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Smith AL, Berry A, Brubaker L, Cunningham SD, Gahagan S, Low LK, Mueller M, Sutcliffe S, Williams BR, Brady SS. The brain, gut, and bladder health nexus: A conceptual model linking stress and mental health disorders to overactive bladder in women. Neurourol Urodyn 2024; 43:424-436. [PMID: 38078701 PMCID: PMC10872494 DOI: 10.1002/nau.25356] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/28/2023] [Accepted: 11/25/2023] [Indexed: 02/06/2024]
Abstract
OBJECTIVE A small, but growing literature links stressors and mental health disorders (MHDs) across the life course to overactive bladder (OAB) and urinary incontinence symptoms. Mechanisms by which stressors and MHDs may impact bladder health are not fully understood, limiting novel prevention and treatment efforts. Moreover, potential biopsychosocial mechanisms involving the brain and gut have not been considered in an integrated, comprehensive fashion. METHODS Members of the prevention of lower urinary tract symptoms Research Consortium developed conceptual models to inform research on biopsychosocial mechanisms through which stress and MDHs may impact bladder health among girls and women, focusing on brain and gut physiology. RESULTS Two conceptual models were developed-one to explain central (brain-based) and peripheral (gut-based) mechanisms linking stressors and MHDs to OAB and bladder health, and one to highlight bidirectional communication between the brain, gut, and bladder. Traumatic events, chronic stressors, and MHDs may lead to a maladaptive stress response, including dysregulated communication and signaling between the brain, gut, and bladder. Gut bacteria produce molecules and metabolites that alter production of neurotransmitters, amino acids, short-chain fatty acids, and inflammatory immune response molecules that mediate communication between the gut and brain. Microbiota signal neurogenesis, microglia maturation, and synaptic pruning; they also calibrate brain-gut-bladder axis communication through neurotransmission and synaptogenesis, potentially influencing bladder symptom development. Life course trajectories of risk may be prevented or interrupted by central and peripheral resources for neuropsychological resilience. CONCLUSIONS Depicted pathways, including brain-gut-bladder communication, have implications for research and development of novel prevention and treatment approaches.
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Affiliation(s)
- Ariana L. Smith
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Amanda Berry
- Division of Urology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Linda Brubaker
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego School of Medicine, University of California San Diego, La Jolla, California
| | - Shayna D. Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT
| | - Sheila Gahagan
- Department of Pediatrics, UC San Diego School of Medicine, University of California, San Diego CA
| | - Lisa Kane Low
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan
| | - Margaret Mueller
- Department of Ob/Gyn, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, MO
| | - Beverly R. Williams
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham (UAB) and Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs
| | - Sonya S. Brady
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN
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Brady SS, Arguedas A, Huling JD, Hellemann G, Lewis CE, Fok CS, Van Den Eeden SK, Markland AD. Financial strain across 25 years and women's bladder health: a life course perspective. Am J Obstet Gynecol 2024; 230:77.e1-77.e12. [PMID: 37778676 PMCID: PMC10842084 DOI: 10.1016/j.ajog.2023.09.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND A small number of cross-sectional studies have found that financial insecurity-a social determinant of health-is associated with lower urinary tract symptoms. OBJECTIVE This study aimed to examine (1) whether women in the Coronary Artery Risk Development in Young Adult Study with higher levels of financial strain, assessed at 7 time points across 25 years beginning in 1985-1986, were more likely to report lower urinary tract symptoms and impact after the 2010-2011 financial strain assessment and (2) whether healthcare access and comorbidities mediated potential associations. STUDY DESIGN This prospective cohort study recruited Black and White participants aged 18 to 30 years at baseline (1985-1986) from the populations of 4 US cities. The analytical sample was composed of women with complete data for analyses involving financial strain trajectories across 7 assessments (n=841) and mediation tests of data collected at 4 assessments (n=886). The outcome variable was previously developed through a cluster analysis of urinary incontinence severity, urinary incontinence impact, other lower urinary tract symptoms severity, and their impact in 2012-2013, which yielded 4 lower urinary tract symptoms and impact cluster categories: women with no symptom or very mild symptoms and no impact vs women with mild, moderate, or severe symptoms and impact. Financial strain was defined as finding it "very hard," "hard," or "somewhat hard" (vs "not very hard") to pay for the very basics, such as food, heating, and medical care. Using proportional odds logistic regression, cluster categories were regressed on the financial strain trajectory group, adjusting for age, race, education, and parity. For mediation analyses, separate financial strain variables (difficulty paying for the very basics, such as food and heating, and