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Toxicology and Environmental Health Information Resources
The Role of the National Library of Medicine
Catharyn T. Liverman, Carrie E. Ingalls, Carolyn E. Fulco, and Howard M. Kipen, Editors
Committee on Toxicology and Environmental Health Information Resources for Health Professionals
Division of Health Promotion and Disease Prevention
INSTITUTE OF MEDICINE
NATIONAL ACADEMY PRESS
Washington, D.C.
1997
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NATIONAL ACADEMY PRESS
2101 Constitution Avenue, N.W. Washington, DC 20418
NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance.
This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy’s 1863 congressional charter responsibility to be an advisor to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.
Support for this project was provided by the National Library of Medicine, National Institutes of Health, under Contract No. N01-OD-4-2139. The views presented are those of the Institute of Medicine Committee on Toxicology and Environmental Health Information Resources for Health Professionals and are not necessarily those of the funding organization.
International Standard Book No. 0-309-05686-1
Additional copies of this report are available for sale from the
National Academy Press,
Box 285, 2101 Constitution Avenue, Washington, DC 20055. Call (800) 624-6242 or (202) 334-3313 in the Washington metropolitan area, or visit the NAP’s on-line bookstore at http://www.nap.edu.
Copyright 1997 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America.
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COMMITTEE ON TOXICOLOGY AND ENVIRONMENTAL HEALTH INFORMATION RESOURCES FOR HEALTH PROFESSIONALS
HOWARD KIPEN, (Chair), Associate Professor and Director,
Division of Occupational Health, Environmental and Occupational Health Sciences Institute, University of Medicine and Dentistry of New Jersey—Robert Wood Johnson Medical School, Piscataway, New Jersey
PAUL FRAME* Family Physician,
Tri-County Family Medicine, Cohocton, New York
MARK FRISSE, Associate Dean,
Washington University School of Medicine, St. Louis, Missouri
SHERRILYNNE FULLER, Acting Director,
Informatics, School of Medicine, and
Director,
Health Sciences Libraries and Information Center, University of Washington, Seattle, Washington
FRED HENRETIG, Pediatric Emergency Physician,
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
DAVID McNELIS, Chief Scientist,
Environmental Science and Engineering, Research Triangle Institute, Research Triangle Park, North Carolina
KATHLEEN REST, Associate Professor,
Department of Family and Community Medicine, Occupational and Environmental Health Program, University of Massachusetts School of Medicine, Worcester, Massachusetts
BARBARA SATTLER, Director,
Environmental Health Education Center, University of Maryland at Baltimore School of Medicine, Baltimore, Maryland
ROSE ANN SOLOWAY, Administrator,
American Association of Poison Control Centers, and
Clinical Toxicologist,
National Capital Poison Center, Washington, D.C.
ROBERT E. TAYLOR, Chairman,
Department of Pharmacology, Howard University College of Medicine, Washington, D.C.
P. IMANI THOMPSON, Behavioral Scientist,
Centers for Disease Control and Prevention, Atlanta, Georgia
Institute of Medicine Staff
CATHARYN T. LIVERMAN, Study Director
CAROLYN E. FULCO, Senior Program Officer
CARRIE E. INGALLS, Research Associate
THOMAS WETTERHAN, Administrative Assistant/Research Assistant
AMELIA MATHIS, Project Assistant
MICHAEL STOTO, Director,
Division of Health Promotion and Disease Prevention (through December 1996)
KATHLEEN STRATTON, Interim Director,
Division of Health Promotion and Disease Prevention (from January 1997)
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Preface
The environment is increasingly recognized as having an impact on human and ecological health, as well as on specific types of human morbidity, mortality, and disability. Since the publication of its landmark report in 1988, Role of the Primary Care Physician in Occupational and Environmental Medicine, the Institute of Medicine (IOM) has conducted two additional studies that have examined the need to integrate environmental and occupational health into the education and practices of nurses and physicians. The recommendations from these reports are currently being implemented.
In 1995, the National Library of Medicine (NLM) asked the IOM to explore a related topic by requesting a study of NLM's Toxicology and Environmental Health Information Program (TEHIP). Specifically, NLM was concerned that health professionals were not fully using the information available in the 16 online databases comprising the TEHIP program. The IOM formed the Committee on Toxicology and Environmental Health Information Resources for Health Professionals. One of the committee's first goals was to seek input from a wide range of health professionals to more thoroughly understand health professionals' toxicology and environmental health information needs. Several mechanisms were used to receive input, including a workshop, during which attendees participated in focus group sessions; a questionnaire, designed to solicit information about health professionals' information needs; and discussions with representatives from federal agencies, health care, and academia.
During the course of the study, the committee reached several conclusions that it viewed as pivotal in advising NLM on how best to provide health professionals with toxicology and environmental health information. First, the committee believes that as environmental health concerns continue to increase, it is important for health professionals and other communities to have ready access
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to information resources in this field. The committee reaffirms the findings of the 1993 NLM Long Range Planning Panel on Toxicology and Environmental Health, which found that NLM's TEHIP program is an important information resource that needs to be strengthened.
