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Mutebi M, Lewison G, Aggarwal A, Alatise OI, Booth C, Cira M, Grover S, Ginsburg O, Gralow J, Gueye S, Kithaka B, Kingham TP, Kochbati L, Moodley J, Mohammed SI, Mutombo A, Ndlovu N, Ntizimira C, Parham GP, Walter F, Parkes J, Shamely D, Hammad N, Seeley J, Torode J, Sullivan R, Vanderpuye V. Cancer research across Africa: a comparative bibliometric analysis. BMJ Glob Health 2022; 7:bmjgh-2022-009849. [PMID: 36356985 PMCID: PMC9660667 DOI: 10.1136/bmjgh-2022-009849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/29/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Research is a critical pillar in national cancer control planning. However, there is a dearth of evidence for countries to implement affordable strategies. The WHO and various Commissions have recommended developing stakeholder-based needs assessments based on objective data to generate evidence to inform national and regional prioritisation of cancer research needs and goals. METHODOLOGY Bibliometric algorithms (macros) were developed and validated to assess cancer research outputs of all 54 African countries over a 12-year period (2009-2020). Subanalysis included collaboration patterns, site and domain-specific focus of research and understanding authorship dynamics by both position and sex. Detailed subanalysis was performed to understand multiple impact metrics and context relative outputs in comparison with the disease burden as well as the application of a funding thesaurus to determine funding resources. RESULTS African countries in total published 23 679 cancer research papers over the 12-year period (2009-2020) with the fractional African contribution totalling 16 201 papers and the remaining 7478 from authors from out with the continent. The total number of papers increased rapidly with time, with an annual growth rate of 15%. The 49 sub-Saharan African (SSA) countries together published just 5281 papers, of which South Africa's contribution was 2206 (42% of the SSA total, 14% of all Africa) and Nigeria's contribution was 997 (19% of the SSA total, 4% of all Africa). Cancer research accounted for 7.9% of all African biomedical research outputs (African research in infectious diseases was 5.1 times than that of cancer research). Research outputs that are proportionally low relative to their burden across Africa are paediatric, cervical, oesophageal and prostate cancer. African research mirrored that of Western countries in terms of its focus on discovery science and pharmaceutical research. The percentages of female researchers in Africa were comparable with those elsewhere, but only in North African and some Anglophone countries. CONCLUSIONS There is an imbalance in relevant local research generation on the continent and cancer control efforts. The recommendations articulated in our five-point plan arising from these data are broadly focused on structural changes, for example, overt inclusion of research into national cancer control planning and financial, for example, for countries to spend 10% of a notional 1% gross domestic expenditure on research and development on cancer.
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Affiliation(s)
- Miriam Mutebi
- Department of Surgery, Aga Khan University, Nairobi, Kenya
| | - Grant Lewison
- King's College London, Institute of Cancer Policy, London, UK
| | - Ajay Aggarwal
- Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Olusegun Isaac Alatise
- Department of Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria
| | - Christopher Booth
- Departments of Oncology & Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Miska Cira
- National Cancer Institute Center for Global Health, Rockville, Maryland, USA
| | - Surbhi Grover
- Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA,Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Julie Gralow
- American Society of Clinical Oncology, Alexandria, Virginia, USA
| | - Serine Gueye
- Service d'urologie de l'Hopital General Idrissa Pouye, Dakar, Senegal
| | | | - T Peter Kingham
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lofti Kochbati
- Abderrahmen Mami Teaching Hospital, Ariana El Manar University, Tunis, Tunisia
| | | | | | | | - Ntokozo Ndlovu
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Groesbeck Preer Parham
- World Health Organization, Geneve, Switzerland,Department of Obstetrics and Gynecology, UTH-Women and Newborn Hospital, University of Zambia, Lusaka, Zambia
| | - Fiona Walter
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Jeannette Parkes
- Department of Radiation Oncology, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Delva Shamely
- Faculty of Health Sciences, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Nazik Hammad
- Department of Medical Oncology, Queen's University, Kingston, Ontario, Canada
| | - Janet Seeley
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Julie Torode
- Global Oncology Group, King's College London, London, UK
| | | | - Verna Vanderpuye
- National Center for Radiotherapy Oncology and Nuclear Medicine and Korle Bu Teaching Hospital, Korle-Bu, Ghana
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Cardiovascular and cancer risk factors analysis for 2001–2020 from the global research output and European newspapers. Scientometrics 2022. [DOI: 10.1007/s11192-022-04465-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
