Objective To determine the relative effectiveness of dietary macronutrient patterns and popular named diet programmes for weight loss and cardiovascular risk factor improvement among adults who are overweight or obese. Design Systematic review and network meta-analysis of randomised trials. Data sources Medline, Embase, CINAHL, AMED, and CENTRAL from database inception until September 2018, reference lists of eligible trials, and related reviews. Study selection Randomised trials that enrolled adults (≥18 years) who were overweight (body mass index 25-29) or obese (≥30) to a popular named diet or an alternative diet. Outcomes and measures Change in body weight, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, systolic blood pressure, diastolic blood pressure, and C reactive protein at the six and 12 month follow-up. Review methods Two reviewers independently extracted data on study participants, interventions, and outcomes and assessed risk of bias, and the certainty of evidence using the GRADE (grading of recommendations, assessment, development, and evaluation) approach. A bayesian framework informed a series of random effects network meta-analyses to estimate the relative effectiveness of the diets. Results 121 eligible trials with 21 942 patients were included and reported on 14 named diets and three control diets. Compared with usual diet, low carbohydrate and low fat diets had a similar effect at six months on weight loss (4.63 v 4.37 kg, both moderate certainty) and reduction in systolic blood pressure (5.14 mm Hg, moderate certainty v 5.05 mm Hg, low certainty) and diastolic blood pressure (3.21 v 2.85 mm Hg, both low certainty). Moderate macronutrient diets resulted in slightly less weight loss and blood pressure reductions. Low carbohydrate diets had less effect than low fat diets and moderate macronutrient diets on reduction in LDL cholesterol (1.01 mg/dL, low certainty v 7.08 mg/dL, moderate certainty v 5.22 mg/dL, moderate certainty, respectively) but an increase in HDL cholesterol (2.31 mg/dL, low certainty), whereas low fat (−1.88 mg/dL, moderate certainty) and moderate macronutrient (−0.89 mg/dL, moderate certainty) did not. Among popular named diets, those with the largest effect on weight reduction and blood pressure in comparison with usual diet were Atkins (weight 5.5 kg, systolic blood pressure 5.1 mm Hg, diastolic blood pressure 3.3 mm Hg), DASH (3.6 kg, 4.7 mm Hg, 2.9 mm Hg, respectively), and Zone (4.1 kg, 3.5 mm Hg, 2.3 mm Hg, respectively) at six months (all moderate certainty). No diets significantly improved levels of HDL cholesterol or C reactive protein at six months. Overall, weight loss diminished at 12 months among all macronutrient patterns and popular named diets, while the benefits for cardiovascular risk factors of all interventions, except the Mediterranean diet, essentially disappeared. Conclusions Moderate certainty evidence shows that most macronutrient diets, over six months, result in modest weight loss and substantial improvements in cardiovascular risk factors, particularly blood pressure. At 12 months the effects on weight reduction and improvements in cardiovascular risk factors largely disappear. Systematic review registration PROSPERO CRD42015027929.