Second, the committee believes that there is a large and diverse potential audience for toxicology and environmental health information. In attempting to understand the user communities, the committee discussed a broad spectrum of potential users ranging from emergency care personnel treating individuals affected by acute toxic exposures to local coalitions struggling to determine the environmental health hazards faced by their communities. Although each of the user communities in this broad spectrum has diverse information needs, there are methods of targeting training and outreach efforts and developing database interfaces that will more adequately meet those disparate needs.
Finally, the committee concluded that NLM, as the nation's premier biomedical library, can and should play a key role in organizing and providing pointers to all toxicology and environmental health information resources (including and beyond the TEHIP databases). NLM, given its library and medical informatics expertise, is well-positioned to further develop the tools that can link health professionals with the wide array of information resources that are available in this important field. Furthermore, this is an area where public-private-sector partnerships can play an important role as there are numerous sources of toxicology and environmental health information.
The committee is grateful to those who provided input to its deliberations including the individuals who contributed their ideas through the workshop and in discussions with the committee (see Appendixes A and C). Additionally, the committee thanks the individuals who took the time to respond to the committee's questionnaire (see Appendix B). The TEHIP program staff, including Jeanne Goshorn and Melvin Spann, provided thorough background materials, assisted in the committee's workshop, and responded promptly to the committee's many requests for additional information or clarification. The committee appreciates all of their efforts. The IOM staff of Cathy Liverman, Carrie Ingalls, and Carolyn Fulco are to be congratulated for their thorough research of the issues and for molding the committee's sometimes wandering deliberations into this report.
Although the committee has recommended some clear directions and mechanisms for implementation, much work remains to be done. The committee hopes that the conclusions and recommendations made in this report will prove to be useful as NLM moves forward in providing health professionals with toxicology and environmental health information.
Howard M. Kipen, M.D., Chair
Committee on Toxicology and Environmental Health Information Resources for Health Professionals
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Contents
EXECUTIVE SUMMARY
1
1
INTRODUCTION
11
Health Professionals and Other User Communities
13
Public Health Impacts of Hazardous Substances
14
Changing Trends in Health Practice
15
Organization of the Report
16
2
THE NATIONAL LIBRARY OF MEDICINE'S TOXICOLOGY AND ENVIRONMENTAL HEALTH INFORMATION PROGRAM
19
National Library of Medicine
20
Division of Specialized Information Services
25
Toxicology and Environmental Health Information Program
26
TEHIP Databases
29
TEHIP Factual Databases
30
TEHIP Bibliographic Databases
47
Conclusions
52
3
OTHER TOXICOLOGY AND ENVIRONMENTAL HEALTH INFORMATION RESOURCES
55
Conclusion and Recommendation
58
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4
UNDERSTANDING THE INFORMATION NEEDS OF HEALTH PROFESSIONALS
69
Information Needs
69
Factors Affecting Information Seeking
71
Current and Potential Users of the TEHIP Databases
75
Conclusion and Recommendation
82
5
INCREASING AWARENESS: TRAINING AND OUTREACH
87
Training
88
Outreach
91
Future Directions and Recommendation
96
6
ACCESSING AND NAVIGATING THE TEHIP DATABASES
101
Access: Getting Connected to the Databases
101
Navigating the TEHIP Databases
105
Future Directions
114
Conclusions and Recommendations
116
7
PROGRAM ISSUES AND FUTURE DIRECTIONS
119
Program Issues
120
Future Directions
126
GLOSSARY AND ACRONYMS
131
APPENDIXES
A Acknowledgments
143
B Questionnaire
145
C Workshop on Toxicology and Environmental Health Information Resources: Agenda, Participants, and Summary of Focus Group Discussions
153
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Tables, Figures, And Boxes
Tables
2.1
Timeline of Events and Changes in Computer Technology and Environmental Health
23
2.2
TEHIP Databases
31
2.3
Types of Information Available in the TEHIP Databases
35
2.4
TOXLINE Subfiles
48
3.1
Sample of Current Toxicology and Environmental Health Databases
59
6.1
Review Process for TEHIP Factual Databases
113
Figures
2.1
National Library of Medicine Organizational Chart
21
2.2
TEHIP Program Budget
28
2.3
Organization of the TEHIP Databases
29
3.1
Executive Branch Departments and Agencies Involved in Environmental Health Issues
57
5.1
National Network of Libraries of Medicine
93
6.1
Primary Access Points to the TEHIP Databases
104
7.1
NLM Advisory Committees
122
B.1
Toxicology and Environmental Health Information Resources Most Often Consulted
147
B.2
Primary Factors Limiting Use of the NLM Toxicology and Environmental Health Databases
147
Boxes
2.1
Locator Field in the ChemID Database
36
2.2
Major Categories of HSDB Data
37
2.3
Excerpt from the TRIFACTS Record on Toluene
45
2.4
DIRLINE Record for the Association of Occupational and Environmental Clinics
46
4.1
Examples of the Applicability of the TEHIP Databases for the Work of Health Professionals
78
5.1
Previous IOM Recommendations on the Training of Health Professionals in Occupational and Environmental Health
90
5.2
Howard University
95
6.1
Methods of Searching the TEHIP Databases
102
6.2
TOXNET Selection Menu
106
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6.3
Sample Search on HSDB
109
6.4
Initial TRI Menu
110
6.5
Experimental World Wide Web Search Interface: Criteria for Narrowing the Search Strategy
111
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