LINKING OCCUPATIONAL DISEASESTO CAUSATIVE AGENTSA Collaborative Effort of the U.S. Department of Labor and the National Library of Medicine

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

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

ORIGIN OF DATABASE

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?

Chemicals Added to Database First content added: 700+ chemicals

from the NIOSH Pocket Guide Each chemical flagged for adverse

effects

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

Source of Information in Haz-Map: The Best and the Most Up-to-Date Journals and Monographs Textbooks CD-ROM Databases Web Sites

CONCEPTUAL FRAMEWORK

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

World Map in 1570

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.

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

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

Starting with the Big Picture

Zooming In and Out

Keeping Everything in Perspective

STRUCTURE OF HAZ-MAP

Eight Major Tables in the Database

*Toxic chemicals include biological agents, e.g., latex rubber.

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

The Diseases Level23

Findings

Diseases Job Tasks

Industries

Jobs

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?

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

WEB SCREENSHOTS

OTHER DATABASES

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

Pulling Information Together from Many Different Sources

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;

GOAL: IDENTIFY & PREVENT

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

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

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;

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;

Mean Blood Lead Level of U.S. Population

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

Number of Los Angeles Days per Year Exceeding Ozone Level of 0.20 ppm

Ozone Levels in Los Angeles

Occupational exposures to styrene in Denmark

Median Levels of Pesticides in Human Milk of Mothers Living in Northern Germany

PCB and DDT in Human Milk

SCIENTIFIC METHOD

Iteration

“a procedure in which repetition of a sequence of operations yields results successively closer to a desired result.” ---Merriam-Webster Dictionary

Iteration in the Scientific Method

Iteration in Map Drawing

Iteration in Surveillance and Prevention

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

NLM/DOL COLLABORATION

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

FINIS