171 Ashley Ave.
Charleston, SC 29425
843-792-1414
800-424-MUSC
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November 2005
Feature Story
By: Mary Sue Lawrence, Trio Solutions Inc.
Pediatric Epidemiology Remains the Framework for Discovery
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| Thomas C. Hulsey, ScD, MSPH |
Having a Division of Pediatric Epidemiology in a Department of Pediatrics is incredibly rare, but then the Children's
Hospital at MUSC is known for advancing off-the-beaten-path and beyond-the-call in the name of research.
"I'm aware of just one other such division in the country," says Dr. Thomas C. Hulsey, ScD, MSPH, the director of pediatric
epidemiology since its inception in 1997.
Epidemiologists study populations and look for trends that provide insight into the underlying mechanisms of disease. The
department's division of pediatric epidemiology conducts population- based research on, specifically, children's health
issues. A population-based view often reveals nuances in disease distribution that other types of investigations overlook.
"By having such a unique division, the department of pediatrics is acknowledging that improving child health goes beyond
that of the traditional physician-patient relationship," notes Dr. Hulsey. "It's a recognition that the discovery of the
relationship between risk factors and disease does not come solely from the laboratory."
In recent years, epidemiology has broadened its focus. "Yet it remains the scientific framework for the discovery of new
information," explains Dr. Hulsey, the only pediatric and perinatal epidemiologist in South Carolina. "We might know, for
instance, that 20 percent of children are going to get sick with a particular disease, but which 20 percent? Epidemiology
provides the tools that allow us to understand which differences are important in disease occurrence and which are not.
Pediatric epidemiology brings in the added resource of studying how the health of populations of children differ and what
characteristics of those populations are associated with those differences."
Working with Dr. Hulsey are two other faculty, a senior data manager, two data analysts, and a program administrator. The
team typically has six to eight ongoing research projects at any one time, ranging from simple to complex, lasting from
one week to six years long.
"As soon as we finish one research project, another comes up," says Dr. Hulsey, noting that the division collaborates with
medical students, residents, fellows, and faculty. "Our division and our skills are highly sought out throughout the MUSC
community and beyond, but our priority is always the members of the pediatric department."
The individual research interests of division members include healthcare financing, childhood and adolescent obesity, and
perinatal health. A recent study, conducted by the division in collaboration with the Center for Disease Control, examined
maternal weight gain and its influence on newborn weight for gestational age. The largest study ever done on this topic,
it examined 2.7 million pregnancies over a two-year period.
The division has also contracted with SC Medicaid to develop guidelines to monitor and evaluate a new proposal currently
underway that changes the way Medicaid finances health care for children. In addition, Dr. Hulsey and his colleagues are
enthusiastic about a newly acquired geographic information systems capability. "We can determine if certain childhood
diseases tend to cluster in different places around the area, giving us new information into the incidence of birth defects
or the prevalence of other persistent conditions."
The division also collaborates with faculty in clinical research and provides an infrastructure and shared resources for
clinical research, data base management and statistical analysis.
"We have been extremely active in the design, data management, statistical analysis, and data safety and monitoring of large
randomized controlled clinical trials," says Dr. Hulsey. The division is currently involved in several NIH-funded clinical
studies and training programs.
The team promotes and supports clinical research by teaching research methods and assisting colleagues in developing testable
research questions, designing clinical trials, analyzing data, and writing grants and articles for publication.
"Quite frequently we're called upon to help design or analyze pilot studies so a project can receive funding later on," notes Dr. Hulsey.
The division is also involved with local community services, state institutions, and national and international investigations
in addressing issues of maternal and child health care. "We collaborate with other pediatric epidemiologists nationally and
internationally," says Dr. Hulsey.
The division recently completed a study examining maternal obesity and its medical effects on newborns among the residents of
La Reunion Island in the Indian Ocean. A recently concluded multi- year project compared the perinatal outcomes between different islands in the Caribbean.
The division oversees an integrated patient information system that includes the Perinatal Information System (PINS) data base
of 90,000 maternal and 90,000 newborn records dating to the 1980s. An extremely valuable resource that allows for research on
the MUSC population, PINS is a joint project between the divisions of epidemiology and neonatology in pediatrics and maternal
fetal medicine in the department of obstetrics and gynecology.
"Not many other institutions have such a resource," notes Dr. Hulsey. The division also maintains a follow-up data base on babies
discharged from the MUSC NICU as well as the MEDUCARE data base on all transported neonates.
Additionally, the network services in the division serve as a repository for multiple hospitals, local, state, and national data
sets, including South Carolina vital records and South Carolina hospital discharge records, and United States vital records,
outpatient, inpatient, and emergency room data. All of the division's databases and the research produced from them are HIPPA-compliant.
"We're looking forward to seeing the division grow, to forming a tighter association with our basic science colleagues, and to
a greater collaboration with translational researchers," says Dr. Hulsey. "It's critical that modern, contemporary epidemiologists
embrace the contributions of biomarkers and other new discoveries to determine how they can be applied to the population and back
again. It's exciting for us to forge collaborative relationships with new multidisciplinary teams in the scientific and medical community.
"Of course," he adds, "we're excited to discover how these team efforts can improve the health of mothers and babies."
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