AbstractCancer and cardiovascular disease (CVD) are now two of the leading components of the global burden of disease, especially in high- and upper-middle-income countries. Causes of the diseases that are amenable to intervention are multiple: tobacco control closely followed by obesity treatment, including promotion of a healthy diet and physical exercise, remain the global priorities. We interrogated the Web of Science (WoS) from 2001 to 2020 to determine the numbers of papers describing research into 14 different possible risk factors causing the two diseases. These ranged in relative importance from tobacco and being overweight to the consumption of excessively hot drinks (linked to oesophageal cancer), pollution (linked to lung cancer particularly) and also non-interventional genetic risks. The risks varied between different continental regions, and obesity has increased as a risk factor for CVD in some of these regions. Because many of these factors are subject to human behavioural choices, we also investigated how such research was being presented to the European public through newspaper reportage. About 40% of the factors that influence the cancer burden can be attributed to particular causes, and more than 85% of those factors influencing CVD can also be so attributed. They are led by tobacco use as a risk factor for cancer, but this is slowly declining in most high-income settings. For CVD, the major risks are metabolic, such as high systolic blood pressure and high body-mass index, but also from tobacco use. Research outputs on some of these different factors in the continental regions correlated positively with their influence on the disease burdens. The selection of European newspaper stories was biased towards those risk factors that could be considered as being under the control of their readers. Reports of research in the mass media have an important role in the control of both cancer and CVD, and should be regarded by public health authorities as a useful means to promulgate health education. This paper is based on one presented at the ISSI conference in Leuven in July 2021 (Pallari and Lewison, in: Glänzel et al (eds) Proceedings of the 18th international conference on scientometrics and informetrics, 2021), but has been extended to cover CVD as well as cancer. The geographical analysis of risk factors and research publications has also been modified.
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Aggarwal A, Patel P, Lewison G, Ekzayez A, Coutts A, Fouad FM, Shamieh O, Giacaman R, Kutluk T, Khalek RA, Lawler M, Boyle P, Sarfati D, Sullivan R. The Profile of Non-Communicable Disease (NCD) research in the Middle East and North Africa (MENA) region: Analyzing the NCD burden, research outputs and international research collaboration. PLoS One 2020; 15:e0232077. [PMID: 32339197 PMCID: PMC7185716 DOI: 10.1371/journal.pone.0232077] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 04/07/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives Despite the rising risk factor exposure and non-communicable disease (NCD) mortality across the Middle East and the North African (MENA) region, public health policy responses have been slow and appear discordant with the social, economic and political circumstances in each country. Good health policy and outcomes are intimately linked to a research-active culture, particularly in NCD. In this study we present the results of a comprehensive analysis of NCD research with particular a focus on cancer, diabetes and cardiovascular disease in 10 key countries that represent a spectrum across MENA between 1991 and 2018. Methods The study uses a well validated bibliometric approach to undertake a quantitative analysis of research output in the ten leading countries in biomedical research in the MENA region on the basis of articles and reviews in the Web of Science database. We used filters for each of the three NCDs and biomedical research to identify relevant papers in the WoS. The countries selected for the analyses were based on the volume of research outputs during the period of analysis and stability, included Egypt, Iran, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, Turkey and the United Arab Emirates. Results A total of 495,108 biomedical papers were found in 12,341 journals for the ten MENA countries (here we consider Turkey in the context of MENA). For all three NCDs, Turkey's output is consistently the highest. Iran has had considerable growth in research output to occupy second place across all three NCDs. It appears that, relative to their wealth (measured by GDP), some MENA countries, particularly Oman, Qatar, Kuwait and the United Arab Emirates, are substantially under-investing in biomedical research. In terms of investment on particular NCDs, we note the relatively greater commitment on cancer research compared with diabetes or cardiovascular disease in most MENA countries, despite cardiovascular disease causing the greatest health-related burden. When considering the citation impact of research outputs, there have been marked rises in citation scores in Qatar, Lebanon, United Arab Emirates and Oman. However, Turkey, which has the largest biomedical research output in the Middle East has the lowest citation scores overall. The level of intra-regional collaboration in NCD research is highly variable. Saudi Arabia and Egypt are the dominant research collaborators across the MENA region. However, Turkey and Iran, which are amongst the leading research-active countries in the area, show little evidence of collaboration. With respect to international collaboration, the United States and United Kingdom are the dominant research partners across the region followed by Germany and France. Conclusion The increase in research activity in NCDs across the MENA region countries during the time period of analysis may signal both an increasing focus on NCDs which reflects general global trends, and greater investment in research in some countries. However, there are several risks to the sustainability of these improvements that have been identified in particular countries within the region. For example, a lack of suitably trained researchers, low political commitment and poor financial support, and minimal international collaboration which is essential for wider global impact.
