CARDIA-PLUS: A Life Course Investigation of Biopsychosocial Pathways to Bladder Health and Lower Urinary Tract Symptoms

项目摘要/摘要 这项建议旨在研究心理社会和社会经济压力来源的四条相互关联的途径。 可能导致较差的膀胱健康(下尿路症状[LUTS]和症状的影响) 女性和男性在整个生命过程中：情感、认知、行为和生理路径。这个 拟议的工作利用了来自NIH的两个倡议--冠状动脉30年的数据和智力资源 1985年开始的成人风险发展(CARDIA)队列研究和下尿液的预防 肠道症状(加)研究联盟，成立于2015年。LUTS，包括膀胱过度活动症(OAB) 和尿失禁(UI)，影响数百万女性和男性的生活。对LUTS的预防一直是 由于缺乏利用生命过程数据的流行病学研究而受到阻碍。此外，几乎没有研究表明 纳入了幸福的概念，并检查了促进和保持膀胱健康的因素，定义了 被PLUS研究联盟评为“一种身体、精神和社会完全健康的状态”(…那 允许日常活动，适应短期的身体和环境压力，并允许最佳的 是(例如，旅行、锻炼、社交、职业或其他活动)。拟议的研究，它扩展了 Beyond Plus研究联盟活动，利用来自女性和男性的现有CARDIA数据 膀胱健康和LUTS，并邀请从35年招募的CARDIA参与者的一个小样本 检查(53-65岁；2021-22年资助)完成新的临床检查。分析将得到加强 可能促进膀胱健康或LUTS的个别途径的证据基础。据推测， 由于(1)抑郁症状(影响)，(2)将观察到较差的膀胱健康/LUTS状态 认知障碍；(3)行为因素(饮食不良、缺乏运动、吸烟)；(4)生理因素 (体重增加、中心性肥胖、高血糖、高血压、炎性生物标志物和盆底肌 弱点)。分析还将为心理社会和社会经济压力来源建立证据基础。它是 假设压力源(不良童年家庭环境、有压力的生活事件、工作压力、照顾他人 压力、长期负担、歧视、经济困难、主观社会地位低)将与 较差的膀胱健康/LUTS状态。最后，分析将检查个体通路是否起中介作用 建议的压力源与较差的膀胱健康/LUTS状态之间的关联，以及资源是否用于 支持削弱了假设的影响。显然有必要开发新的方法来改善这两种情况 下尿路结石的预防和早期治疗。我们的发现可能会为“上游”方法提供信息(例如，改进 被证明是危险因素的特定应激源，增强社会支持和关系被证明是 保护性因素)，以及“下游”方法(例如，治疗抑郁症状；认知 训练运动；减肥；行为矫正，包括盆底运动)。

Project Summary/Abstract This proposal aims to examine four interrelated pathways by which psychosocial and socioeconomic stressors may lead to poorer bladder health (lower urinary tract symptoms [LUTS] and impact of symptoms) among women and men across the life course: affective, cognitive, behavioral, and physiological pathways. The proposed work leverages data and intellectual resources from two NIH initiatives, the 30+ year Coronary Artery Risk Development in Adults (CARDIA) cohort study, initiated in 1985, and the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium, initiated in 2015. LUTS, including overactive bladder (OAB) and urinary incontinence (UI), affect the lives of millions of women and men. Prevention of LUTS has been hindered by a lack of epidemiologic research utilizing life course data. In addition, little research has incorporated the concept of well-being and examined factors that promote and maintain bladder health, defined by the PLUS Research Consortium as “a state of complete physical, mental, and social well-being…that permits daily activities, adapts to short-term physical and environmental stressors, and allows optimal well- being (e.g., travel, exercise, social, occupational, or other activities).” The proposed research, which extends beyond PLUS Research Consortium activities, utilizes existing CARDIA data from women and men with bladder health and LUTS and invites a subsample of CARDIA participants recruited from the Year 35 examination (ages 53-65; funded for 2021-22) to complete a new clinical examination. Analyses will strengthen the evidence base for individual pathways that may promote bladder health or LUTS. It is hypothesized that poorer bladder health/LUTS status will be observed as a result of (1) depressive symptoms (affect), (2) impaired cognition, (3) behavioral factors (poor diet, physical inactivity, smoking), and (4) physiological factors (weight gain, central adiposity, hyperglycemia, hypertension, inflammatory biomarkers, and pelvic floor muscle weakness). Analyses will also establish the evidence base for psychosocial and socioeconomic stressors. It is hypothesized that stressors (adverse childhood family environment, stressful life events, job strain, caregiving stress, chronic burden, discrimination, financial hardship, low subjective social standing) will be associated with poorer bladder health/LUTS status. Finally, analyses will examine whether individual pathways mediate proposed associations between stressors and poor bladder health/LUTS status, and whether resources for support weaken hypothesized effects. There is a clear need to develop new approaches to improve both prevention and early treatment of LUTS. Our findings may inform “upstream” approaches (e.g., amelioration of specific stressors shown to serve as risk factors, enhancement of social support and ties shown to serve as a protective factors), as well as “downstream” approaches (e.g., treatment of depressive symptoms; cognitive training exercises; weight loss; behavior modification, including pelvic floor exercises).