Promoting Heart Healthy Behaviors in Youth.

描述(由申请人提供)：这项K23指导的以患者为导向的研究职业发展奖的候选人Tammy Brady博士是约翰霍普金斯大学医学院儿科肾脏病学部的儿科学助理教授。她出色的训练和大量的研究为她职业生涯的下一个阶段做好了准备，这将使她从高技能的观察研究员成功地转变为进行临床干预试验的独立临床科学家。在她接受培训的早期，Brady博士被约翰霍普金斯大学彭博公共卫生学院授予临床流行病学健康科学硕士学位。在她的培训期间和早年担任教员期间，她进行了多项研究，涉及主要数据收集和次要数据分析。除了是美国国立卫生研究院资助的几项多中心研究的联合研究员外，她最近还完成了一项为期一年的前瞻性观察队列研究，研究对象为49名高血压儿童，题为《原发性高血压儿童左心室肥厚回归的纵向研究》。作为首席研究员，她从几个机构获得了支持这项研究的资金：马里兰州国家肾脏基金会、美国肾脏学会、美国心脏协会和国家卫生研究院/约翰斯·霍普金斯临床和翻译研究所。到目前为止，她已经发表了10篇经过同行评审的原创科学论文，其中4篇是第一作者，1篇是资深作者，另外还有3篇原创科学手稿将在未来几个月内提交(2篇是第一作者，1篇是资深作者)。意识到额外培训对促进她的研究追求的价值，她以KL2临床研究学者的身份获得了NIH/Johns Hopkins临床与翻译研究所的资助，这使她得以全日制参加JHSPH的临床调查博士研究生培训计划。在完成第一年的教学后，她获得了NEMA临床研究奖，因为她在综合考试中获得了最高分。自从她最初申请K23以来，她已经完成了学位所需的所有课程，并计划在2014年3月12日为她的论文研究辩护。她成为一名独立研究人员的一个重要组成部分是在行为干预的开发和实施以及临床试验的设计和实施方面进行实践指导培训。她提出的研究将实现这些目标。由于已知的儿童肥胖症流行导致成人出现严重的心血管疾病，预防儿童肥胖和其他心血管危险因素是最重要的。缺乏有效的策略来加强青少年参与治疗性生活方式的改变，这对于纠正导致这种流行病的次优学习行为至关重要，这是她目前研究提案背后的动机。此外，信息技术的广泛使用，特别是在青少年中的手机，为有效和高效地向青年提供生活方式干预提供了一个令人难以置信的机会。在过去几个月里， 布雷迪博士对她提出的干预方案在六名患有高血压的青少年中进行了一项试点研究。这项由马里兰州国家肾脏基金会资助的研究为她提出的干预措施提供了丰富的定性和定量数据。因此，她正在与她的导师和项目顾问团队合作，以改进传递给参与者的信息，并利用从这项试点研究中获得的知识，改进了她的K23研究战略。因此，这项提案的总体目标是：(1)测试 研究目的是：(1)假设一种技术支持的行为健康生活方式干预措施在降低肥胖、高血压前期青少年中的肥胖、血压(BP)和左心室重量(LVM)方面比护理标准更有效；以及(2)比较干预措施对(A)血压、生长、肥胖的激素调节因素；(B)血脂危险因素；以及(C)同一组儿童中血压和血压的昼夜变异性的影响。布雷迪博士将在约翰·霍普金斯大学丰富的培训环境中进行这项研究，并在拉里·阿佩尔博士、皮特·米勒博士和芭芭拉·菲弗什博士的协作和支持指导下进行。她还将与她的项目顾问团队中有成就的成员密切合作：Felicia Hill-Briggs博士、Ben Caballo博士和Debbie Young博士、Jeanne Charleston女士和Arlene Dalin女士。这些流行病学、临床试验和行为医学领域的领导者将确保她提出的干预试验顺利完成。这种有指导的培训，加上持续的教学培训，将使Brady博士成长为一名独立的儿科临床科学家，设计和进行临床试验，这些试验不仅将塑造为心血管风险增加的儿童提供的护理，还将有助于扩大对疾病起源的了解。

DESCRIPTION (provided by applicant): The candidate for this K23 Mentored Patient-Oriented Research Career Development Award, Dr. Tammy Brady, is an Assistant Professor of Pediatrics at the Johns Hopkins University School of Medicine in the Division of Pediatric Nephrology. Her exceptional training and considerable research have prepared her well for this next phase in her career, which will result in her successful transition from highly skilled observational researcher to independent clinician scientist conducting clinical intervention trials Early in her training, Dr. Brady was awarded a Masters in Health Science in Clinical Epidemiology at the Johns Hopkins Bloomberg School of Public Health (JHSPH). During her training and early years on faculty she conducted multiple studies involving primary data collection and secondary data analysis. In addition to being co-investigator on several NIH funded multicenter studies, she has recently completed a year-long prospective, observational cohort study of 49 hypertensive children, entitled Longitudinal Study of Left Ventricular Hypertrophy Regression in Children with Primary Hypertension. As Principal Investigator, she obtained funding from several agencies to support this study: the National Kidney Foundation of Maryland, the American Society of Nephrology, the American Heart Association, and the National Institutes of Health/ Johns Hopkins Institute for Clinical and Translational Research. To date she has published 10 peer-reviewed original science articles, 4 as first author and one as senior author, and has three additional original science manuscripts to be submitted in the coming months (two as first author and one as senior author). Recognizing the value in additional training to further her research pursuits, she secured funding from the