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Affiliation(s)
- Ajay Aggarwal
- Institute of Cancer Policy, Cancer Epidemiology, Population & Global Health, School of Cancer Sciences, King’s College London, London, United Kingdom
- Department of Clinical Oncology, Guy’s & St.Thomas’ NHS Trust, London, United Kingdom
- * E-mail:
| | - Preeti Patel
- Department of War Studies, King’s College London, London, United Kingdom
- Conflict and Health Research Group, King’s College London, London, United Kingdom
| | - Grant Lewison
- Institute of Cancer Policy, Cancer Epidemiology, Population & Global Health, School of Cancer Sciences, King’s College London, London, United Kingdom
| | - Abdulkarim Ekzayez
- Department of War Studies, King’s College London, London, United Kingdom
- Conflict and Health Research Group, King’s College London, London, United Kingdom
| | - Adam Coutts
- Department of Sociology, University of Cambridge, Cambridge, United Kingdom
| | - Fouad M. Fouad
- Global Health Institute/Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
| | | | - Rita Giacaman
- Institute of Community and Public Health, Birzeit University, Birzeit, West Bank, occupied Palestinian territory
| | - Tezer Kutluk
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Rima Abdul Khalek
- Global Health Institute/Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
| | - Mark Lawler
- Queen’s University Belfast, Centre for Cancer Research and Cell Biology, Belfast, United Kingdom
| | - Peter Boyle
- International Prevention Research Institute, Lyon, France
| | - Diana Sarfati
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Richard Sullivan
- Institute of Cancer Policy, Cancer Epidemiology, Population & Global Health, School of Cancer Sciences, King’s College London, London, United Kingdom
- Conflict and Health Research Group, King’s College London, London, United Kingdom
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Syrimi E, Lewison G, Sullivan R, Kearns P. Analysis of Global Pediatric Cancer Research and Publications. JCO Glob Oncol 2020; 6:9-18. [PMID: 32031437 PMCID: PMC7000229 DOI: 10.1200/jgo.19.00227] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2019] [Indexed: 11/20/2022] Open
Abstract
This study sought to investigate the amount of global research activity and investment in pediatric cancer research, using publications as a proxy measure, and to understand geographical differences in research activity. To do this, we used a quantitative method-bibliometrics-to analyze Web of Science publications in the 10 years from 2007 to 2016. We found that global pediatric cancer research outputs have increased from 2,937 in 2007 to 4,513 in 2016, at an annual growth rate of 4.3%. This rate is slower than for both cancer research as a whole and general pediatric research. The increase in output was due almost entirely to China. International collaboration was similar to that in cancer research overall, with the highest levels among countries in close geographical proximity. Hematological and CNS childhood cancers are the main areas for research. Genetics and prognosis were the main research domains, and there was little work on radiotherapy or palliative care. In terms of citations, the best-performing countries were the Netherlands, the United States, and the United Kingdom. On the basis of estimates of the cost of research papers in different countries, the total world pediatric cancer research expenditure is estimated to have been 1.54 billion US dollars (USD) in 2013, and 1.79 billion USD in 2016. Our data suggest that current global policy toward pediatric cancer needs significant review and change to increase investments, balance research portfolios, and improve research that is relevant to low- and middle-income countries.
