Prevention of Lower Urinary Tract Symptoms in Women: Yale Bladder Health Clinical Center

 描述（由申请方提供）：下尿路功能障碍（LUTD）包括与膀胱储尿、排空、疼痛和感染相关的症状。LUTD是一种非常普遍的慢性疾病，对妇女的影响不成比例，并导致总体发病率。根据人口增长和患病率估计，预计在未来30年内，下尿路症状（LUTS）和疾病将影响超过4300万妇女。LUTS和相关问题（如福尔斯和生产力损失）给社会带来的成本估计每年超过650亿美元。LUTS还干扰参与社会和体育活动，这影响生活质量，并对其他慢性疾病产生负面影响。 医疗状况，如心血管疾病、糖尿病、肥胖症和抑郁症。显然，这对个人和社会都有很大的影响，但许多妇女并不了解这些影响，甚至有症状的妇女也往往不寻求治疗。这可能是由于专注于疾病治疗，而没有充分了解哪些行为会影响LUTS的发展和进展。PLUS联盟将建立必要的证据基础，以便在女孩和妇女中进行未来的预防干预研究。我们的应用程序的目的是展示我们如何使用生态系统理论作为指导框架，建立膀胱健康的知识库，这种方法可以解决个人，家庭/同伴和社区层面的风险因素。健康结果受到个人和环境层面各种复杂和相互关联的因素的影响。目前大多数关于膀胱健康和LUTS风险因素的证据是基于个体特征的，因此大多数干预措施都集中在生态模型的单一层次上，而没有考虑其他层次内的背景目标。利用现有的数据库、焦点小组和纵向队列研究，我们将考虑生物因素、行为、知识、环境和卫生服务等问题，这些问题将决定谁有发展LUTS的风险，以及如何解决和管理早期症状。一个多层次的方法是必不可少的任何可持续的，有效的计划;因此，一个生态框架，占多个背景因素是至关重要的识别和最终改变的行为，lad到LUTS和相关的健康结果。我们为耶鲁大学膀胱健康临床中心组建的多学科团队包括LUTS护理和研究专家，以及具有健康行为和流行病学研究专业知识的调查人员，这些研究涉及女性年龄范围，包括吸烟，疫苗接种，肥胖，产前护理，尿路感染和残疾。研究人员从初级保健诊所和社区招募了女性患者进行大量的纵向研究，他们的慢性病预防方法将为LUTS的风险和保护因素研究提供新的思路。临床医生和预防科学家之间的这种创新合作将有助于将LUTS重新定义为公共卫生问题，并最终改善数百万女孩的长期健康和健康 和妇女

 DESCRIPTION (provided by applicant): Lower urinary tract dysfunction (LUTD) includes symptoms related to bladder storage, emptying, pain, and infection. LUTD is a highly prevalent chronic medical condition that disproportionately affects women and contributes to overall morbidity. Based on population growth and prevalence estimates, lower urinary tract symptoms (LUTS) and conditions are expected to affect more than 43 million women over the next 30 years. The cost to society for LUTS and related issues such as falls and lost productivity is estimated to be over $65 billion per year. LUTS also interfere with participation in social and physical activities, which affects quality of life and also contributes negatively to other chronic medical conditions such as cardiovascular disease, diabetes, obesity, and depression. Clearly, there is high individual and societal impact, however many women do not understand these implications, and even symptomatic women often don't seek treatment. This is likely due to a focus on disease treatment without adequate understanding of what behaviors affect LUTS development and progression. The PLUS consortium will establish the evidence base necessary to conduct future prevention intervention studies in girls and women. The objective of our application is to demonstrate how we can build the knowledge base for bladder health using Ecological Systems Theory as a guiding framework, an approach that addresses risk factors at the individual, family/peer, and community levels. Health outcomes are affected by a variety of complex and interrelated factors both at the individual and environmental level. The majority of current evidence for bladder health and risk factors for LUTS is based on individual traits, and therefore most interventions have focused on a single stratum of the ecologic model without consideration of contextual targets within other levels. Utilizing existing databases, focus groups, and longitudinal cohort studies, we will consider issues including biologic factors, behaviors, knowledge, environment, and health services that will determine who is at risk to develop LUTS and how early symptoms are addressed and managed. A multi-level approach is essential to any sustainable, effective program; hence, an ecological framework that accounts for multiple contextual factors is critical to identifying and ultimately changing behaviors that lad to LUTS and associated health outcomes. The multidisciplinary team we have assembled for the Yale Bladder Health Clinical Center includes experts in LUTS care and research in addition to investigators with expertise in health behaviors and epidemiologic studies across the age range of females including smoking, vaccination, obesity, prenatal care, urinary tract infection, and disability. Investigators have recruited female patients both from primary care clinics and the community into numerous longitudinal studies, and their approach to chronic disease prevention will shed new light on the study of risk and protective factors for LUTS. This innovative collaboration between clinicians and prevention scientists will help redefine LUTS as a public health issue and ultimately improve the long term health and wellness of millions of girls and women.