North and South: bridging the information gap

Kidney medicine meets computer vision: a bibliometric analysis

BACKGROUND AND OBJECTIVE

Rapid advances in computer vision (CV) have the potential to facilitate the examination, diagnosis, and treatment of diseases of the kidney. The bibliometric study aims to explore the research landscape and evolving research focus of the application of CV in kidney medicine research.

METHODS

The Web of Science Core Collection was utilized to identify publications related to the research or applications of CV technology in the field of kidney medicine from January 1, 1900, to December 31, 2022. We analyzed emerging research trends, highly influential publications and journals, prolific researchers, countries/regions, research institutions, co-authorship networks, and co-occurrence networks. Bibliographic information was analyzed and visualized using Python, Matplotlib, Seaborn, HistCite, and Vosviewer.

RESULTS

There was an increasing trend in the number of publications on CV-based kidney medicine research. These publications mainly focused on medical image processing, surgical procedures, medical image analysis/diagnosis, as well as the application and innovation of CV technology in medical imaging. The United States is currently the leading country in terms of the quantities of published articles and international collaborations, followed by China. Deep learning-based segmentation and machine learning-based texture analysis are the most commonly used techniques in this field. Regarding research hotspot trends, CV algorithms are shifting toward artificial intelligence, and research objects are expanding to encompass a wider range of kidney-related objects, with data dimensions used in research transitioning from 2D to 3D while simultaneously incorporating more diverse data modalities.

CONCLUSION

The present study provides a scientometric overview of the current progress in the research and application of CV technology in kidney medicine research. Through the use of bibliometric analysis and network visualization, we elucidate emerging trends, key sources, leading institutions, and popular topics. Our findings and analysis are expected to provide valuable insights for future research on the use of CV in kidney medicine research.

Composition of the editorial staff of major spinal journals based on geo-economic background: A survey analysis

Background

The widespread absence of papers originating in low and middle income economies (LAMIE) across various scholarly disciplines has been widely acknowledged. One potential reason for this could be editorial biases against submissions from LAMIE. Although this bias has been observed in different academic areas, its extent in spinal research remains largely uninvestigated. This research endeavored to investigate the composition of editorial staff members (ESM) within major spinal journals and scrutinize the degree of international diversity represented among the ESM.

Methods

We pinpointed ten major spinal journals by referencing their presence in the Journal Citation Reports of 2021. Countries of the ESM affiliated with these journals were categorized according to World Bank classifications. Following this, we conducted a thorough analysis of the ESM compositions.

Results

A total of 982 ESM from 50 countries were identified. The United States exhibited the highest representation among ESM (395, 40.22%), followed by South Korea (57, 5.80%), Switzerland (53, 5.40%). When segmented by geographical regions, North America emerged with the highest representation, constituting 43.38% of ESM at 426, trailed by Europe & Central Asia at 31.16% (306), East Asia & Pacific at 17.92% (175). The majority of ESM, amounting to 87.98%, hailed from high income economies (HIE). There was an absence of ESM representation of low income economies. The relationship regarding the quantity of ESM in each country and its population failed to demonstrate significance (p = 0.274, r = 0.281). However, a notable positive correlation emerged when exploring the connection between ESM numbers and gross domestic product (p = 0.033, r = 0.517).

Conclusions

Major spinal journals exhibit a notable absence of international representation within their editorial boards, predominantly comprising members from HIE. This underscores a substantial underrepresentation of ESM originating from LAMIE within the sphere of spinal investigation.

Analyzing the composition of the editorial boards in high-impact medical ethics journals: a survey study

BACKGROUND

The underrepresentation of scholarly works from low- and middle-income countries (LMICs) in academic literature is a documented concern, attributed partly to editorial biases. This trend, prevalent across various disciplines, has been less explored in the context of medical ethics journals. This study aimed to examine the composition of editorial board members (EBM) in high-impact medical ethics journals and to evaluate the extent of international diversity within these editorial teams.