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Affiliation(s)
- Eleni Syrimi
- University of Birmingham, Institute of Immunology and Immunotherapy, Birmingham, United Kingdom
| | - Grant Lewison
- King’s College London, Institute of Cancer Policy, Conflict and Health Research Group, School of Cancer Sciences, Guy’s Hospital, London, United Kingdom
| | - Richard Sullivan
- King’s College London, Institute of Cancer Policy, Conflict and Health Research Group, School of Cancer Sciences, Guy’s Hospital, London, United Kingdom
| | - Pamela Kearns
- University of Birmingham, Cancer Research UK Clinical Trials Unit, National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, UK Institute of Cancer and Genomic Sciences, Birmingham, United Kingdom
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Aggarwal A, Lewison G, Rodin D, Zietman A, Sullivan R, Lievens Y. Radiation Therapy Research: A Global Analysis 2001-2015. Int J Radiat Oncol Biol Phys 2018; 101:767-778. [PMID: 29976487 DOI: 10.1016/j.ijrobp.2018.03.009] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/26/2018] [Accepted: 03/09/2018] [Indexed: 11/19/2022]
Abstract
Radiation therapy is a core modality of cancer treatment; however, concerns have been expressed regarding its underutilization and its lack of prioritization as a research domain relative to other cancer treatment modalities, despite its rapid technical evolution. It is therefore important to understand, from a public policy perspective, the evolution of global radiation therapy research, to identify strengths, weaknesses, and opportunities. This study used a bibliometric approach to undertake a quantitative analysis of global radiation therapy research published between 2001 and 2015 and available in the Web of Science (Wos) database, with particular focus on the 25 leading research-active countries. A total of 62,550 radiation therapy research articles from 127 countries, published in 2531 international journals, were analyzed. The United States was responsible for 32.3% of these outputs, followed by Japan (8.0%) and Germany (7.7%). Nearly half of all publications related to preparation and delivery of radiation therapy, combined-modality regimens, and dose fractionation studies. Health services research, palliative care, and quality of life studies represented only 2%, 5%, and 4% of all research outputs, respectively. Countries varied significantly in their commitment to different research domains, and trial-related publications represented only 5.1% of total output. Research impact was analyzed according to 3 different citation scores, with research outputs from Denmark, The Netherlands, and the United States consistently the highest ranked. Globally, radiation therapy publication outputs continue to increase but lag behind other spheres of cancer management. The types of radiation therapy research undertaken appear to be regionally patterned, and there is a clear disconcordance between the volume of research output from individual countries and its citation impact. Greater support for radiation therapy research in low- and middle-income countries is required, including international collaboration. The study findings are expected to provide the requisite knowledge to guide future radiation therapy research programs.
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Affiliation(s)
- Ajay Aggarwal
- Institute of Cancer Policy, King's College London, London, United Kingdom; Department of Clinical Oncology, Guy's & St Thomas' NHS Trust, London, United Kingdom.
| | - Grant Lewison
- Institute of Cancer Policy, King's College London, London, United Kingdom; Evalumetrics Ltd, London, United Kingdom
| | - Danielle Rodin
- Department of Radiation Oncology, Dana Farber/Brigham and Women's Cancer Center, Boston, Massachusetts; Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Anthony Zietman
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Richard Sullivan
- Institute of Cancer Policy, King's College London, London, United Kingdom
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
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Bibliometric approximation of a scientific specialty by combining key sources, title words, authors and references. J Informetr 2018. [DOI: 10.1016/j.joi.2017.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Pulgar R, Jiménez-Fernández I, Jiménez-Contreras E, Torres-Salinas D, Lucena-Martín C. Trends in World Dental Research: an overview of the last three decades using the Web of Science. Clin Oral Investig 2012; 17:1773-83. [DOI: 10.1007/s00784-012-0862-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 10/10/2012] [Indexed: 11/30/2022]
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Vieira PC, Teixeira AAC. Are finance, management, and marketing autonomous fields of scientific research? An analysis based on journal citations. Scientometrics 2010. [DOI: 10.1007/s11192-010-0292-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Expansion of scientific journal categories using reference analysis: How can it be done and does it make a difference? Scientometrics 2009. [DOI: 10.1007/s11192-007-1975-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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López-Illescas C, de Moya-Anegón F, Moed HF. The actual citation impact of European oncological research. Eur J Cancer 2008; 44:228-36. [DOI: 10.1016/j.ejca.2007.10.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2007] [Revised: 10/11/2007] [Accepted: 10/23/2007] [Indexed: 12/01/2022]