difficulty paying for medical care) were created by combining 1995-1996 and 2000-2001 values. Two healthcare access variables (difficulty receiving care and underutilization of care) and a single comorbidity index (smoking, physical inactivity, body mass index, hypertension, diabetes mellitus, and depressive symptoms) were created by combining 2005-2006 and 2010-2011 values. Regression analyses and structural equation modeling were used to test whether healthcare access and comorbidities mediated associations between financial strain and lower urinary tract symptoms and impact cluster categories. RESULTS In comparison to women who were consistently not financially strained, women who were consistently strained (odds ratio, 2.10; 95% confidence interval, 1.13-3.91), shifted into being strained (odds ratio, 2.00; 95% confidence interval, 1.29-3.10), or experienced >1 shift in strain (odds ratio, 1.99; 95% confidence interval, 1.46-2.71) had roughly twice the odds of reporting greater lower urinary tract symptoms and impact. Underutilization of healthcare and comorbidities mediated the association between difficulty paying for medical care and lower urinary tract symptoms and impact. In the structural equation model, difficulty paying for medical care and underutilization of care were associated (β=.31; P<.01), as was underutilization of care and greater lower urinary tract symptoms and impact (β=.09; P<.01). Moreover, difficulty paying for medical care and the comorbidity index were associated (β=.34; P<.01), as was the comorbidity index and greater lower urinary tract symptoms and impact (β=.24; P<.01). Collectively, these mediation pathways eliminated a direct association between difficulty paying for medical care and lower urinary tract symptoms and impact. CONCLUSION Underutilization of healthcare and comorbidities explained an association between financial strain (difficulty paying for medical care) and lower urinary tract symptoms and impact. Research is needed to confirm the findings and examine other mechanisms that may further explain the association. Accumulated evidence may inform future policies and practices.
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Affiliation(s)
- Sonya S Brady
- Program in Health Disparities Research, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN.
| | - Andrés Arguedas
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN
| | - Jared D Huling
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN
| | - Gerhard Hellemann
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Cora E Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Cynthia S Fok
- Department of Urology, University of Minnesota Medical School, Minneapolis, MN
| | - Stephen K Van Den Eeden
- Division of Research, Kaiser Permanente Northern California, Oakland, CA; Department of Urology, University of California, San Francisco, San Francisco, CA
| | - Alayne D Markland
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL; Birmingham VA Medical Center, Birmingham, AL
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Brady SS, Arguedas A, Huling JD, Hellemann G, Lewis CE, Fok CS, Van Den Eeden SK, Markland AD. Discrimination and bladder health among women in the CARDIA cohort study: Life course and intersectionality perspectives. Soc Sci Med 2024; 341:116547. [PMID: 38159485 PMCID: PMC10840419 DOI: 10.1016/j.socscimed.2023.116547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 09/10/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE This study examines whether discriminatory experiences are associated with lower urinary tract symptoms (LUTS) and their impact among 972 women in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort study, which recruited participants from 4 cities in the United States. METHOD Exposure to discrimination was assessed 3 times (1992-93, 2000-01, 2010-11) and averaged across assessments. Participants separately reported whether they experienced discrimination on the basis of their gender, race or color, and socioeconomic position or social class. For each social identity, discrimination was assessed in 6-7 settings (e.g., when getting a job, medical care, or housing). At different time points, women who reported discriminatory experiences for a given social identity were asked how frequently the discrimination occurred and how stressful experience(s) were. Following the 2010-11 assessment, data on LUTS and their impact were collected. Women were classified into bladder health versus mild, moderate, or severe symptoms/impact clusters. RESULTS More Black than White women reported discriminatory experiences across all social identities and most settings. Perceived stress of discriminatory experiences did not differ between Black and White women. In analyses stratified by race and social identity, White women reported LUTS/impact with discriminatory experiences in more settings, more frequent discriminatory experiences across settings, and each additional social identity for which discrimination was experienced. Black women reported LUTS/impact with more frequent discriminatory experiences across settings. For Black women, greater perceived stress of both gender and race discrimination were associated with LUTS/impact. For White women, only greater perceived stress of race discrimination was associated with LUTS/impact. CONCLUSIONS This is one of the first studies to examine discrimination in relation to LUTS/impact. Additional research is needed to better understand differences in how discriminatory experiences based on potentially intersecting identities may be related to bladder health among women.