NIH/Johns Hopkins Institute for Clinical and Translational Research as a KL2 Clinical Research Scholar which allowed her to enroll full time in the Graduate Training Program for Clinical Investigation PhD program at the JHSPH. She received the NEMA Research Clinical Research Award at the completion of her first didactic year for receiving the highest score on the Comprehensive Examination. Since her initial K23 application, she has completed all of the required coursework for her degree and is scheduled to defend her thesis research on March 12, 2014. An essential component of her evolution into an independent researcher is hands-on mentored training in the development and implementation of a behavioral intervention and the design and conduct of a clinical trial. The research she proposes will accomplish these goals. With the known obesity epidemic in children contributing to the significant CV disease present in adults, prevention of obesity and other CV risk factors in childhood is of the upmost importance. The paucity of available strategies to enhance adolescent engagement in therapeutic lifestyle change, essential to correct the suboptimal learned behaviors contributing to this epidemic, is the motivation behind her current research proposal. Further, the widespread use of information technology, particularly cell phones among adolescents, presents an incredible opportunity to effectively and efficiently deliver lifestyle interventions to youth. Over the last several months, Dr. Brady conducted a pilot study of her proposed intervention among six adolescents with elevated blood pressure. This study, funded by the National Kidney Foundation of Maryland, provided her with rich qualitative and quantitative data regarding her proposed intervention. As a result, she is working with her mentors and Project Advisory Team to improve the messages delivered to participants and has enhanced her K23 research strategy using the knowledge gained from this pilot study. The overall objectives of this proposal are therefore to (1) test the hypothesis that a technology supported behavioral Healthy Lifestyle intervention is more effective than the standard of care on reducing adiposity, blood pressure (BP) and left ventricular mass (LVM) among obese, pre-hypertensive adolescents; and (2) compare the effects of the intervention on (a) hormonal regulators of blood pressure, growth, adiposity; (b) lipid risk factors; and (c) diurnal BP and BP variability among the same group of children. Dr. Brady will carry out this research in the rich training environment of Johns Hopkins University under the collaborative and supportive mentorship of Dr. Larry Appel, Dr. Pete Miller and Dr. Barbara Fivush. She will also work closely with the accomplished members of her Project Advisory team: Drs. Felicia Hill-Briggs, Ben Caballero, and Debbie Young; Ms, Jeanne Charleston; and Ms. Arlene Dalcin. These leaders in the field of epidemiology, clinical trials and behavioral medicine will ensure the successful completion of her proposed interventional trial. This mentored training, along with continued didactic training, will enable Dr. Brady to grow into an independent pediatric clinician scientist, designing and conducting clinical trials that will no only shape the care provided to children at increased CV risk but will also contribute to the expanding knowledge regarding the origins of disease.