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

摘要 下尿路症状（LUTS），包括储尿、排尿、尿失禁症状和疼痛， 其相关诊断是常见的，昂贵的，并对妇女的生活质量产生负面影响， 生命历程尽管其常见且成本高，但迄今为止很少有研究关注 确定LUTS和预防的风险和保护因素，甚至更少的重点是促进 和维持膀胱健康。为了解决这一差距，预防下尿路症状 （PLUS）研究联盟（我们的研究中心是其中的创始临床研究中心）成立， 为未来基于证据的膀胱健康促进和LUTS预防奠定科学基础 对青少年和成年妇女的干预。在本申请中，我们建议在基础工作的基础上 在PLUS 1中进行，以进一步推动这一科学基础。具体而言，我们建议建立一个大的， 一项纵向、国家、基于人群的观察性队列研究（目前正在开发中， 由华盛顿大学医学院研究中心PI）设计，用于：a）确定 一般女性人群中膀胱健康随时间的变化;以及B）识别新的风险和保护性措施， LUTS和膀胱健康的因素适合干预。根据FOA，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： 排尿延迟，这是女性一生中的一种常见行为，可以通过以下方式解决： 在多个社会生态层面的预防性干预，有助于膀胱健康恶化 以及LUTS的发展？在干预规划方法和社区合作伙伴洞察力的指导下， 我们将通过开展一系列创新的、多方法的、 嵌套在基于人群的队列研究中的跨学科研究，以及对此的补充 study.总之，这套全面的定量和定性研究将提供：1）关键的新数据 为了说明慢性延迟排尿和膀胱健康/LUTS之间的因果关系（即， 高质量的前瞻性流行病学数据，没有时间偏差和支持性的生物学、机制 数据）; 2）为未来预防干预措施的最佳重点和交付模式提供信息的新发现（即， 关于最强的个人行为、人际关系、机构和社区/社会的多方法数据 慢性排尿延迟的决定因素，教育干预的最有效方式 [假设未来的干预措施将包括教育部分]， 信息）; 3）评估未来干预措施的新工具。因此，这套补充研究 有望大大扩展未来膀胱健康促进的知识基础 和LUTS预防干预措施。

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.