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Affiliation(s)
- Sonya S Brady
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Program in Health Disparities Research, 717 Delaware Street SE, Suite 166, Minneapolis, MN, 55414, USA.
| | - Andrés Arguedas
- Division of Biostatistics, University of Minnesota School of Public Health, University Office Plaza 2221 University Ave SE, Suite 200, Minneapolis, MN, 55414, USA.
| | - Jared D Huling
- Division of Biostatistics, University of Minnesota School of Public Health, University Office Plaza 2221 University Ave SE, Suite 200, Minneapolis, MN, 55414, USA.
| | - Gerhard Hellemann
- Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Ryals Public Health Building (RPHB), 1665 University Boulevard, Birmingham, AL, 35233, USA.
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Ryals Public Health Building (RPHB), 1665 University Boulevard, Birmingham, AL, 35233, USA.
| | - Cynthia S Fok
- Department of Urology, University of Minnesota Medical School, Mayo Building 420 Delaware St. Se. MMC 394, Minneapolis, MN, 55454, USA.
| | - Stephen K Van Den Eeden
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway Oakland, CA, 94612, USA; Department of Urology, University of California, San Francisco, 400 Parnassus Ave, San Francisco, CA, 94143, USA.
| | - Alayne D Markland
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham School of Medicine, 933 19th Street South, CH19 201 Birmingham, AL, 35294, USA; Birmingham VA Medical Center, 700 19th St S, Birmingham, AL, 35233, USA.
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Fitzgerald CM, Cunningham SD, Berry A, Gahagan S, Joinson C, Lindberg S, Newman DK, Schmitz KH, Smith AL, Sutcliffe S, Shoham DA. Is there an association between physical activity and lower urinary tract symptoms in adolescent girls? Results from the Avon Longitudinal Study of Parents and Children. Int Urogynecol J 2023; 34:2995-3003. [PMID: 37715786 PMCID: PMC10962925 DOI: 10.1007/s00192-023-05639-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/22/2023] [Indexed: 09/18/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Lower urinary tract symptoms (LUTS) are common among adolescent girls. Physical activity (PA) has been implicated as both a risk (high-impact PA) and protective factor (low-impact, moderate to vigorous intensity PA) for LUTS in adult women, but its role in adolescent girls is unclear. This study investigated the prospective association between physical activity and LUTS risk in adolescent girls. METHODS The sample comprised 3,484 female participants in the Avon Longitudinal Study of Parents and Children. Multivariate logistic regression models were used to examine daily minutes of moderate to vigorous PA (MVPA) at ages 11 and 15 years in relation to LUTS at ages 14 and 19 respectively. MVPA was assessed by 7-day accelerometer data. LUTS were assessed by questionnaire. MVPA were analyzed as continuous (minutes/day) and categorical variables (<10th percentile, 10-89th percentile, ≥90th percentile). RESULTS Prevalence of LUTS ranged from 2.0% for bedwetting to 9.5% for nocturia at age 14 and from 2.0% for straining to urinate to 35.5% for interrupted urine flow at age 19. Physical activity was not associated with LUTS at either time-point. CONCLUSIONS Given the prevalence of LUTS in female adolescent populations, although this study did not find an association with accelerometer-measured MVPA, other aspects of PA that may serve as risk or protective factors deserve investigation.
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Affiliation(s)
- Colleen M Fitzgerald
- Department of Obstetrics, Gynecology and Urology, Loyola University Chicago, Chicago, IL, USA
| | - Shayna D Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA.
