Background The health benefits of physical exercise have been shown to be important in the prevention of cardiovascular diseases in patients with hypertension, dyslipidaemia or diabetes. However, few strategies have demonstrated efficacy and practicality in the promotion of physical exercise among this group of patients in general practice. Methods The PEPPER clinical study is a randomised controlled trial to evaluate the efficacy over a period of 12 months, in terms of physical activity level, of an intervention based on structured information delivery, a personalised written physical activity prescription in number of steps per day, a pedometer and a pedometer logbook, in 35 to 74-year-old patients with cardiovascular risk factors. 140 patients will be recruited in 15 GP practices and randomised in the intervention group or in the control group where patients will receive verbal advice of physical exercise. The primary outcome is the change at three months in total energy expenditure measured by an accelerometer over a 7-day period. Secondary outcomes include changes at 3 and 12 months in physical activity levels (accelerometer and International Physical Activity Questionnaire), quality of life (SF-36), blood pressure, weight, waist circumference, perceived obstacles to physical activity and patient compliance with the recommended strategy. Both groups will be compared using mixed models. Discussion The results are expected at the end of 2019. If the intervention proves effective in durably increasing the level of physical activity, this strategy could be tested in a larger trial to examine its impact on cardiovascular diseases. Trial registration US National Institutes of Health Clinical Trials Registry NCT02317003 , December 15, 2014.

This study shows that strategy of early contact with general practice in medical training should be continued. Information concerning the administrative formalities and aids available must be provided during medical training.

Background Near-peer tutoring appears to be an efficient approach for teaching clinical skills. However, the clinical experience gained in the form of student medical internships may offset any interest in such tutoring programme. We then investigated the long-term benefits of this programme. Methods This study was conducted in a medical school that experimented in near-peer tutoring for semiology intended for undergraduate medical students. Objective Structured Clinical Examinations and a written semiology test were used to assess students’ clinical skills immediately on its conclusion and repeated one and 2 years after the tutoring was completed. Results 116 students were evaluated initially (80 tutored and 36 untutored), 38 at 1 year (16 tutored and 22 untutored), 42 at 2 years (21 tutored and 21 untutored). In the global score for Objective Structured Clinical Examinations: at 1 year, the tutored group scored 14.0 ± 1.05 and the untutored group scored 11.3 ± 2.3 (p < 0.001), at 2 years, the tutored group scored 15.1 ± 1.5 and the untutored group scored 12.4 ± 2.2 (p < 0.001). We found a similar but smaller difference for the written semiology test. The difference for Objective Structured Clinical Examinations between tutored and untutored students vanished over time for cross-cutting skills. Conclusions Near-peer tutoring in semiology for undergraduate medical students led to better results that remained with the passing of time. Though internships do allow an improvement in the clinical skills of untutored students, they did not reach the level of tutored students.

Introduction. Les aidants naturels de malades Alzheimer jouent un rôle prépondérant dans la prise en charge de ces patients. La moitié des aidants naturels sont les conjoints, souvent âgés. Ce rôle a une répercussion importante sur la santé des aidants. Depuis 2010, il est recommandé aux médecins généralistes franç ais d'organiser un suivi médical annuel spécifique. Les objectifs de cette étude étaient de comprendre le vécu de cette situation par le conjoint aidant et comment celui-ci perç oit le rôle joué par son médecin généraliste dans ce contexte. Matériel et méthode. Une étude qualitative a été réalisée par entretiens individuels semi-dirigés auprès de 14 aidants conjoints recrutés via des structures d'accueil de jour d'Angers, France. Résultats. L'analyse des entretiens a montré que la maladie d'Alzheimer représentait une crise existentielle pour les aidants-conjoints. L'engagement et le lien affectif pour la personne malade les impliquaient activement dans le soin. Cela n'avait pas modifié le rythme de leurs consultations médicales, mais pouvait les amener à retarder les soins non urgents. Leur réticence à se faire aider et une interaction avec l'équipe soignante de la personne malade gênaient l'implication de leur propre médecin traitant. Conclusion. L'adaptation de l'aidant à la maladie du conjoint engendre des conduites à risque mais aussi des conduites bénéfiques. Plutôt que de proposer une consultation annuelle centrée sur la santé des aidants, l'amélioration de la communication entre tous les intervenants y compris le médecin généraliste de l'aidant pourrait permettre de mieux cibler et mieux répondre aux besoins de ce dernier.Mots clés : aidants naturels, suivi médical, maladie d'Alzheimer, médecine générale, personne âgée Abstract. Background. The caregivers of patients with Alzheimer's disease (AD) play a key role in their management. Half of them are spouses. This involvement may alter their own health, leading to exhaustion and depression. Since 2010, general practitioners (GPs) have been invited in France to offer an annual specific medical support to spouse caregivers. The aims of this study were to understand their experience of this situation by spouse caregivers, and how the spouse caregiver perceives the role of the GP in this context. Methods. A qualitative approach was conducted using semi-structured interviews of 14 spouse caregivers recruited from adult day care in Angers, France. Results. The analysis of interviews showed that AD was an existential crisis for the dyad AD patient/spouse caregiver. The emotional connection and the sense of commitment strongly involved the spouse caregivers into cares for the loved ones. Even if the frequency of medical consultations remained unchanged, caregivers were more prone to delay non-urgent cares for themselves. Moreover their intention to handle things on their own and the interaction with health professionals of the care recipients interfered with the involvement of the caregivers' GPs. Conclusions. Caregivers' adaptation to their spouses' AD ...

Background Regular physical activity improves health and quality of life for people with cardiovascular risk factors. However, few studies have demonstrated the applicability of strategies in health care to promote physical activity. Objective To evaluate if a written physical activity prescription combined with pedometer increases physical activity over one year compared with verbal advice in patients with cardiovascular disease risk in primary care. Methods The randomised-controlled, interventional, 12-month PEPPER study recruited patients aged 35 to 74 years, having quarterly followed-ups for hypertension, dyslipidaemia, or diabetes, and judged insufficiently active. Seventeen practices randomised patients into either the experimental group, who received a written, personalised prescription for daily step numbers, pedometer and logbook, or control group, who received verbal advice to do at least 15 min of rapid walking or equivalent daily. The primary outcome was the change in total weekly energy expenditure measured using an accelerometer at 3 months. The secondary outcomes were changes in step count, physical activity levels, quality of life, perceived obstacles to physical activity, and biomedical indicators at 3 and 12 months. Results One hundred and twenty-one participants were randomised. Although, weekly energy expenditure did not differ between the prescription and verbal instruction group, the estimated time spent doing moderate-intensity activity was significantly higher in the prescription group than the verbal group by an average of four minutes/week (p = 0.018)(95% CI [0.7 – 7.4]) reaching 48 min after 12 months (95% CI: 8 – 89). Similarly, this was associated with a clinically, higher average step number of 5256 steps/week increase over a year (95% CI: 660 – 9852). Among the most sedentary subgroup, walking less than 5000 steps/day at baseline, an 8868 steps/week (95% CI [2988 – 14700]) increase was observed in the prescription group. Conclusion Prescribing physical activity did not significantly modify total weekly energy expenditure, but slightly increased moderate-intensity activity duration and step counts, particularly among the most sedentary participants. Prescribing personalised physical activity goals encourages sedentary patients to engage in physical activity. Trial registration The PEPPER trial is registered in the US National Institutes of Health Clinical Trials Registry under number NCT02317003 (15/12/2014).