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

 描述(申请人提供)：下尿路功能障碍(LUTD)包括与膀胱储存、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，对女性的影响不成比例，并导致总体发病率。根据人口增长和患病率估计，下尿路症状(LUT)和情况预计将在未来30年影响4300多万妇女。据估计，LUTS以及跌倒和生产力丧失等相关问题每年给社会造成的成本超过650亿美元。LUTS还干扰社会和身体活动的参与，从而影响生活质量，并对其他慢性疾病造成负面影响 健康状况，如心血管疾病、糖尿病、肥胖和抑郁症。显然，这有很高的个人和社会影响，然而许多妇女不理解这些影响，即使是有症状的妇女通常也不寻求治疗。这可能是由于对疾病治疗的关注，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开展未来的预防干预研究。我们的应用程序的目标是演示如何使用生态系统理论作为指导框架来构建膀胱健康知识库，这是一种在个人、家庭/同龄人和社区层面解决风险因素的方法。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。目前关于膀胱健康和LUTS风险因素的大多数证据都是基于个体特征的，因此大多数干预措施都集中在生态模型的单个层次上，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，我们将考虑包括生物因素、行为、知识、环境和卫生服务在内的问题，这些问题将确定谁有患LUTS的风险，以及如何处理和管理早期症状。多层次的方法对于任何可持续、有效的计划都是必不可少的；因此，考虑到多种背景因素的生态框架对于识别并最终改变导致LUT的行为和相关的健康结果至关重要。我们为耶鲁大学膀胱健康临床中心组建的多学科团队除了在健康行为和流行病学研究方面拥有专业知识的研究人员外，还包括LUTS护理和研究专家，研究对象包括吸烟、疫苗接种、肥胖、产前护理、尿路感染和残疾。研究人员招募了来自初级保健诊所和社区的女性患者进行了大量的纵向研究，他们预防慢性病的方法将为下尿路感染的风险和保护因素的研究提供新的线索。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福祉 还有女人。

 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.