| | - Amanda Berry
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sheila Gahagan
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Carol Joinson
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Lindberg
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Diane K Newman
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kathryn H Schmitz
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ariana L Smith
- Division of Urology, Perelman School of Medicine, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, and the Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - David A Shoham
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA
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Brady SS, Shan L, Markland AD, Huling JD, Arguedas A, Fok CS, Van Den Eeden SK, Lewis CE. Trajectories of depressive symptoms over 20 years and subsequent lower urinary tract symptoms and impact among women. Menopause 2023; 30:723-731. [PMID: 37159879 PMCID: PMC10313766 DOI: 10.1097/gme.0000000000002193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE The aim of the study is to examine the association between depressive symptoms and subsequent lower urinary tract symptoms (LUTS) and impact (a composite outcome) among women (N = 1,119) from the Coronary Artery Risk Development in Young Adults study. METHODS The Center for Epidemiologic Studies-Depression Scale (CES-D) was administered in 1990-1991 and every 5 years through 2010-2011. In 2012-2013, LUTS and impact data were collected for the first time. Accumulation of risk was examined in the following three ways: (1) mean CES-D score across 20 years (5 observations); (2) depressive symptom trajectory group, determined by group-based trajectory modeling; and (3) intercepts and slopes obtained from women's individual CES-D score trajectories through two-stage mixed effects modeling. For each approach, ordinal logistic regression analyses examined odds of having "greater LUTS/impact" for each unit change in a depressive symptom variable. RESULTS (1) With each one-unit increase in mean CES-D score over the 20-year period, women were 9% more likely to report greater LUTS/impact (odds ratio [OR] = 1.09, 95% CI = 1.07-1.11). (2) In comparison with women with consistently low depressive symptoms, women with consistently threshold depression or consistently high depressive symptoms were twice (OR = 2.07, 95% CI = 1.59-2.69) and over five times (OR = 5.55, 95% CI = 3.07-10.06) as likely, respectively, to report greater LUTS/impact. (3) Women's individual symptom intercept and slope interacted. Increases in depressive symptoms across 20 years (greater slopes) were associated with greater LUTS/impact when women's initial CES-D score (intercept) was in the moderate-to-high range relative to the sample. CONCLUSIONS Depressive symptoms over 20 years, examined with different degrees of nuance, were consistently associated with subsequently measured LUTS and impact.
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Affiliation(s)
- Sonya S. Brady
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health
| | - Liang Shan
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL
| | - Alayne D. Markland
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham School of Medicine and Birmingham VA Medical Center, Birmingham, AL
| | - Jared D. Huling
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN
| | - Andrés Arguedas
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN
| | - Cynthia S. Fok
- Department of Urology, University of Minnesota Medical School, Minneapolis, MN
| | - Stephen K. Van Den Eeden
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
- Department of Urology, University of California, San Francisco, San Francisco, CA
| | - Cora E. Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
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Zhang X, Li M, Dong W, Lv X, Li L, Yang X, Cao Y. Prevalence and influencing factors of lower urinary tract symptoms in female nurses: a cross-sectional study based on TARGET. Front Public Health 2023; 11:1201184. [PMID: 37404267 PMCID: PMC10315681 DOI: 10.3389/fpubh.2023.1201184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/25/2023] [Indexed: 07/06/2023] Open
Abstract
Background Even though occupational women have a high incidence of lower urinary tract symptoms (LUTS), which seriously affect their daily work life, few large scale sample studies have provided empirical evidence to support this phenomenon among female nurses in China. Consequently, this article investigated female nurses who was presupposed to have a high prevalence of LUTS, which adversely exposes their health and patient safety to these risks. Additionally, it is considered important to explore the factors associated with LUTS in female nurses for patient care safety and nurse bladder health practice. Objectives The purpose of this study was to assess the incidence of LUTS and symptoms-related risk factors among female nurses, to provide evidence for the prevention and control of LUTS. Methods An online survey recruiting 23,066 participants was carried out in a multicenter cross-sectional study in 42 hospitals from December 2020 to November 2022. Stepwise multivariate logistic regression analysis and nomogram were used to identify the factors associated with lower urinary tract symptoms. Besides, SPSS version 26.0, R version 4.2.2, and GraphPad Prism Version 8.3 software packages were used for statistical analysis. Results Based on the completion rate of the questionnaire which was 84.1% (n = 19,393), it was found that among 19,393 female nurses, the prevalence of LUTS was 67.71% and this rate was influenced by age, Body Mass Index (BMI), marital status, years of working, menstrual status, mode of delivery, history of breastfeeding, history of miscarriage, history of alcohol and coffee or tea consumption (p < 0.05). Interestingly, we also find that in addition to the above mentioned factors, anxiety, depression, and perceived stress were also related to LUTS in female nurses (p < 0.05). Conclusion Given the high prevalence of LUTS among female nurses and their potential influencing factors, female nurses should focus on their reproductive health and develop good lifestyle habits. Thus, nursing managers should provide a warm and harmonious work environment and sensitize female nurses to increase their awareness about the importance of drinking clean water and urinating during work in a hygienic environment.
