded significant protective associations with DR.\ud \ud Conclusions-\ud \ud People with type 2 diabetes on insulin have a high risk of macular oedema and DR. Vitamin D deficiency yielded almost three times greater odds of DR, while intensive blood pressure control reduces DR risk by 20% and moderate physical activity by 31%. Healthcare professionals should use this evidence to identify those people most at risk to ensure that proper treatment and healthy lifestyles are recommended.

BACKGROUND-\ud \ud The COVID-19 pandemic caused an unprecedented move to emergency remote learning around the world, leading to increased digital screen time for children and adolescents. This review highlights the potential risk of increased screen time to the eye and general health and makes recommendations to mitigate the risks posed.\ud \ud METHODS-\ud \ud A narrative review of evidence of increased digital time during the COVID-19 pandemic, the risks linked to increased screen time and offer possible steps to mitigate these in students.\ud \ud RESULTS-\ud \ud Digital screen time was found to have increased for children and adolescents in all the studies examined during the pandemic and data suggests that this has an impact on eye and general health. We discuss the associated risk factors and adverse outcomes associated with increased digital screen time.\ud \ud CONCLUSIONS-\ud \ud This review offers evidence of increased digital time, highlights some of the well-known and not so well-known risks linked to increased screen time, and offers possible steps to mitigate these in children and adolescents during the pandemic, as well as offering schools and parents strategies to support the eye health of children and adolescents post-pandemic. We discuss a number of interventions to reduce the risk of eye strain, myopia, obesity, and related diseases that have been shown to be linked to increased digital screen time.

Background Several coronavirus disease (COVID-19) vaccines have already been authorized and distributed in different countries all over the world, including Bangladesh. Understanding public acceptance of such a novel vaccine is vital, but little is known about the topic. Objectives This study aimed to investigate the determinants of intention to receive a COVID-19 vaccine and willingness to pay (WTP) among people in Bangladesh. Methods An anonymous and online-based survey of Bangladeshi people (mean age = 29.96 ± 9.15 years; age range = 18–60 years) was conducted using a self-reported questionnaire consisting of socio-demographics, COVID-19 experience, and vaccination-related information as well as the health belief model (HBM). Multivariable logistic regression was performed to determine the factors influencing COVID-19 vaccination intent and WTP. Results Of the 894 participants, 38.5% reported a definite intention to receive a COVID-19 vaccine, whereas 27% had a probable intention, and among this intent group, 42.8% wanted to get vaccinated as soon as possible. Older age, feeling optimistic about the effectiveness of COVID-19 vaccination, believing that vaccination decreases worries and risk of COVID-19 infection, and being less concerned about side effects and safety of COVID-19 vaccination under the HBM construct were found to be significant factors in COVID-19 vaccination intention. Most of the participants (72.9%) were willing to pay for a COVID-19 vaccine, with a median (interquartile range [IQR]) amount of BDT 400/US$ 4.72 (IQR; BDT 200–600/US$ 2.36–7.07) per dose. Factors associated with higher WTP were younger age, being male, having higher education, residing in an urban area, having good self-rated health status, positivity towards COVID-19 vaccination's effectiveness, and being worried about the likelihood of getting infected with COVID-19. Participants who were COVID-19 vaccination intent preferred an imported vaccine over a domestically-made vaccine (22.9% vs. 14.8%), while 28.2% preferred a routine immunization schedule. Conclusion The findings indicate a considerable proportion of Bangladeshi people intended to get vaccinated and had WTP for the COVID-19 vaccine. However, urgent education and awareness programs are warranted to alleviate public skepticism regarding the COVID-19 vaccination.