Regular physical activity is beneficial for reducing mortality in patients with high BP. More research is needed to establish the impact of specific kinds of physical activity and whether any differences exist between sexes.

Canadian women are twice as likely to be severely obese compared to men, are more likely to be physically inactive, and comprise the majority of patients undergoing bariatric treatment for severe obesity. Physical activity (PA) is one of the strongest predictors of successful long-term weight management and is a recommended adjunct to bariatric surgery. However, patients often do not increase levels of PA following surgery and physical inactivity among severely obese women remains poorly understood. Twelve women (mean age 47±9 years), who had undergone bariatric surgery in the last two years, were interviewed to explore perceptions of barriers and facilitators to PA.

BackgroundSyncope, or fainting, affects approximately 6.2% of the population, and is associated with significant comorbidity. Many syncopal events occur secondary to excessive venous pooling and capillary filtration in the lower limbs when upright. As such, a common approach to the management of syncope is the use of compression stockings. However, research confirming their efficacy is lacking. We aimed to investigate the effect of graded calf compression stockings on orthostatic tolerance.Methodology/Principal FindingsWe evaluated orthostatic tolerance (OT) and haemodynamic control in 15 healthy volunteers wearing graded calf compression stockings compared to two placebo stockings in a randomized, cross-over, double-blind fashion. OT (time to presyncope, min) was determined using combined head-upright tilting and lower body negative pressure applied until presyncope. Throughout testing we continuously monitored beat-to-beat blood pressures, heart rate, stroke volume and cardiac output (finger plethysmography), cerebral and forearm blood flow velocities (Doppler ultrasound) and breath-by-breath end tidal gases. There were no significant differences in OT between compression stocking (26.0±2.3 min) and calf (29.3±2.4 min) or ankle (27.6±3.1 min) placebo conditions. Cardiovascular, cerebral and respiratory responses were similar in all conditions. The efficacy of compression stockings was related to anthropometric parameters, and could be predicted by a model based on the subject's calf circumference and shoe size (r = 0.780, p = 0.004).Conclusions/SignificanceThese data question the use of calf compression stockings for orthostatic intolerance and highlight the need for individualised therapy accounting for anthropometric variables when considering treatment with compression stockings.

Despite decades of pain research, substandard pain management continues to be distressingly prevalent across health-care settings. This integrative literature review analyzes and synthesizes barriers to effective pain management and identifies areas for future investigation in a Canadian context. Three sets of key barriers were identified through thematic analysis of 24 original research studies published in the period 2003-13: patient, professional, and organizational. These barriers rarely occurred in isolation, with many studies reporting examples in all three categories. This suggests that interventions need to reflect the multifactorial nature of pain management. Reframing pain education as a public health initiative could lead to sustainable improvement, as could the strengthening of partnerships between patients and health-care providers. There are tremendous opportunities for the advanced practice nurse to take a lead in pain management. The delivery of high-quality care that encompasses effective pain management strategies must be a priority for nursing. Research approaches, such as pragmatic mixed methods, that offer contextual understanding of how pain is managed are suggested.

An informational piece provided by the Obesity Action Coalition (OAC) and the Rudd Center for Food Policy and Obesity What is Weight Bias? Weight bias refers to negative stereotypes directed toward individuals affected by excess weight or obesity, which often lead to prejudice and discrimination. Weight bias is evident in many aspects of living such as healthcare, education, employment, the media and more. The prevalence of weight discrimination in the United States is comparable to racial discrimination. Since the majority of Americans are now affected by excess weight or obesity, this is an important clinical concern, one that no healthcare provider can afford to ignore.

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surgical treatment. The primary outcome was weight change (kg). Between-group changes were analyzed using multivariable regression adjusted for age, sex, and baseline weight and "last-observation-carried-forward" was used for missing data. Subjects crossing over to the next treatment phase (wait-listed to medical management or medical management to surgery) were censored at the time of crossover. Results: At baseline, mean age was 43.7AE9.6 yrs, mean weight was 131.9AE25.1 kg, mean BMI was 47.9AE8.1 kg/m2, and 88% were female. 412 subjects (82%) completed 2-year follow-up and 143 (29%) subjects crossed over to the next treatment phase. Absolute and relative (% of baseline) mean weight reductions were 1.5AE 8.5 kg (0.9AE6.1%) for wait-listed subjects, 4.1AE11.6 kg (2.8AE8.1%) for medical management, and 22.0AE19.7 kg (16.3AE13.5%) for surgery (p<0.001). The proportion of subjects who achieved at least 10% weight loss was 9% for wait-listed, 17% for medically managed, and 63% for surgery (p<0.001). Within the surgery group, weight reductions were 7.0AE9.7 kg (5.8AE7.9%) with banding, 21.4AE16.0 kg (16.4AE11.6%) with sleeve gastrectomy, and 36.6AE19.5 kg (26.1AE12.2%) with gastric bypass (p<0.001). Rates of hypertension, diabetes, and dyslipidemia decreased to a significantly greater degree with surgery than medical management (p<0.001) and stayed the same or increased in wait-listed subjects. Interpretation: Population-based medical and surgical bariatric care was clinically effective. Mean two-year weight losses and reductions in cardiovascular comorbidities were far greater with surgery, particularly gastric bypass, compared to medical treatment. Waitlisted patients exposed to "usual care" experienced modest weight loss and accrued cardiovascular comorbidities over the twoyear period. (Trial registration: Clinicaltrials.gov NCT00850356)

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