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Affiliation(s)
- Xinyue Zhang
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Mengli Li
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Wenshuo Dong
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
| | - Xiaoyan Lv
- Department of Nursing, Qilu Hospital of Shandong University, Shandong, Jinan, China
- Nursing Theory and Practice Innovation Research Center, Shandong University, Jinan, Shandong, China
| | - Li Li
- Department of Nursing, Qilu Hospital of Shandong University, Shandong, Jinan, China
- Nursing Theory and Practice Innovation Research Center, Shandong University, Jinan, Shandong, China
| | - Xiaorong Yang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Yingjuan Cao
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
- Department of Nursing, Qilu Hospital of Shandong University, Shandong, Jinan, China
- Nursing Theory and Practice Innovation Research Center, Shandong University, Jinan, Shandong, China
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Grobeisen-Duque O, Mora-Vargas CD, Aguilera-Arreola MG, Helguera-Repetto AC. Cycle Biodynamics of Women's Microbiome in the Urinary and Reproductive Systems. J Clin Med 2023; 12:4003. [PMID: 37373695 DOI: 10.3390/jcm12124003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
The genitourinary microbiome plays a crucial role in the establishment and maintenance of urinary and reproductive health in women throughout their lives. Particularly during the reproductive stage, resident microorganisms contribute to implantation and protect against perinatal complications, including preterm birth, stillbirth, and low birth weight, while also serving as the first line of defense against pathogens that can cause infections, such as urinary tract infections and bacterial vaginosis. This review aimed to elucidate the relationship between a healthy microbiome environment and women's overall health. We examine the variability and dynamics of the microbiome during different developmental stages, ranging from the prepubertal to the postmenopausal stage. Furthermore, we explore the significance of a healthy microbiota in successful implantation and pregnancy development and investigate potential differences between women experiencing infertility. In addition, we analyze the local and systemic inflammatory responses associated with the establishment of a dysbiotic state and compare it to a condition where a healthy microbiome was established. Lastly, we present the most recent evidence regarding preventive measures, such as dietary interventions and the use of probiotics to promote and maintain a healthy microbiome, thereby ensuring comprehensive women's health. By highlighting the importance of the genitourinary microbiome in reproductive health, this review aimed to enhance this microbiome's visibility and significance in the field.
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Affiliation(s)
- Orly Grobeisen-Duque
- Departamento de Inmunobioquímica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Ciudad de Mexico 11000, Mexico
- Facultad de Ciencias de la Salud, Universidad Anahuac Mexico, Ciudad de Mexico 52786, Mexico
| | - Carlos Daniel Mora-Vargas
- Departamento de Inmunobioquímica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Ciudad de Mexico 11000, Mexico
- Escuela Nacional de Ciencias Biologicas del Instituto Politecnico Nacional, Ciudad de Mexico 11350, Mexico
| | | | - Addy Cecilia Helguera-Repetto
- Departamento de Inmunobioquímica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Ciudad de Mexico 11000, Mexico
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Smith AL, Rudser K, Harlow BL, McGwin G, Barthold J, Brady SS, Brubaker L, Cunningham SD, Griffith JW, Kenton K, Klusaritz H, Lewis CE, Lukacz ES, Maki J, Markland AD, Mueller ER, Newman DK, Nodora J, Rickey LM, Rockwood T, Simon M, Wyman JF, Sutcliffe S. RISE FOR HEALTH: Rationale and protocol for a prospective cohort study of bladder health in women. Neurourol Urodyn 2023; 42:998-1010. [PMID: 36321762 PMCID: PMC10151425 DOI: 10.1002/nau.25074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/09/2022] [Accepted: 10/16/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The spectrum of bladder health and the factors that promote bladder health and prevent lower urinary tract symptoms (LUTS) among women are not well understood. This manuscript describes the rationale, aims, study design, sampling strategy, and data collection for the RISE FOR HEALTH (RISE) study, a novel study of bladder health in women conducted by the Prevention of Lower Urinary Tract Symptom (PLUS) Research Consortium. METHODS AND RESULTS RISE is a population-based, multicenter, prospective longitudinal cohort study of community-dwelling, English- and Spanish-speaking adult women based in the United States. Its goal is to inform the distribution of bladder health and the individual factors (biologic, behavioral, and psychosocial) and multilevel factors (interpersonal, institutional, community, and societal) that promote bladder health and/or prevent LUTS in women across the life course. Key study development activities included the: (1) development of a conceptual framework and philosophy to guide subsequent activities, (2) creation of a study design and sampling strategy, prioritizing diversity, equity, and inclusion, and (3) selection and development of data collection components. Community members and cross-cultural experts shaped and ensured the appropriateness of all study procedures and materials. RISE participants will be selected by simple random sampling of individuals identified by a marketing database who reside in the 50 counties surrounding nine PLUS clinical research centers. Participants will complete self-administered surveys at baseline (mailed paper or electronic) to capture bladder health and LUTS, knowledge about bladder health, and factors hypothesized to promote bladder health and prevent LUTS. A subset of participants will complete an in-person assessment to augment data with objective measures including urogenital microbiome specimens. Initial longitudinal follow-up is planned at 1 year. DISCUSSION Findings from RISE will begin to build the necessary evidence base to support much-needed, new bladder health promotion and LUTS prevention interventions in women.
