Increasing understanding of risk factors and outcomes associated with continence problems in children and adolescents

研究背景：失禁问题（尿床、白天尿床和弄脏）是儿童时期最常见的慢性疾病之一。虽然失禁问题的流行率随着年龄的增长而下降，但许多儿童在进入青春期后仍然受到影响。目前，流行病学研究中几乎没有基于证据的信息来区分如预期那样获得膀胱和肠道控制的儿童和那些在童年后期和青春期继续遭受尿湿和脏污的儿童。来自大型队列的实证研究结果可以大大增加对尿失禁问题持续存在的风险因素的理解，并有助于识别有慢性尿失禁风险的儿童。持续的自制问题进入青春期可能会给年轻人和他们的家庭带来相当大的痛苦。然而，目前还没有实证研究评估尿失禁对青少年一系列结果的影响。需要有关于失禁对年轻人影响的循证知识，以解决他们的复杂需求并为干预措施提供信息。目的和目的：拟议的项目将调查当代英国大型队列——雅芳父母和儿童纵向研究（ALSPAC）中与儿童和青少年失禁问题相关的风险因素和结果。具体而言，我们将研究与儿童和家庭有关的因素是否与近11,000名儿童从早期到晚期（4至9岁）的膀胱和肠道控制的不同发展模式（发展轨迹）有关。这些轨迹描述了膀胱和肠道控制的不同发展模式，包括正常发育，膀胱/肠道控制延迟实现，持续湿/脏，以及长时间失禁后复发。我们将调查儿童期失禁的特定模式（如高频率和/或持续性失禁）是否不太可能在青春期解决。我们还将研究儿童晚期和青春期尿失禁的持续性是否与心理健康、社会心理功能、教育成就和未来目标/愿望的不良后果有关。潜在的应用和好处：我们预计这项研究将导致对失禁问题病因的重要新认识。提高对与持续性失禁问题相关的风险因素的认识，可能会导致更好的识别、更早的干预、更快的转诊到治疗时间，并增加向最有可能受益的儿童提供服务的可能性。及时转诊和管理自制问题应有助于改善儿童、青年人及其家庭的生活质量，并减少自制问题对青年人生活的不利个人影响。提高对精神卫生问题等合并症的认识将为干预措施提供信息，从而为儿童和青年及其父母/照料者带来更好的结果。

Context of the research: Continence problems (bedwetting, daytime wetting and soiling) are among the most common chronic conditions of childhood. While the prevalence of continence problems decreases with age, many children are still affected well into adolescence. There is currently little evidence-based information from epidemiological studies on the factors that distinguish between children who attain bladder and bowel control as expected and those who continue to suffer from wetting and soiling into later childhood and adolescence. Empirical findings from large cohorts could substantially increase understanding of risk factors for persistence of continence problems and aid identification of children who are at risk of chronic incontinence. Persistence of continence problems into adolescence is likely to lead to considerable distress for young people and their families. However, there are no empirical studies assessing the impact of incontinence on a wide range of outcomes in adolescence. Evidence-based knowledge of the impacts of incontinence on young people is needed to tackle their complex needs and to inform interventions. Aims and objectives: The proposed project will investigate risk factors and outcomes associated with continence problems in children and adolescents from a large contemporary UK cohort- The Avon Longitudinal Study of Parents and Children (ALSPAC). Specifically, we will examine whether factors relating to the child and family are associated with different patterns of development (developmental trajectories) of bladder and bowel control in almost 11,000 children from early through to late childhood (4 to 9 years). These trajectories describe different patterns of development of bladder and bowel control, including normal development, delayed attainment of bladder/bowel control, persistent wetting/soiling, and relapse after an extended period of continence. We will investigate whether particular patterns of incontinence in childhood (e.g. high frequency and/or persistent incontinence) are less likely to resolve by adolescence. We will also examine whether persistence of incontinence into late childhood and adolescence is associated with adverse outcomes for mental health, psychosocial functioning, educational attainment and goals/aspirations for the future.Potential applications and benefits: We anticipate that the research will lead to significant new understanding of the aetiology of continence problems. Greater awareness of risk factors associated with persistent continence problems is likely to result in improved identification, earlier intervention, faster referral- to-treatment times and increased likelihood of delivering services to those children who are most likely to benefit. Timely referral and management of continence problems should help to improve quality of life for children, young people and their families and reduce adverse personal impacts of continence problems on young peoples' lives. Greater awareness of co-morbid conditions such as mental health problems will inform interventions, leading to better outcomes for children and young people and their parents/carers.