METHODS

This study incorporated an analysis of 16 high-impact medical ethics journals. Information regarding the EBM of these journals was systematically gathered and categorized based on the World Bank's country income classifications. An in-depth examination of the editorial board compositions was then conducted.

RESULTS

The study identified 669 EBM across the selected journals. A predominant 89.84% (601) of these members were from high-income countries (HICs), with upper-middle-income countries contributing 7.47% (50) and lower-middle-income countries 2.69% (18). No EBM were associated with low-income countries. A regional breakdown indicated that North America was the most represented area, accounting for 48.88% (327), followed by Europe & Central Asia (27.50%, 184), East Asia & Pacific (13.45%, 90), Latin America & Caribbean (4.63%, 31), Sub-Saharan Africa (4.19%, 28), Middle East & North Africa (0.75%, 5), and South Asia (0.60%, 4). In total, these EBMs hailed from 46 different countries, with the United States representing the largest proportion (43.80%, 293), followed by the United Kingdom (13.15%, 88), Australia (7.92%, 53), Germany (6.73%, 45), and Canada (5.08%, 34).

CONCLUSIONS

There is a significant lack of international representation within the EBM of high-impact medical ethics journals. The majority of editors in this field are affiliated with HICs, leading to a severe underrepresentation of LMICs within the editorial boards.

Underrepresentation of Low- and Middle-Income Nations in Ophthalmology Journals: A Critical Analysis on Diversity, Equity, and Global Representation

Purpose

Low- to middle-income nations contain more than 80% of the world's population; however, only 4% of articles in ophthalmology journals belong to these countries. We aim to analyze the global diversity of the editorial boards of ophthalmology journals.

Methods

Cross-sectional study, including all journals in the Ophthalmology section of the SCImago Journal & Country Rank (SJR). Journals were classified according to the country of origin, SJR interquartile range (Q1-Q4), impact factor, and open-access policy. Global diversity among journals was determined by the country of affiliation of editors-in-chief and editorial board members. Nations were classified by income according to the World Bank's 2022 system. The association between editorial diversity and the journal's metrics and country of origin was analyzed using the χ2 test and the Mann-Whitney U test.

Results

A total of 116 journals were included and 83.6% belonged to high-income nations. Only 18 (13.3%) editors-in-chief and 582 (13.5%) board members were affiliated with middle-income nations. The most prevalent middle-income countries in editorial boards were Brazil (n = 184, 4.26%), India (n = 150, 3.47%), Turkey (n = 42, 0.97%), and Iran (n = 36, 0.83%). Only 40 (1.07%) editorial board members of Q1 journals were affiliated with non-high-income nations, most belonging to India (n = 28, 70%). Journals from middle-income nations had a statistically significant lower prevalence in the first- and second-quartile ranking (P < 0.001) and a higher proportion of open-access policies (P = 0.019).

Conclusions

A clear underrepresentation of low- to middle-income nations was observed in ophthalmology journals. Promoting editorial diversity and minimizing the possibility of editorial bias could lead to greater exposure to real-world data from resource-constrained settings.

Translational Relevance

The documented underrepresentation of low- to middle-income nations in ophthalmology journals highlights the importance of promoting diversity and inclusion.

How international are the editorial boards in the field of hand research? A cross-sectional study of leading subspecialty hand journals

BACKGROUND

Although low- and middle-income countries (LMIC) have great disease burden, but the lack of studies from LMIC have been shown in several fields. Multiple researchers from LMIC perceive editorial bias against their studies. Editorial board members (EBMs) from LMIC are under-represented across many medical journals. It is still unclear whether this phenomenon exists in the field of hand research. The purpose of this study was to investigate the composition of EBMs in leading subspecialty hand journals, and to reveal the international representation of EBMs in the field of hand research.