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Affiliation(s)
- Ariana L. Smith
- University of Pennsylvania, Perelman School of Medicine, Division of Urology, Philadelphia, Pennsylvania
| | - Kyle Rudser
- University of Minnesota, Division of Biostatistics, Minneapolis, Minnesota, United States
| | - Bernard L Harlow
- Boston University School of Public Health, Department of Epidemiology, Boston, Massachusetts
| | - Gerald McGwin
- University of Alabama at Birmingham, Department of Epidemiology, Birmingham, Alabama
| | - Julia Barthold
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda MD
| | - Sonya S. Brady
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, Minnesota
| | - Linda Brubaker
- University of California San Diego, Department of Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego School of Medicine, La Jolla, California
| | - Shayna D. Cunningham
- University of Connecticut, School of Medicine, Department of Public Health Sciences, Farmington, Connecticut
| | - James W. Griffith
- Northwestern University, Feinberg School of Medicine, Department of Medical Social Sciences, Chicago, Illinois
| | - Kim Kenton
- Northwestern University, Feinberg School of Medicine, Department of Obstetrics and Gynecology, Chicago, Illinois
| | - Heather Klusaritz
- University of Pennsylvania, Perelman School of Medicine, Department of Family Medicine and Community Health, Philadelphia, Pennsylvania
| | - Cora E. Lewis
- University of Alabama at Birmingham, Department of Epidemiology, Birmingham, Alabama
| | - Emily S. Lukacz
- University of California San Diego, Department of Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego School of Medicine, La Jolla, California
| | - Julia Maki
- Washington University in St. Louis, Division of Public Health Sciences, Department of Surgery, St. Louis, Missouri
| | - Alayne D. Markland
- University of Alabama at Birmingham, Department of Medicine, Birmingham, Alabama and Birmingham VA Medical Center Birmingham, Alabama
| | - Elizabeth R. Mueller
- Loyola University Chicago, Department of Obstetrics, Gynecology and Urology, Maywood, Illinois
| | - Diane K. Newman
- University of Pennsylvania, Perelman School of Medicine, Division of Urology, Philadelphia, Pennsylvania
| | - Jesse Nodora
- University of California San Diego, Herbert Wertheim School of Public Health & Human Longevity Science, La Jolla, California
| | | | - Todd Rockwood
- University of Minnesota, Division of Health Policy and Management, Minneapolis, Minnesota
| | - Melissa Simon
- Northwestern School of Medicine, Department of Obstetrics and Gynecology, Chicago, Illinois
| | - Jean F. Wyman
- University of Minnesota, School of Nursing, Minneapolis, Minnesota, United States
| | - Siobhan Sutcliffe
- Washington University in St. Louis, Division of Public Health Sciences, Department of Surgery, St. Louis, Missouri, United States
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9
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O'Shea SD, Pope R, Freire K, Orr R. Prevalence of lower urinary tract symptoms in a cohort of Australian servicewomen and female veterans. Int Urogynecol J 2023; 34:885-896. [PMID: 35763047 PMCID: PMC10038961 DOI: 10.1007/s00192-022-05254-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 05/27/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Lower urinary tract symptoms (LUTS) are common in the general female population. It was hypothesised that Australian female military personnel and veterans would experience similar types and prevalence of LUTS as the broader Australian female population. METHODS An online cross-sectional survey was utilised to explore the pelvic health of active servicewomen and veterans in the Australian Defence Force (ADF). For the purposes of this report, only the demographic and LUTS data (excluding urinary tract infections) were extracted and descriptively analysed. RESULTS A total of 491 complete survey responses were received and analysed. Respondent characteristics were comparable to those documented in a departmental report regarding ADF servicewomen. No LUTS were reported by 38% of respondents. Regular symptoms of urinary incontinence were experienced by 27% of respondents (stress urinary incontinence = 23%, urge urinary incontinence = 16%, mixed urinary incontinence = 13%), bladder storage issues by 20-27%, and various voiding impairments by 9-27%. In addition, 41% reported regularly experiencing two or more LUTS, and for over two thirds of respondents, LUTS were an ongoing issue. Relationships between age, parity, and symptoms of urinary incontinence were also seen. CONCLUSIONS Consistent with wider research in Australian female populations, LUTS were commonly experienced during service by ADF female military personnel and veterans. Given the high likelihood of female military personnel experiencing LUTS during their service, and a proportion experiencing ongoing symptoms, tailored monitoring and support for urinary health should be available to enhance occupational health, safety, and performance.