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Lima RAD, Velho LMLS, Faria LILD. Delimitação de uma área multidisciplinar para análise bibliométrica de produção científica: o caso da Bioprospecção. TRANSINFORMACAO 2007. [DOI: 10.1590/s0103-37862007000200006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Os indicadores bibliométricos em ciência e tecnologia surgem da necessidade de mensuração da produção das instituições científica, partindo da premissa de que a ciência se encontra, em grande parte, incorporada em sua literatura. Como a ciência torna-se cada vez mais multidisciplinar, uma das principais dificuldades da análise bibliométrica tem sido a construção de indicadores de áreas com essa característica. Isso ocorre porque as bases de dados científicas adotam uma classificação própria de áreas, subáreas e disciplinas científicas e atribuem tais classificações aos periódicos. Este trabalho insere-se nesse contexto, contribuindo especificamente para a delimitação e construção de indicadores de uma área científica de atividade caracteristicamente multidisciplinar, a bioprospecção. Esta área de conhecimento vem se destacando na esfera política e econômica dos últimos anos. Os resultados deste estudo demonstram ainda a importância dessa área no meio acadêmico, ao comprovar o crescimento da área pelo número de artigos publicados, de disciplinas envolvidas, dos principais periódicos e das instituições de pesquisa que se destacam na produção dos conhecimentos multidisciplinares da bioprospecção.
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Cambrosio A, Keating P, Mercier S, Lewison G, Mogoutov A. Mapping the emergence and development of translational cancer research. Eur J Cancer 2006; 42:3140-8. [PMID: 17079135 DOI: 10.1016/j.ejca.2006.07.020] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2006] [Accepted: 07/28/2006] [Indexed: 11/16/2022]
Abstract
Cancer research is one of the principal targets of translational research, yet the nature of the relationships between different forms of cancer research remains controversial. The paper examines publications in the cancer field during the 1980-2000 period. A network analysis software program was used to map evolving patterns of inter-citations between cancer publications, their different research levels and the transformation of their relational content. Both inter-citation and content maps provide striking evidence of the consolidation in the 1990s of a translational interface that was practically non existent a few decades before. In 1980, research was polarized according to the allegiance to either a clinical or a laboratory style. This same duality obtains in the year 2000, albeit with the additional presence of a third, biomedical player whose activities are similarly structured by a common orientation, rather than by an exclusive commitment to a specific sub-domain.
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Affiliation(s)
- Alberto Cambrosio
- Department of Social Studies of Medicine, McGill University, Montreal, QC, Canada.
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Abstract
AIMS To examine the volume and potential impact of gastroenterology research outputs from 1985 to 1998 from 14 developed countries; the overlap with research in cancer, infectious diseases, and genetics; and the funding sources for this research. To determine if countries' research outputs correlated with their burden of corresponding diseases and inputs to their research. METHODS Selective retrieval of papers from the Science Citation Index and manual look up of a sample to determine funding sources. Classification of journals by four categories of research level (clinical/basic) and potential impact (low/high). RESULTS Gastroenterology represents about 8% of world biomedical research but over 11% in Italy, Japan, and Spain. Its potential impact is highest (but declining) for the USA. It has increased noticeably in most European countries, particularly in Finland. Gastroenterology research has become more clinical in Japan, Spain, Australia, and the Netherlands but more basic in Canada, Germany, Finland, Israel, and South Africa. Funding comes primarily from national governments, followed by national private non-profit sources and industry but little industrial funding occurs in some countries. There is a strong and positive correlation between reported deaths from gastrointestinal neoplasms and countries' outputs of research in gastrointestinal oncology. CONCLUSIONS Bibliometric analysis can reveal differences between countries in their research in a subject when a common methodology is applied to an international database. Variations in research methods in different countries can plausibly explain some of the variation in the potential impact of the work.
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Affiliation(s)
- G Lewison
- Policy Unit, the Wellcome Trust, 210 Euston Road, London NW1 2BE, UK.
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