METHODS

This cross-sectional study included seven leading subspecialty hand journals. The EBMs were obtained from the journals' websites. The country affiliations of EBMs were categorized based on their locations and economy status. The composition of EBMs was investigated.

RESULTS

There were 211 EBMs in the seven journals. A total of 185 EBMs (87.7%) were affiliated with high-income countries (HIC), 18 (8.5%) with upper middle-income countries, and 8 (3.8%) with lower middle-income countries. None EBMs were affiliated with low income countries. The EBMs were affiliated with 30 countries. The biggest number of EBMs were affiliated with the USA 74 (35.07%), followed by the United Kingdom (45, 21.33%), and France (13, 6.16%). Most of EBMs were based in Europe and Central Asia (86, 40.8%) and North America (81, 38.4%).

CONCLUSIONS

The EBMs of leading subspecialty hand journals are dominated by HIC with a very low representation of LMIC. There is a need to make the editorial boards more international in the field of hand research.

Poor Representation of Developing Countries in Editorial Boards of Leading Obstetrics and Gynaecology Journals

Evidence suggests a limited contribution to the total research output in leading obstetrics and gynaecology journals by researchers from the developing world. Editorial bias, quality of scientific research produced and language barriers have been attributed as possible causes for this phenomenon. The aim of this study was to understand the prevalence of editorial board members based out of low and lower-middle income countries in leading journals in the field of obstetrics and gynaecology. The top 21 journals in the field of obstetrics and gynaecology were selected based on their impact factor, SCImago ranking and literature search. The composition of the editorial boards of these journals was studied based on World Bank Income Criteria to understand the representation status of researchers from low and lower-middle income countries. A total of 1315 board members make up the editorial composition of leading obstetrics and gynaecology journals. The majority of these editors belong to high-income countries (n = 1148; 87.3%). Low (n = 6; 0.45%) and lower-middle income (n = 55; 4.18%) countries make up for a very minuscule proportion of editorial board members. Only a meagre 9 out of 21 journals have editorial board members from these countries (42.85%). Low and low-middle countries have poor representation in the editorial boards of leading obstetrics and gynaecology journals. Poor representation in research from these countries has grave consequences for a large proportion of the global population and multidisciplinary collaborative efforts must be taken to rapidly change this statistic with immediate effect.

PreprintMatch: A tool for preprint to publication detection shows global inequities in scientific publication

Preprints, versions of scientific manuscripts that precede peer review, are growing in popularity. They offer an opportunity to democratize and accelerate research, as they have no publication costs or a lengthy peer review process. Preprints are often later published in peer-reviewed venues, but these publications and the original preprints are frequently not linked in any way. To this end, we developed a tool, PreprintMatch, to find matches between preprints and their corresponding published papers, if they exist. This tool outperforms existing techniques to match preprints and papers, both on matching performance and speed. PreprintMatch was applied to search for matches between preprints (from bioRxiv and medRxiv), and PubMed. The preliminary nature of preprints offers a unique perspective into scientific projects at a relatively early stage, and with better matching between preprint and paper, we explored questions related to research inequity. We found that preprints from low income countries are published as peer-reviewed papers at a lower rate than high income countries (39.6% and 61.1%, respectively), and our data is consistent with previous work that cite a lack of resources, lack of stability, and policy choices to explain this discrepancy. Preprints from low income countries were also found to be published quicker (178 vs 203 days) and with less title, abstract, and author similarity to the published version compared to high income countries. Low income countries add more authors from the preprint to the published version than high income countries (0.42 authors vs 0.32, respectively), a practice that is significantly more frequent in China compared to similar countries. Finally, we find that some publishers publish work with authors from lower income countries more frequently than others.

Bias Amplification in Gender, Gender Identity, and Geographical Affiliation

In the quest for greater equity in science, individual attitudes and institutional policies should also embrace greater diversity and inclusion of minority groups. This viewpoint calls for a broader definition of gender bias in STEM to include gender identity and for increased attention to the issue of bias amplification due to geographic affiliation in the field of computational chemistry and chemoinformatics. It briefly discusses some active interventions to tackle bias on gender, gender identity, and geographic affiliation in STEM.

