R. Bourret

Systems Medicine Approaches for the Definition of Complex Phenotypes in Chronic Diseases and Ageing. From Concept to Implementation and Policies

Chronic diseases are diseases of long duration and slow progression. Major NCDs (cardiovascular diseases, cancer, chronic respiratory diseases, diabetes, rheumatologic diseases and mental health) represent the predominant health problem of the Century. The prevention and control of NCDs are the priority of the World Health Organization 2008 Action Plan, the United Nations 2010 Resolution and the European Union 2010 Council. The novel trend for the management of NCDs is evolving towards integrative, holistic approaches. NCDs are intertwined with ageing. The European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) has prioritised NCDs. To tackle them in their totality in order to reduce their burden and societal impact, it is proposed that NCDs should be considered as a single expression of disease with different risk factors and entities. An innovative integrated health system built around systems medicine and strategic partnerships is proposed to combat NCDs. It includes (i) understanding the social, economic, environmental, genetic determinants, as well as the molecular and cellular mechanisms underlying NCDs; (ii) primary care and practice-based interprofessional collaboration; (iii) carefully phenotyped patients; (iv) development of unbiased and accurate biomarkers for comorbidities, severity and follow up of patients; (v) socio-economic science; (vi) development of guidelines; (vii) training; and (viii) policy decisions. The results could be applicable to all countries and adapted to local needs, economy and health systems. This paper reviews the complexity of NCDs intertwined with ageing. It gives an overview of the problem and proposes two practical examples of systems medicine (MeDALL) applied to allergy and to NCD co-morbidities (MACVIA-LR, Reference Site of the European Innovation Partnership on Active and Healthy Ageing).

Developmental determinants in non-communicable chronic diseases and ageing

Prenatal and peri-natal events play a fundamental role in health, development of diseases and ageing (Developmental Origins of Health and Disease (DOHaD)). Research on the determinants of active and healthy ageing is a priority to: (i) inform strategies for reducing societal and individual costs of an ageing population and (ii) develop effective novel prevention strategies. It is important to compare the trajectories of respiratory diseases with those of other chronic diseases.

Living Lab MACVIA-LR Équilibre et prévention des chutes

La Presse Medicale - In Press.Proof corrected by the author Available online since vendredi 16 octobre 2015

Living Lab MACVIA Maladies chroniques

La Presse Medicale - In Press.Proof corrected by the author Available online since jeudi 15 octobre 2015

Title: Strategic Intelligence Monitor on Personal Health Systems Phase 3 (SIMPHS 3) – MACVIVA-LR (France) Case Study Report

The MACVIA-LR integrated care approach deployed in the Languedoc-Roussillon region in the South of France rests on three main initiatives that put particular emphasis on the prevention of unhealthy ageing of patients suffering from chronic conditions by implementing a series of actions that range from the early diagnosis and management of chronic respiratory diseases to the detection of un-recognised co-morbidities. The initiatives form part of a set of activities as a reference site for the European Innovation Partnership on Active and Healthy Ageing initiative in the Languedoc-Roussillon region and comprise: Integrated care pathways for airway diseases (AIRWAYS ICPs); Allergic Rhinitis and its Impact on Asthma (ARIA); and the Co-morbidity Clinics.