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LINKING OCCUPATIONAL DISEASESTO CAUSATIVE AGENTSA Collaborative Effort of the U.S. Department of Labor and the National Library of Medicine
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PRESENTED BY
JAY A. BROWN, MD, MPHCONSULTANT FOR THE U.S.
DEPARTMENT OF LABOR AND THE NATIONAL LIBRARY OF MEDICINEHaz-Map Database: hazmap.nlm.nih.govAbout Haz-Map: haz-map.com
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Main Points
• Origin of the Database• Conceptual Framework of Haz-Map• Structure of Haz-Map• Screenshots of Haz-Map on the Web• Comparison to Other Toxicology Databases• Goal: Identify & Prevent Occupational
Diseases• Iteration and the Scientific Method• Collaboration between the U.S. NLM and
DOL
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ORIGIN OF DATABASE
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Question
Why can't we have a relational database of toxic chemicals and occupational diseases to store and query information similar to ones used by companies to manage data about employees, products, and customers?
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Chemicals Added to Database First content added: 700+ chemicals
from the NIOSH Pocket Guide Each chemical flagged for adverse
effects
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Controlled Vocabulary of Adverse Effects
Category Adverse Effects
Lung Toxin Asthma, Pneumonitis, Chronic Bronchitis, Fibrosis, and Cancer
Neurotoxin Neuropathy, Parkinson's Syndrome, and CNS Solvent Syndrome
Hematotoxin Methemoglobinemia, Aplastic Anemia, and Hemolytic Anemia
Dermatotoxin Contact Dermatitis, Chloracne, and Skin Burns
Carcinogen Known, Probable, or Possible
Other Tissue Toxin Hepatotoxin, Nephrotoxin, and Reproductive Toxin
Other Poison Organophosphate, Carbamate, Organochlorine, Uncoupler, Chemical Asphyxiant, and Simple Asphyxiant
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Source of Information in Haz-Map: The Best and the Most Up-to-Date Journals and Monographs Textbooks CD-ROM Databases Web Sites
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CONCEPTUAL FRAMEWORK
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According to a Report Released Today
X Y ZCoffeeComputer terminalsDaycareRed wineStressFatty foodsExerciseSmoking
A feeling of well beingSexual dysfunctionDepressionGlaucomaSpontaneous remissionBreast cancerHeart diseaseHypothermia
Men 25-40Overweight smokersRats7 out of 10 womenArthritis sufferersTwinsChildrenTwo-income families
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World Map in 1570
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Knowledge Mapping
“Decision support systems can provide preliminary analysis that allows scarce human resources to focus on the key problems while ignoring a vast sea of irrelevancy.” [O’Carroll et al. 2003]
Knowledge is information in context. Mapping means pulling together and sifting
information from a lot of different sources. Knowledge mapping is comprehensively
collecting and systematically indexing a knowledge domain.
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Knowledge Mapping
Links occupational exposures to acute and chronic diseases
Begins with the big picture Keeps all information in context of the whole Distills the facts from the vast sea of data Most useful in information-intensive specialties Helps one not to get lost in the details
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Drawing the Knowledge Map The Project by the National Institute for
Occupational Safety and Health (NIOSH) Published list in 1991 Occupational sentinel health events or SHE(O)s
The Haz-Map project Expand the list Add detailed toxicology information Put in relational database
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Starting with the Big Picture
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Zooming In and Out
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Keeping Everything in Perspective
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STRUCTURE OF HAZ-MAP
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Eight Major Tables in the Database
*Toxic chemicals include biological agents, e.g., latex rubber.
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Each Table Contains Records
225 Diseases 2801 Agents (Chemicals)
224 Job Tasks 51 Processes
277 Jobs 26 Activities
624 Industries 122 Findings
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The Chemicals Level22
Chemicals
Processes
Activities
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The Diseases Level23
Findings
Diseases Job Tasks
Industries
Jobs
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Occupational Diseases in Haz-Map
Airway Diseases Pneumoconioses Hypersensitivity
Pneumonitis Infections
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Occupational Diseases in Haz-Map
Acute Poisons Chronic Poisons Metals Skin Diseases Cancer
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High-Risk Job Tasks and Prevention Identify high risk groups Not just presence of chemicals in the workplace
that puts the worker at risk But exposure AND absorption of sufficient dose What is the specific job task that puts the worker at
risk for the disease?
