Understanding early life determinants and mechanisms to preventing life course multimorbidity

生命的早期阶段--从微小的胚胎，到子宫中的婴儿，再到出生，一直到婴儿期和幼儿期--是许多事件发生的时候，这些事件可能会对我们的生活产生重要而持久的影响。我们希望找到方法尽可能地使我们生命的这些早期阶段变得尽可能好，这样我们进入成年时就会健康，能够很好地应对生活可能会抛给我们的东西。我们的研究将调查影响我们心脏、血管、心理健康和新陈代谢的早期生活事件(我们的身体如何将食物转化为能量和蛋白质等构建块，并消除浪费)。我们想要找到预防早年生活事件的方法，这些事件导致我们在晚年生活中出现几个健康问题。我们称之为“多种疾病”，指的是两种或两种以上的长期疾病或残疾。从早期到成年观察健康状况的想法已经存在了一段时间，但将早期生活事件的信息与多发性疾病联系起来的实际情况仍然相当罕见。我们是一群在早期生活和成人健康方面具有互补专业知识的新群体。例如，我们有研究心脏和血管的实验室科学家；研究运动和体力活动如何影响母亲和儿童的心理学家；提供一线护理的儿童医生，同时也在研究帮助患者的最佳方法；数据工程师；公共卫生研究人员，他们致力于数十年来跟踪人们的健康状况的研究。我们知道，要回答有关早期生活事件和多发性疾病的重大问题，我们需要在我们的专业领域以新的方式进行合作。我们现在提出了一个为期6个月的项目，将我们所知道的和我们不同的技术(方法)结合在一起，并完善我们更大的4年计划。我们更大的计划有四个相关的部分：A.我们将发现并理解不同类型的现有证据，这些证据表明早期生活中多发病的驱动因素。我们将与利益相关者(父母、照顾者、儿童、政策制定者、专业人士)合作绘制一张地图，帮助人们更清楚地思考导致或预防多发性疾病的早期生活事件，看到我们知识中的差距，并决定下一步要回答哪些问题。b.为了回答这些问题，我们将电子链接现有的英国数据(例如脚后跟刺痛样本、红皮书问题)，并使用人工智能等新方法进行探索。我们还将收集新的数据来填补空白。C.由于这些数据有助于我们更好地了解早期生活事件及其如何影响后来的健康，我们将共同设计新的“干预措施”来改变这些事件。例如，我们可能会开发药物、健康监测器，或者让人们以不同的方式做事。它们可能是针对个人或人群的。D.我们将始终让患者和公众参与进来，以确保专注于重要的事情，并确保干预措施在现实生活中发挥良好的作用。在最初的6个月里，我们将使用三个特定的领域来试验我们的想法和技术。在这些领域：早期生活事件已经知道会影响晚年的多发病，但这种情况如何发生尚不清楚；有很大的潜力进行更好的干预；我们拥有丰富的专业知识。这些领域是：-母亲的心脏和血管健康，对母亲/孩子的婴儿压力事件的影响，对荷尔蒙和后来的孩子健康的影响--母亲/孩子的运动和体力活动，以及对母亲/孩子的心脏和血液健康和压力的影响这项研究将改变提供健康和护理的方式，从诊断和治疗看起来像是个体情况的情况，转向对早期生活心理、社会和医学问题的干预。这将为大量的人在以后的生活中防止多重问题。这将改善儿童和家长的健康，并减轻家庭和服务的负担。这项研究还将有助于告知政府在生命早期收集哪些信息对监测公共卫生是重要的。

The early part of life-from tiny embryo, to baby in the womb, to birth, through infancy and early childhood-is a time when many events happen that can have important, lasting effects on our lives. We want to find ways to make these early parts of our lives as good as they can be, so that we enter adulthood healthy and able to cope well with things that life may throw at us.Our research will investigate the early life events that affect our hearts, blood vessels, mental health, and metabolism (how our bodies convert food to energy and to building blocks such as proteins, and eliminate waste). We want to find ways to prevent early life events that lead us to have several health problems in later life. We call this "multi-morbidity", meaning two or more long-term conditions or disabilities.The idea of looking at health from early life into adulthood has been around for a while, but it is still fairly rare to actually link information from early life events with multimorbidity. We are a new group of people with complementary expertise in early life and adult health. For example, we have lab scientists studying hearts and blood vessels; psychologists investigating how movement and physical activity affects mothers and children; children's doctors providing front line care while also researching the best ways to help their patients; a data engineer; and public health researchers working on studies that follow people's health for decades. We know that to answer the big questions about early life events and multimorbidity we need to collaborate in new ways across our areas of expertise. We are now proposing a 6-month project to bring together what we know and our different techniques ('methods'), and to refine our bigger 4-year plan. Our bigger plan has four related parts:A. We will find and make sense of different types of existing evidence about early life drivers of multimorbidity. We will work with stakeholders (parents, carers, children, policy makers, professionals) to draw up a map that will help people to think more clearly about early life events that cause or prevent multimorbidity, see the gaps in our knowledge, and decide which questions to answer next.B. To answer these questions, we will electronically link up existing UK-based data (e.g. heel prick samples, red book questions) and use new methods, such as artificial intelligence, to explore it. We will also collect new data to fill gaps.C. As the data helps us better understand early life events and how they affect later health, we will co-design new 'interventions' to alter these events. For example, we may develop medicines, health monitors, or ways for people to do things differently. They may be for individuals or populations.D. We will involve patients and the public throughout to ensure focus on what matters and that the interventions work well in real life.In the initial 6 months, we will use three particular areas to pilot our ideas and techniques. These are areas where: early life events are already known to affect later life multimorbidity but how this happens is not clear; there is great potential for better interventions; and we have substantial expertise. The areas are:- mother's heart and blood vessel health, and influence on baby- stressful events for the mother/child, and effects on hormones and later child health- mother/child movement and physical activity, and effects on mother/child heart and blood health and stressThis research will change the way health and care is provided, moving from diagnosing and treating individual conditions as they appear to intervening on early life psychological, social and medical issues. This will prevent multiple problems later in life for large numbers of people. This will improve child and parent health, and reduce the burden on families and services. This research will also help inform what information is important for governments to collect in early life to monitor public health.