The code name may seem mysterious. PREVE.DI But the principle of the project co-supported by La Palmosa hospital is basically very clear. The aim is to prevent strokes – as well as dementia – in the territory of the French Riviera and Western Liguria. In association with the local health agency of Liguria (ASL 1).
To carry out this project, the two structures will each be awarded one million euros, over three years, following the file has been accepted by the European program Alcotra. A successful masterstroke thanks to the joint work of the Franco-Italian teams.
More than half of strokes can be prevented
And more specifically from Carlo Serrati, Professor of Neurology and Head of the Neuroscience Department of Western Liguria – who manages the clinical aspect. From Lorenzo Abbo, president of the Establishment Medical Commission in La Palmosa, which carries the project on behalf of the hospital center. And Stéphanie Trombetta, director of medical and paramedical human resources, interlocutor of the Italian authorities for the development of the file.
“On both sides of the border, regarding 35% of the population is over 65 years old. However, this is the public most affected by strokes. In my department around Imperia, we take care of between 500 and 600 strokes every year”, asks Professor Serrati straight away. Aware that treatment in the acute phase is a good thing, but that we are failing in terms of prevention.
Lorenzo Abbo, Mylene Ezavin, Carlo Serrati and Stephanie Trombetta.Photo DR.
“At the hospital, we can only tell the family: these are the effects of a stroke. But when we know that 70% can be avoided, it is certain that we must go further”, he shouts. Especially since the contributing factors are well known: high blood pressure, smoking, hypercholesterolemia, diabetes, heart rhythm disorders, obesity, sedentary lifestyle. “And it’s not just the medical aspect, but also the loneliness, the stress, the depression”, completes the Italian. Anxious to bet on a complete vision of the problem. “By preventing strokes, we also prevent dementia. Because one in four strokes turns into dementia…”, he adds.
Concretely, when a patient is the victim of a stroke, the teams will offer screening to voluntary members of his family. A little over 4,000 people would be followed in this way. While the cost of stroke treatment for Health Insurance was estimated at 3 billion euros in 2017 – 8.6 including the cost of post-accident disability – the financial stakes are enormous. “In addition to preventing disease, the PREVE.DI project aims to improve public finances. And the quality of life, including for caregivers”assures the director of La Palmosa, Mylène Ezavin. We are lucky to be able to work collaboratively. At Menton hospital, we don’t have a neurologist, even though we are in the process of structuring a neurology course in the area. On the other hand, we have a very efficient plateau in imagery which can be used for the province of Imperia.”
And if the European funding will only be spread over three years, the manager does not intend to stop on the deadline. “This gives us three years to make the estate profitable and be autonomous.”
La Palmosa has a high-performance imaging platform, which will be very useful to the project.J.-FO.
Several prevention phases in the cross-border program
In detail, how will prevention take place? Everything has not yet been decided from a practical and administrative point of view, but Carlo Serrati can already give a concrete outline. It will first discuss a screening (= screening) primary. An appointment with a neurologist who will perform examinations: cognitive tests, atrial fibrillation, diabetes, cholesterol, alcohol… “Afterwards, we will see the emotional state: loneliness, stress. We know it is a risk factor. Even if it is little taken into account clinically, scientific data proves it”, slips the professor. indicating that another screening further can then be done using MRI and CT.” Through special tests, carried out in conjunction with the University of Genoa, in search of neurofilaments. Their presence demonstrates fine lesions in the brain. It’s a pretty experimental part.” And screening physical activity will also be offered; the fact of moving greatly facilitates prevention.
And Mylène Ezavin to synthesize the logic: “Someone comes to the hospital following a stroke. We treat him, then we call his family. The volunteers follow a consultation with a neurologist, who will determine if there is a need to use imaging to detect neurofilaments. If there are concordant factors, we put on a treatment to prevent.
Would the modus operandi mean that the stroke has a genetic bearing? Not really, dismisses Professor Serrati. “The genetic load is found more in the stroke of young people, when there is no apparent risk factor but several young people from the same family have a stroke. But it’s marginal.”
Memo
The national public health agency notes that “cerebrovascular accident (CVA) is a serious disease resulting in a neurological deficit linked to cerebral lesions of vascular origin”.
There are two main types of stroke: ischemic or cerebral infarction – which represent 80% of strokes – “consecutive to the obstruction of a cerebral artery”. And the hemorrhagic (20%), “due to rupture of a cerebral blood vessel”.
In numbers? Public Health France is formal: stroke is the first cause of non-traumatic motor disability, and the second cause of dementia. It is also the leading cause of death among women.
Former partnership
The director of La Palmosa hospital, Mylène Ezavin, points out that Italy is already a privileged partner. “Patients, like professionals, know no borders. We are already carrying out very close work“, she assures, reading several data and actions put in place going in this direction.
30% of the patient population within the establishment is Italian.
20% agents, paramedics and medical, are also.
A local cross-border perinatal center was created as soon as 2003, in La Palmosa, following the closure of the maternity hospital in Menton. Its originality? It welcomes women from an area of life ranging from Roquebrune to San Remo.
The nursing training institute (IFSI) is itself cross-border.
La Palmosa has signed an agreement with the association of craftsmen and merchants of the province of Liguria for easier care of Italian nationals. In practice, a mobile phone with an Italian Sim card is provided to bilingual secretaries who make appointments.