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Examples of 224 Hazardous Job Tasks
Manufacture polyurethane products
Remove insulation installed before 1975
Extract coal Inhale dust of moldy
hay, silage, straw or grain
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Handle medical needles or surgical instruments;
Operate internal combustion engine with inadequate ventilation;
Repair or maintain gasoline or jet fuel tanks;
Remove lead coatings;
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Examples of 224 Hazardous Job Tasks
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WEB SCREENSHOTS
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OTHER DATABASES
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Comparison of Haz-Map to Other Toxicology Databases ACGIH Documentation of TLVs and BEIs NLM ChemIDplus and HSDB NIOSH Pocket Guide and IDLH ATSDR ToxProfiles and Case Studies EPA CAMEO CCOHS CHEMINFO EXTOXNET Emergency Response Guidebook
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Pulling Information Together from Many Different Sources
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Unique Features of Haz-Map
First relational database of hazardous chemicals and occupational diseases;
Designed as a decision-support system to prevent occupational diseases;
Integrates the best information in toxicology, industrial hygiene, epidemiology, and occupational medicine;
Collects information from many sources to help users distinguish between significant and harmless exposures;
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GOAL: IDENTIFY & PREVENT
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Occupational Diseases Are Preventable If the Causes Are Correctly Identified
By removing the worker from exposure
By removing the exposure from the workplace Ban chemical Enclose process Establish exposure
limit
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Why Occupational Diseases Are Difficult to Recognize
• Look like non-occupational diseases
• Latency between exposure and disease
• Inadequate training of medical students
• Thousands of jobs, chemicals and diseases
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Looking Through a Rearview Mirror
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Looking Through a Rearview Mirror
“. . . the profile of agents used in the industry has changed significantly over time, necessitating caution in applying the results of studies of health effects in prior decades, especially those evaluating carcinogenic risks of the industry, for currently exposed workers.”--- Steven Markowitz, p. 1025 “Synthetic Rubber Industry” in Textbook of Clinical Occupational and Environmental Medicine
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US Environmental Laws 1969-1980 Federal Insecticide, Fungicide & Rodenticide Act; National Environmental Policy Act (NEPA), 1969; Federal Coal Mine Safety & Health Act , 1969; Occupational Safety and Health Act (OSHA),
1970; Clean Air Act (CAA), 1970; Safe Drinking Water Act (SDWA), 1974, 1979; Toxic Substances Control Act (TSCA), 1976; Comprehensive Environmental Response,
Compensation & Liability Act (CERCLA), 1980;
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Hazardous Substances Banned in US, 1972-1991 All agricultural uses of DDT—1972; Thallium rodenticides –1972; Production of benzidine for commercial sale –
1974; Asbestos in insulation materials –1975; Leaded gasoline in new vehicles –1975; Production of PCBs –1977; Sale of lead-based paint to consumers –1978; Use of mercury in exterior paints –1991;
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Mean Blood Lead Level of U.S. Population
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Of 696 data sets that reported exposures over time in recent decades , 78% showed linear trends towards lower exposure levels.
Long Term Trends in Occupational Exposure
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Number of Los Angeles Days per Year Exceeding Ozone Level of 0.20 ppm
Ozone Levels in Los Angeles
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Occupational exposures to styrene in Denmark
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Median Levels of Pesticides in Human Milk of Mothers Living in Northern Germany
PCB and DDT in Human Milk
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SCIENTIFIC METHOD
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Iteration
“a procedure in which repetition of a sequence of operations yields results successively closer to a desired result.” ---Merriam-Webster Dictionary
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Iteration in the Scientific Method
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Iteration in Map Drawing
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Iteration in Surveillance and Prevention
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Just Right!
The fine line between understating and overstating the risk
Drawing a map that is increasingly accurate with each iteration
Disseminating public health information that fits the current risk
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NLM/DOL COLLABORATION
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Collaboration Between Agencies U.S. National Library of Medicine (NLM) and U.S. Department of Labor (DOL) To increase the number of chemical profiles To increase the frequency of updates to three times per year Uses the links between causative agents and occupational
diseases to support the decisions of DOL claims examiners Sound decisions supported by facts distilled from the vast sea
of data in the scientific literature
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FINIS