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Affiliation(s)
- Simone D O'Shea
- School of Allied Health, Exercise and Sport Sciences, Charles Sturt University, PO Box 789, Albury, NSW, 2640, Australia.
| | - Rod Pope
- School of Allied Health, Exercise and Sport Sciences, Charles Sturt University, PO Box 789, Albury, NSW, 2640, Australia
- Tactical Research Unit, Bond University, Robina, Australia
| | - Katharine Freire
- Three Rivers Department of Rural Health, Charles Sturt University, Albury, Australia
| | - Robin Orr
- Tactical Research Unit, Bond University, Robina, Australia
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10
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Freire K, O'Shea S, Pope R, Orr R. Servicewomen's experiences of managing pelvic health in occupational settings. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231183839. [PMID: 37377334 DOI: 10.1177/17455057231183839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
BACKGROUND Despite increasing numbers of women serving in defence forces worldwide, little is currently known about how servicewomen manage their pelvic health in the traditionally male environment of the military. OBJECTIVES The aim of this study was to explore the impacts of pelvic health issues on Australian Defence Force servicewomen and their experiences of managing their pelvic health in occupational settings. DESIGN A qualitative hermeneutic design. METHODS Telephone interviews were conducted on six currently serving female members of the Australian Defence Force located Australia-wide. A semi-structured interview guide, based on the study objectives, was used to guide the audio-recorded interviews. Data were analysed thematically. RESULTS Nine themes were identified. The first six themes explored the experiences of servicewomen in maintaining their pelvic health, including suppressing the urge to go, adjusting hydration depending on toilet access, managing menstruation, regaining 'full' fitness postpartum, awareness and prevention of pelvic health conditions, and inhibiting conversations about women's health. The last three themes explored how servicewomen coped with pelvic health conditions, including self-managing symptoms, diagnosing and treating pelvic conditions, and support for servicewomen's pelvic health. CONCLUSION This study suggests workplace culture, low levels of insight into pelvic health norms, and limited healthcare strategies within the Australian Defence Force to support female pelvic health have contributed to servicewomen self-managing pelvic health issues using approaches that may have had significant impacts on their health and well-being.
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Affiliation(s)
- Kate Freire
- Three Rivers Department of Rural Health, Charles Sturt University, Wagga Wagga, NSW, Australia
| | | | - Rod Pope
- Charles Sturt University, Albury, NSW, Australia
- Bond University, Gold Coast, QLD, Australia
| | - Rob Orr
- Bond University, Gold Coast, QLD, Australia
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11
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Joseph C, Srivastava K, Ochuba O, Ruo SW, Alkayyali T, Sandhu JK, Waqar A, Jain A, Poudel S. Stress Urinary Incontinence Among Young Nulliparous Female Athletes. Cureus 2021; 13:e17986. [PMID: 34660161 PMCID: PMC8516023 DOI: 10.7759/cureus.17986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 09/15/2021] [Indexed: 11/12/2022] Open
Abstract
Urinary incontinence (UI) is described as unintentional voiding of urine that is usually seen in post-partum and post-menopausal women due to the weakening of pelvic floor muscles (PFM). Recent studies have shown an increase in the prevalence of stress urinary incontinence (SUI) among young nulliparous female athletes. The association between UI and high-impact physical activity is due to increased intra-abdominal pressure during high-impact sports exceeding intra-urethral pressure. Usually, the levator ani muscle (LAM) helps in urethral closure. However, weakening or injury of LAM can reduce the pelvic support and cause UI in young female athletes. This study aims to assess the prevalence of SUI among young nulliparous athletes and also explore the association between SUI and athletic sports in young females. We searched PubMed and Google Scholar as databases to find specific articles about the topic. After the inclusion and exclusion criteria were applied, 52 articles were selected for this review. It is found that there is an increased UI prevalence, mainly SUI, among young nulliparous female athletes, especially in volleyball players and long-distance runners. Nulliparous athletes involved in high-impact exercises were found to have an increased cross-sectional area of LAM and puborectalis muscle width. SUI is usually under-reported and underdiagnosed due to lack of knowledge and unawareness, which can negatively affect the personal and social life of young females. PFM training is considered the first line of therapy among nulliparous athletes. However, it is unclear whether the high-impact effects of sports cause UI through PFM fatigue or PFM damage. More research is needed to better understand this effect.