How international are the editorial boards in the field of foot and ankle surgery?: A STROBE-compliant cross-sectional study

Very low proportions of publications from low- and middle-income countries (LAMIC) have been proved in multiple fields. Some researchers from these countries believe that there is a biased attitude of editors against their studies. Under-representation of editorial board members from LAMIC were revealed in many research fields. However, it has not been investigated in the field of foot and ankle surgery. The current study aimed to analyze the composition of the editorial board members in leading foot and ankle journals, and to provide the international representation of editorial boards in the field of foot and ankle surgery. Five leading journals in the field of foot and ankle surgery were included. The editorial board members were collected from the official websites of these journals. The countries of board members were classified based on World Bank. The board compositions of the journals were analyzed. In total, 229 editorial board members were identified. These editors were from 29 countries. The United States (29.69%) had the greatest number of editors, followed by the United Kingdom (20.52%), Australia (8.30%), Italy (6.11%), and Germany (5.68%). When the editors were classified by regions, 49.34% of board members were from Europe & Central Asia, followed by North America (31.44%), East Asia & Pacific (14.41%), Latin America & Caribbean (2.62%), and Middle East & North Africa (2.18%). No editors were from South Asia and Sub-Saharan Africa. A total of 217 editors (94.76%) were from high-income countries, followed by upper-middle-income countries (3.06%), and lower-middle-income countries (2.18%). No members were from low-income countries. There is a lack of international representation on editorial boards of leading foot and ankle journals. Editorial board members in the field of foot and ankle surgery are largely composed by editors from high-income countries with sever under-representation of LAMIC.

Geographical distribution of authorship for leading cardiothoracic surgery journals

BACKGROUND

Evolution of surgical practice is influenced by publications in the leading journals of that field. If the authorship of a publication lacks geographical diversity, this could create bias and limit generalizability of the evidence. Accordingly, we conducted a geographical analysis of the leading Cardiothoracic Surgery journals worldwide.

METHODS

Using 2020 Impact Factor, we searched the leading Cardiothoracic Surgery journals over the past decade. Only original articles were included. Data regarding first, second and last authors were extracted from every article. From this, we analysed country of affiliation, highest academic degree obtained and author location by metropolitan or rural setting.

RESULTS

A total of 12,706 original articles were published in the top 5 ranked Cardiothoracic journals between 2011 and 2020. Authors originated from 69 countries, with the majority being from North America and Western Europe. The United States was the most common country of affiliation (42.8%) in all five journals, with New York City the most prominent city. A total of  63.7% of the authorship originated from large metropolitan areas (estimated as population greater than 500,000 residents), and the most common degrees obtained by authors were MD and PhD.

CONCLUSION

The prominent Cardiothoracic authorship is predominantly located in Western countries, most commonly large metropolitan centers in the United States. This raises questions as to whether the literature adequately reflects populations in other geographical areas such as the continents of South America and Africa and rural settings. Leading journals should consider policies which encourage publication by authors from geographical locations that are underrepresented globally.

Trends in country and gender representation on editorial boards in anaesthesia journals: a pooled cross-sectional analysis

