Bladder health promotion and LUTS prevention inadolescent and adult women across the life course

摘要 下尿路症状(LUT)，包括储尿、排尿、尿失禁症状和疼痛， 与其相关的诊断是常见的、昂贵的，并在整个过程中对女性的生活质量产生负面影响 生命的历程。尽管它们经常发生，而且成本很高，但到目前为止，很少有研究集中在 确定LUTS的风险和保护因素并进行预防，而关注推广的更少 和维持膀胱健康。为了弥补这一差距，预防下尿路症状 (加上)成立了研究联盟(我们的网站是其创始临床研究中心)，以 为今后循证促进膀胱健康和预防下尿路感染奠定科学基础 对青少年和成年妇女的干预。在本应用程序中，我们建议以基础工作为基础 在+1中进行，以促进这一科学基础。具体地说，我们建议建立一个大型、 纵向的、全国性的、以人口为基础的观察性队列研究(目前正在制定和共同领导 由华盛顿大学医学院网站PI)设计以：a)确定和 一般女性人群中膀胱健康随时间的变化；以及b)确定新的风险和保护措施 影响LUTS和膀胱健康的因素是可以干预的。根据FOA的说法，我们选择了一个重要的 纳入基于人群的队列研究的风险/保护因素研究问题：慢性 排尿延迟，这是女性一生中的一种常见行为，可以通过 社会生态多层次的预防性干预，导致膀胱健康恶化 那么LUTS的发展呢？在干预映射方法和社区合作伙伴洞察的指导下， 我们将通过进行一系列创新的、多方法的、 在基于人群的队列研究中嵌套的跨学科研究，以及对此的补充 学习。综合起来，这套全面的定量和定性研究将提供：1)关键的新数据 为了解决慢性排尿延迟和膀胱健康/LUTS之间的关联的因果性质(即， 高质量、前瞻性的流行病学数据，没有时间偏差和支持性的生物学、机械性 数据)；2)新的发现，为未来预防干预措施的最佳重点和提供方式提供信息(即， 关于最强大的个人的多方法数据--行为、人际、机构和社区/社会 慢性排尿延迟的决定因素--最有效的教育干预方式 [假设未来的干预措施将包括教育组成部分]，以及最初有希望的教育 消息)；以及3)评估未来干预措施的新工具。因此，这组互补的研究 承诺为未来的膀胱健康促进极大地扩展知识基础 和LUTS预防干预。

ABSTRACT Lower urinary tract symptoms (LUTS), including storage, voiding, urinary incontinence symptoms and pain, and their associated diagnoses are common, costly, and negatively impact women's quality of life throughout the life course. Despite their common occurrence and high cost, little research to date has focused on identification of risk and protective factors for LUTS and prevention, and even less has focused on promotion and maintenance of bladder health. To address this gap, the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium (of which our site is a founding Clinical Research Center) was established to develop the scientific foundation for future evidence-based bladder health promotion and LUTS prevention interventions in adolescent and adult women. In this application, we propose to build upon foundational work conducted in PLUS 1 to further this scientific foundation. Specifically, we propose to establish a large, longitudinal, national, population-based, observational cohort study (currently under development and co-led by the Washington University School of Medicine site PI) designed to: a) determine the distribution of and changes in bladder health over time in the general female population; and b) identify new risk and protective factors for LUTS and bladder health amenable to intervention. Per the FOA, we have selected one important risk/protective factor research question for incorporation into the population-based cohort study: does chronic delayed voiding, a common behavior among women across the life course that can be addressed by preventive interventions at multiple levels of social ecology, contribute to bladder health deterioration and the development of LUTS? Guided by an intervention mapping approach and community partner insight, we will build the evidence base for this research question by conducting a series of innovative, multi-method, transdiciplinary studies nested within the population-based cohort study, as well as complementary to this study. Together, this comprehensive set of quantitative and qualitative studies will provide: 1) critical new data to address the causal nature of associations between chronic delayed voiding and bladder health/LUTS (i.e., high-quality, prospective epidemiologic data devoid of temporal biases and supportive biologic, mechanistic data); 2) new findings to inform the optimal focus and mode of delivery of future prevention interventions (i.e., multi-method data on the strongest individual-behavioral, interpersonal, institutional, and community/societal determinants of chronic delayed voiding, the most effective mode of delivery of educational interventions [assuming that future interventions will include an educational component], and initial promising educational messages); and 3) new tools to evaluate future interventions. As such, this complementary set of studies holds the promise to greatly expand the foundation of knowledge for future bladder health promotion and LUTS prevention interventions.