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Affiliation(s)
- Christine Joseph
- Urology and Obstetrics & Gynecology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Kosha Srivastava
- Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Olive Ochuba
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sheila W Ruo
- General Surgery Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Tasnim Alkayyali
- Pathology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Jasmine K Sandhu
- Obstetrics & Gynecology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ahsan Waqar
- Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Ashish Jain
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sujan Poudel
- Psychiatry and Behavioral Sciences, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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12
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Converging on Bladder Health through Design Thinking: From an Ecology of Influence to a Focused Set of Research Questions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124340. [PMID: 32560510 PMCID: PMC7345219 DOI: 10.3390/ijerph17124340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 11/16/2022]
Abstract
Lower urinary tract symptoms affect a substantial number of women in the United States (U.S.) and globally. In 2015, the Prevention of Lower Urinary tract Symptoms in women (PLUS) Research Consortium was funded to establish the scientific basis for prevention efforts by (1) understanding healthy bladder function and (2) identifying risk and protective factors for bladder health in women across the lifecourse. This transdisciplinary consortium generated a list of over 600 candidate risk and protective factors for bladder health in women and girls and refined and prioritized these into 29 focused research questions to inform a national longitudinal observational study in the U.S. This paper describes that process using design thinking, a human-centered set of principles and strategies by which innovations are developed, as a framework. Design thinking is an iterative process consisting of five stages: Empathizing with end-users of innovations, Defining core principles girding the work, Ideation of all possible solutions, and rapid-cycle Prototyping and Testing of solutions. Lessons learned are offered to inform future prevention science research endeavors that might benefit from such an approach.
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Smith AL, Rickey LM, Brady SS, Fok CS, Lowder JL, Markland AD, Mueller ER, Sutcliffe S, Bavendam TG, Brubaker L. Laying the Foundation for Bladder Health Promotion in Women and Girls. Urology 2020; 150:227-233. [PMID: 32197984 DOI: 10.1016/j.urology.2020.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 02/27/2020] [Accepted: 03/05/2020] [Indexed: 01/03/2023]
Abstract
Prevention strategies have been effective in many areas of human health, yet have not been utilized for lower urinary tract symptoms (LUTS) or bladder health (BH). This commentary outlines LUTS prevention research initiatives underway within the NIH-sponsored Prevention of Lower Urinary Tract Symptoms Research Consortium (PLUS). Prevention science involves the systematic study of factors associated with health and health problems, termed protective and risk factors, respectively. PLUS is enhancing traditional prevention science approaches through use of: (1) a transdisciplinary team science approach, (2) both qualitative and quantitative research methodology (mixed methodology), and (3) community engagement. Important foundational work of PLUS includes development of clear definitions of both BH and disease, as well as a BH measurement instrument that will be validated for use in the general population, adolescents, and Latinx and Spanish-speaking women.1 The BH measurement instrument will be used in an upcoming nationally-representative cohort study that will measure BH and investigate risk and protective factors. PLUS investigators also developed a conceptual framework to guide their research agenda; this framework organizes a broad array of candidate risk and protective factors that can be studied across the life course of girls and women.1 As PLUS begins to fill existing knowledge gaps with new information, its efforts will undoubtedly be complemented by outside investigators to further advance the science of LUTS prevention and BH across additional populations. Once the BH community has broadened its understanding of modifiable risk and protective factors, intervention studies will be necessary to test LUTS prevention strategies and support public health efforts. LUTS providers may be able to translate this evolving evidence for individual patients under their care and act as BH advocates in their local communities.
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Affiliation(s)
- Ariana L Smith
- Department of Surgery, University of Pennsylvania's Perelman School of Medicine, Philadelphia, PA.
| | - Leslie M Rickey
- Department of Urology, Yale University School of Medicine, New Haven, CT
| | - Sonya S Brady
- Department of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Cynthia S Fok
- Department of Urology, University of Minnesota, Minneapolis MN
| | - Jerry L Lowder
- Department of Obstetrics and Gynecology, Washington University, St Louis, MO
| | - Alayne D Markland
- Department of Medicine, University of Alabama at Birmingham and the Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, AL
| | - Elizabeth R Mueller
- Departments of Obstetrics and Gynecology & Urology, Stritch School of Medicine, Loyola University Chicago, Chicago IL
| | | | | | - Linda Brubaker
- Department of Obstetrics, Gynecology and Reproductive Sciences, UC San Diego, San Diego, CA
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