Some partnerships were meant to be, and it would be difficult to imagine a more perfect one than June Cho, PhD, RN, and Wally A. Carlo, MD. An assistant professor of nursing in the University of Alabama at Birmingham School of Nursing, Cho sought out Carlo when she first came to UAB in 2008. Carlo, a world-renowned neonatologist and researcher, is the Edwin M. Dixon Professor of Pediatrics and director of the Division of Neonatology at UAB. Cho was eager to discuss her work with very low birth-weight preterm infants.
Working with mother-preterm pairs, Cho had been studying gender differences in infant health, in mother-infant interactions, and in infant cognitive, motor, and language development. The literature suggested that preterm boys have more health issues than girls—and that testosterone might somehow be related. Cho wanted to zero in on the relationship between the mother's stress level, her baby's testosterone level, and the baby's cognitive, motor, and language development. She also wanted to study how these hormones affect interaction between mother and child.
"When I explained my hypothesis to Dr. Carlo and other research collaborators at UAB, they immediately understood," said Cho. "So it was a very smooth start. I feel incredibly fortunate."
Carlo helped her put together a team anchored by Kenneth McCormick, MD, director of the UAB Pediatrics Division of Endocrinology, and Fred Biasini, PhD, director of UAB's Lifespan Developmental Psychology Program.
"We are very interested in doing collaborative research with other investigators throughout the university," Carlo explained. "Collaboration brings people together from different fields, people with different interests and perspectives. It moves us forward faster by giving us a broader understanding of the issues. Dr. Cho came to us with great ideas for a project on hormones. We thought the project was very innovative, so we were eager to support her research program."
A Dean's Scholar Award funded a one-year pilot study for Cho. Such funds are strategic investments by the UAB School of Nursing to help researchers develop pilot projects that ultimately lead to federal funding. In Cho's case, promising results from that initial study led to a successful bid for a two-year R21 grant for $407,875 from the National Institute of Health (NIH). "Dr. Cho really has had a nice trajectory of research," said Karen Meneses, PhD, RN, FAAN, who is one of Cho's mentors within the School of Nursing. "She's extremely hard-working, and she wisely seeks Dr. Carlo's advice on publication and team-building. He is a great mentor."
UAB has a sophisticated network of partnerships and mentoring programs whereby new researchers can work with and learn from world-renowned experts in many health care fields, with colleagues building on each other's discoveries. Even in highly specialized fields, the university has the infrastructure to propel research forward and sustain it over time. By sharing both financial resources and intellectual capital, the School of Nursing can tap into those resources, offering researchers like Cho the opportunity to discover new knowledge that informs clinical practice and improves care for patients—even the tiniest, most vulnerable ones.
Through Cho's research with her UAB team, she has learned that cortisol and testosterone levels rise and fall together in infants and fetuses. Elevated stress in an expectant mother raises her cortisol level—and that of the fetus—which means testosterone levels also rise. Higher testosterone in preterm babies is associated with increased health risks. These babies are already prone to serious health problems as they develop, Cho said, and they have socioeconomic hurdles to overcome, as well. Preterm birthrates are higher among younger, poorer, minority women, she said. One great benefit to the study was that she and her collaborators were able to provide these mothers with information and access to care and assistance. But Cho still has many more questions to answer.
As she applies for an R01 NIH grant to sustain her research, she knows that her successful collaboration with Carlo, McCormick, and Biasini, as well as the resources they generously share with her, will be a deciding factor. "I'm a beginner—I'm not a senior researcher," Cho said. "So it's very important that I demonstrate the ability to form a great research team. I could never do that without my collaborators. Dr. McCormick and Dr. Biasini provide expertise in endocrinology and developmental psychology, and Dr. Carlo is a wonderful mentor. He once sent me an article while he was traveling. That might seem like a small gesture, but it was very encouraging."
"In many fields of health care, including nursing, more research is being taught as part of the clinical programs because it's important not only to be able to do research, but also to understand the research that is being published," Carlo explained. "Every day, hundreds of manuscripts are published in medicine, and most of them are research based. So if clinicians know how to do research, they will be better able to review those papers and understand how the results apply to clinical care. That's so important because a large part of our purpose—I would say one of our main purposes—in doing research is to improve patient care."
Cho's ultimate goal is to develop an affordable screening for elevated cortisol/testosterone and develop a stress-reduction intervention for expectant mothers. The hope is that reducing stress in mothers would lower babies' testosterone and, consequently, reduce health risks.
"Babies are innocent," Cho said. "They're just beginning life. They have no control over what happens to them. I would like to see us give them a healthier start and a brighter future. "
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