Xavier Fritel

Menopause is associated with increased blood pressure (BP) and vasomotor symptoms (VMS), both elevating cardiovascular risk. Exercise can induce postexercise hypotension (PEH), with responses varying by exercise type and population characteristics. This study aimed to (1) examine the effect of high‐intensity interval exercise (HIIE) and isometric resistance exercise (IRE) compared to control session (CONT) on PEH in normotensive postmenopausal women and (2) examine the VMS effect on PEH responses. A cross‐over randomized controlled trial was conducted in 29 women (15 with moderate‐to‐severe VMS, 14 without), aged 55 ± 3 years. HIIE included 2 sets of 12*15‐s at 100% maximal aerobic power, IRE included 4*2‐min at 30% maximal voluntary contraction, and CONT included a sitting period. PEH was assessed 30 min post‐session and with 24‐h assessment, providing data on dipping profiles and BP variability. Repeated measures ANOVA with Bonferroni post hoc tests were conducted. HIIE induced systolic PEH at +30 min postexercise compared to pre‐exercise (−6.1 mmHg, p = 0.048) and CONT (−8.1 mmHg, p = 0.010). For IRE, nocturnal systolic (SBP) and diastolic (DBP) BP decreased versus CONT (SBP: −3.2 mmHg, p = 0.008; DBP: −2.0 mmHg, p = 0.003) and HIIE (SBP: −3.4 mmHg, p = 0.004; DBP: −2.2 mmHg, p < 0.001), increasing dippers proportion. In women with VMS, nocturnal SBP was lower after IRE than HIIE (−5.6 mmHg, p = 0.002). Both HIIE and IRE induced PEH in postmenopausal women, with HIIE reducing BP +30 min postexercise and IRE improving nocturnal BP and increasing dippers. In women with VMS, the nocturnal BP response varies according to exercise modality. Trial Registration: The study is registered on clinicaltrials.gov ( n °NCT06533982)

Objective: We aimed to compare self-rated health after MUS insertion by retropubic versus transobturator approach, and to compare self-rated health in our sample with women in the French population. Design: Prospective cohort study using a register. Setting: 27 French surgical centres. Population: 1789 women participating in the VIGI-MESH register who had MUS surgery for female stress urinary incontinence. Methods: A multivariate analysis including an inverse probability of treatment weighting approach was used to emulate a trial. Self-rated health in our sample was compared to surveys in the French population. Main Outcome Measures: Women’s self-perception of health, impression of improvement, and quality of life outcomes were assessed by questionnaires. Results: A total of 1230 participants received a retropubic sling and 559 received a transobturator sling placed by 139 surgeons in 27 French centres. 34 months later, 79.6% of participants reported “good” or “very good” health (13.8% more than expected for the general population of the same age), and 78.6% felt much better. The mean quality of life scale was 76.0/100, 4.1 points higher than expected for the general population of the same age. We found no difference in the self-rated health outcomes between the two groups: retropubic and transobturator. Conclusion: Women participating to the VIGI-MESH register were in good health 3 years after MUS insertion, better than what was expected for the general French population. Regarding self-rated health, there was no difference between the two approaches: retropubic and transobturator

Objective To understand what leads to the non-adherence to the cervical cancer screening (CCS) recommendations during a consultation. Design For this qualitative study, in-depth semistructured interviews were carried out with French healthcare professionals. An interview guide was developed and tested. It included the following themes: CCS recommendations, patients’ profiles, relationship with patients, emotional work, over-screening and under-screening. Interviews were carried out until data saturation (no new data, theoretical diversity reached). The grounded theory was used for data analysis. Participants Gynaecologists, midwives and general practitioners (GPs). The sample diversity was achieved using the following criteria: place of work, type of healthcare profession, type of patients, private-sector or hospital professional. Setting Interviews were conducted between July and December 2022 in six regions in France. Results In-depth semistructured interviews were carried out with 15 midwives, 24 GPs and 11 gynaecologists from six French regions. Their analysis highlighted that the following factors contributed to the non-adherence to the CCS recommendation: burden of caring for family members for some women, adhesion to the principle of yearly screening by healthcare professionals and patients, need of negotiating the respect of the CCS recommendations, use of emotions, and arbitration to prioritise what is needed for good health maintenance. The search for mutual emotional comfort led some healthcare professionals to adopt attitudes towards the CCS that avoid positioning conflicts, even if this means departing from the recommendations. Conclusion CCS can be correctly performed if healthcare professionals and patients agree on the need of actively taking care of their health, which is difficult for women from lower sociocultural backgrounds. During the one-to-one meeting with their patients, healthcare professionals may find difficult to apply the CCS recommendations, although they know and agree with them.

Objective: To evaluate the health status and recovery of women after mid‐urethral sling (MUS) revision in response to complications.Design: Cross‐sectional study using a questionnaire sent to women from a registry.Setting: Twenty‐two French surgical centres.Population: A total of 287 women from the VIGI‐MESH registry responded, having undergone MUS revision for complications.Methods: Our sample of women were compared against a representative set of French women taken from the Eurostat database. Multivariate analysis was performed to identify clinical predictors for successful MUS revision. A qualitative analysis was carried out on free‐text comments.Main outcome measures: Health status, defined by the Minimum European Health Module, and recovery, assessed by Patient Global Impression of Improvement.Results: The response rate was 76% (287/378), with 49% of the women (141/287, 95% CI 43%–55%) reporting good health status, which was 8 points lower than that expected from the comparator French set (57%, 95% CI 55%–58%). Overall, 53% (147/275, 95% CI 47%–59%) of the women reported feeling much better after MUS revision. Just over one‐third (35%, 95/275, 95% CI 29%–40%) of respondents reported poor health with little or no improvement. Multivariate analysis showed that being operated on for pain at revision was associated with worse self‐perceived health than being operated on for exposure (OR 0.36, 95% CI 0.14–0.95); women with pre‐existing comorbidity reported a poorer health status following MUS revision (OR 0.22, 95% CI 0.13–0.38).Conclusions: Our results suggest that half of the women recovered good health status after MUS revision, whereas a proportion appeared to be seriously affected by an MUS complication despite the revision.