ObjectiveTo determine the relative efficacy of structured named diet and health behaviour programmes (dietary programmes) for prevention of mortality and major cardiovascular events in patients at increased risk of cardiovascular disease.DesignSystematic review and network meta-analysis of randomised controlled trials.Data sourcesAMED (Allied and Complementary Medicine Database), CENTRAL (Cochrane Central Register of Controlled Trials), Embase, Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and ClinicalTrials.gov were searched up to September 2021.Study selectionRandomised trials of patients at increased risk of cardiovascular disease that compared dietary programmes with minimal intervention (eg, healthy diet brochure) or alternative programmes with at least nine months of follow-up and reporting on mortality or major cardiovascular events (such as stroke or non-fatal myocardial infarction). In addition to dietary intervention, dietary programmes could also include exercise, behavioural support, and other secondary interventions such as drug treatment.Outcomes and measuresAll cause mortality, cardiovascular mortality, and individual cardiovascular events (stroke, non-fatal myocardial infarction, and unplanned cardiovascular interventions).Review methodsPairs of reviewers independently extracted data and assessed risk of bias. A random effects network meta-analysis was performed using a frequentist approach and grading of recommendations assessment, development and evaluation (GRADE) methods to determine the certainty of evidence for each outcome.Results40 eligible trials were identified with 35 548 participants across seven named dietary programmes (low fat, 18 studies; Mediterranean, 12; very low fat, 6; modified fat, 4; combined low fat and low sodium, 3; Ornish, 3; Pritikin, 1). At last reported follow-up, based on moderate certainty evidence, Mediterranean dietary programmes proved superior to minimal intervention for the prevention of all cause mortality (odds ratio 0.72, 95% confidence interval 0.56 to 0.92; patients at intermediate risk: risk difference 17 fewer per 1000 followed over five years), cardiovascular mortality (0.55, 0.39 to 0.78; 13 fewer per 1000), stroke (0.65, 0.46 to 0.93; 7 fewer per 1000), and non-fatal myocardial infarction (0.48, 0.36 to 0.65; 17 fewer per 1000). Based on moderate certainty evidence, low fat programmes proved superior to minimal intervention for prevention of all cause mortality (0.84, 0.74 to 0.95; 9 fewer per 1000) and non-fatal myocardial infarction (0.77, 0.61 to 0.96; 7 fewer per 1000). The absolute effects for both dietary programmes were more pronounced for patients at high risk. There were no convincing differences between Mediterranean and low fat programmes for mortality or non-fatal myocardial infarction. The five remaining dietary programmes generally had little or no benefit compared with minimal intervention typically based on low to moderate certainty evidence.ConclusionsModerate certainty evidence shows that programmes promoting Mediterranean and low fat diets, with or without physical activity or other interventions, reduce all cause mortality and non-fatal myocardial infarction in patients with increased cardiovascular risk. Mediterranean programmes are also likely to reduce stroke risk. Generally, other named dietary programmes were not superior to minimal intervention.Systematic review registrationPROSPERO CRD42016047939

Background Stress has a bad impact on mental, physical, psychological health of teacher and it can interfere with job performance and job satisfaction. This study will not only measure the frequency of work related stress among teachers but it also will correlate the work related stress, anxiety and depression with the different risk factors in school environment and their effect on the health status of the teacher. Objective To measure the frequency of work related stress,anxiety and depression among school teachers in governmental schools in kobri el koba district, to measure the frequency and extent to which school teachers are exposed to possible riskfactors of stress in school environment as well as to study the possible effects of work related stress, anxiety, depression on school teachers. participants and Methods A cross-sectional study was conducted on 400 teachers from governmental school in kobri elkoba district and their ages range from 20 to 59years old and the percentage of males (35.8%) is almost half the percentage of the females (64.3%). Results There were significant positive correlations between stresss score, anxiety& depression scores. In Logistic regression for factors favouring having anxiety (E. Sev) among the studied teachers: question number 63 in the sources of administrative stress which is (the lack of the support from the administration) was significant factors that increased the anxiety, while single status was a significant factor that decreased the anxiety. In Logistic regression for factors favouring having depression (Sev/E. Sev) among the studied teachers: School grades (preparatory and secondary) were significant factors that decreased the depresssion, while question number 66 in the sources of administrative stress which is (No participation in the adoption of administrative decisions) also question number 71which is (the school administration interferes with all my responsibilities) were significant factors that increased the depresssion. Conclusion Drawn from this study is that the degree of work related stress, anxiety and depression among teachers in governmental schools in kobri el koba district is considerably high. This indicates that we are in need to do Further studies on teachers for better assessment of the epidemiology of work related stress, anxiety and depression and the risk factors also Intervention studies are highly recommended as the prevelance of stress, anxiety and depression in the present study is almost 100% which is considered extremely high and in need to urgent intervention,Authorities should be informed about the results and should be encouraged to reduce work related stress, anxiety and depression, Asking the competent authorities to increase salaries to be suitable with the requirements of the life, Establishment of committee to assess stress, anxiety and depression among teachers and to suggest the coping strategies,Informal group meeting should be periodically held between managers and the teachers to allow expression of feelings, to promote lines of communication where constructive critical feedback from supervisors and subordinates can be exchanged, and to provide a sense of success through rewards, appreciation and recognition of task completion.

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