UNDERACTIVE BLADDER: EPIDEMIOLOGIC ANALYSES, SCREENER DEVELOPMENT AND VALIDATION

项目概要/摘要 虽然膀胱过度活动症（OAB）是一种经过充分研究的常见泌尿系统疾病，但它的明显相反， 膀胱活动不足（UAB）仍然被忽视和了解甚少。UAB越来越被认为是 下尿路症状（LUTS）的可能原因，在临床实践中经常遇到， 会严重影响病人的生活质量如果未得到诊断和治疗，UAB可导致显著的发病率 并且可能危及生命。流行病学研究被认为是发展 有希望的治疗方式，但目前的研究状况被称为“初级”。 UAB的基础病理生理学仍然知之甚少，其客观特征 不确定为了开始填补围绕UAB的知识空白，我们提出了两个逻辑相关的研究 阶段：在第一阶段，我们将完成重点统计/流行病学分析， 采用来自一项大型国际公认的泌尿科队列研究-波士顿地区社区的数据 健康调查。这些分析将集中在假设的和病理生理学上合理的 一系列潜在危险因素与疑似症状性UAB的相关性： 已经提供，并分为概念上不同的领域（社会人口，人体测量/生活 事件、营养、合并症、手术干预和药物）。由于可能的性别特异性 表型，我们将分别考虑女性和男性的症状性UAB。我们还将审查未满足的 UAB需要，UAB如何与其他泌尿系统症状重叠，以及UAB是否可预测（哨兵事件 （二）后续疾病。第二阶段逻辑上遵循的是一个简短的自我- 管理的多维UAB风险评估工具，将整合临床信息因素， 两个阶段。已详细计划量表开发和验证，包括项目开发和 认知测试和正式的心理测量评估，包括评分指南和有效的诊断 UAB的临界点。在完成两个阶段（流行病学分析和经验证的UAB筛查）后， 我们将在顶级专业期刊上发表结果（以获得科学认可）， 在主要临床会议上展示结果（以获得临床可接受性）。在线健康信息时代 寻求，患者赋权和共同决策，这种基于证据的工具将提供风险UAB 患者有用的信息，以触发初级保健提供者和泌尿科医生对更适当的诊断 有效管理UAB。该工具还将提供一种具有成本效益的预筛选手段， 符合条件的UAB患者，用于未来有希望的干预措施的RCT。

PROJECT SUMMARY/ABSTRACT While the overactive bladder (OAB) is a well-researched and common urologic condition, its apparent opposite, the underactive bladder (UAB), remains neglected and poorly understood. UAB is increasingly recognized as a likely cause of lower urinary tract symptoms (LUTS), is commonly encountered in clinical practice, and severely impacts a patient's quality of life. If undiagnosed and untreated, UAB can lead to significant morbidity and may be life threatening. Epidemiologic research is considered a necessary step towards development of promising treatment modalities, but the present state of this research has been characterized as “rudimentary”. The underlying pathophysiology of UAB remains poorly understood and its objective characterization uncertain. To begin to fill knowledge gaps surrounding UAB we propose research with two logically related phases: During Phase l we will complete focused statistical/epidemiologic analyses which cost-efficiently employ data from a large internationally respected urologic cohort study—the Boston Area Community Health (BACH) survey. These analyses will focus on the hypothesized and pathophysiologically plausible association of a range of potential risk factors with suspected symptomatic UAB: data on numerous factors are already available and grouped into conceptually distinct domains (socio-demographic, anthropometric/life events, nutrition, comorbidities, surgical interventions and medications). Because of likely gender-specific phenotypes we will consider symptomatic UAB separately in women and men. We will also examine unmet UAB need, how UAB overlaps with other urologic symptoms and whether UAB is predictive of (a sentinel event for) subsequent disease. Phase ll logically follows with the construction and clinical validation of a brief self- administered multidimensional UAB risk assessment tool, which will integrate clinically informative factors from both phases. Scale development and validation have been planned in detail and include item development and cognitive testing, and formal psychometric assessment, including scoring guidelines and validated diagnostic cutpoints for UAB. Upon completion of both phases (epidemiologic analyses and validated UAB screener development) we will publish results in top tier professional journals (to gain scientific acceptability) and present results at major clinical meetings (to gain clinical acceptability). In the age of online health information seeking, patient empowerment and shared decision making, this evidence-based tool will provide at-risk UAB patients useful information to trigger primary care providers and urologists towards more appropriate diagnosis and effective management of UAB. The tool will also provide a means to cost-efficiently prescreen potentially eligible UAB patients for future RCTs of promising interventions.