Evidence exists that women and people from low- and middle-income countries are under-represented on the editorial boards of medical journals. This may adversely influence the journal output. We conducted a pooled, cross-sectional evaluation of the editorial board membership of anaesthesia journals. We collected data on members of editorial boards from the founding year and at 5-yearly intervals until 2020. For each editor, we recorded gender, country of affiliation, World Bank income classification (1990 onwards) and editorial role (2020 only). The composite editorial board diversity score was calculated for each editorial board. We obtained complete data for the composition of editorial boards from all 30 journals for 2020, but for only 171 out of 304 editorial boards (56%) over the time period examined. In 2020, 409 out of 1973 (21%) were women (range across the editorial boards 0-39%) and 139 out of 1982 (7%) were from low-, low-middle- and upper-middle-income countries (range across the editorial boards 0-71%). In 2020, of editorial board positions with known seniority status, 109 out of 259 (42%) of women and 306 out of 960 (32%) of men were in senior roles. In the same year, 397 out of 1115 (36%) of people from high-income countries were in senior roles, compared with 19 out of 93 (20%) of people from upper-middle-income countries and 0 out of 14 (0%) people from lower-middle-income countries. The median composite editorial board diversity score was 4 (range 2-6) in 2020 - 5 or less suggests poor diversity, while 8 or more suggests good diversity. Women and people from low- and middle-income countries are under-represented on anaesthesia journal editorial boards. The editorial boards do not reflect the anaesthesia workforce and may act as a barrier to the publication of research produced by these groups. Urgent action is required to improve diversity.

Relationship between modifiable lifestyle factors and chronic kidney disease: a bibliometric analysis of top-cited publications from 2011 to 2020

BACKGROUND

Chronic kidney disease (CKD) affects 8 to 16% of the world's population and is one of the top ten important drivers of increasing disease burden. Apart from genetic predisposition, lifestyle factors greatly contribute to the incidence and progression of CKD. The current bibliometric analysis aims to characterize the current focus and emerging trends of the research about the impact of modifiable lifestyle factors on CKD.

METHODS

We searched articles addressing the impact of modifiable lifestyle factors on the incidence and/or progression of CKD, published between 2011 and 2020, from the Science Citation Index Expanded (SCIE) database. An adjusted citation index, which considered both the original citation count and publication year, was derived for the selection of most-cited publications. Publishing trends, co-authorship network, keywords, and research hotspots were analyzed and visualized.

RESULTS

Among the top 100 most influential articles, 32 were narrative reviews, 16 systematic reviews and/or meta-analysis, 44 clinical research, and 8 basic research. The United States occupied a dominant position in the perspective of article numbers and international partnerships, followed by European countries. The modifiable factors that drew the most and constant attention over the decade were diet or nutrition management reported in 63 papers, followed by obesity or body mass index (n = 27), and physical activity or exercises (n = 8). Alcohol consumption, fish oil, chain fatty-acids, and water-soluble vitamins were emerging hotspots identified in the recent most cited publications.

CONCLUSIONS

Based on the bibliometric analysis of the most influential articles, our study provides a comprehensive description of publishing trends and research focus over a decade in the field of lifestyle factors' impact on CKD. Diet, obesity, and physical activity were factors receiving the most attention in this topic.

Patient Functional Status as an Indication for Primary Total Hip Arthroplasty: A Systematic Review and Meta-Analysis

BACKGROUND

The number of total hip arthroplasties performed per year is increasing for reasons not fully explained by a growing and aging population. The purpose of this study was to determine the role of patient functional status as an indication for surgery and determine if patients are undergoing surgery at a better functional status than in the past.

METHODS

A systematic review and meta-analysis of the MEDLINE, EMBASE, and Cochrane databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Functional status was assessed using the 36-Item Short-Form Health Survey's Physical Component Summary score. Only primary procedures were included; revisions were excluded. Articles were screened by 2 independent reviewers with conflicts resolved with a third reviewer. Meta-regression analysis was performed to determine the effect of time, patient age, and gender. Subgroup analysis was performed to compare geographic regions.

RESULTS

A total of 1504 articles were identified. Data from 172 groups representing 18,644 patients recruited from 1990 to 2013 and identified from 107 articles were included. The mean preoperative Physical Component Summary score was 31.2 (95% confidence interval 30.5-31.9) with a 95% prediction interval of 22.6-39.8. The variance across studies was statistically significant (P = .000) with 97.25% true variance. Year of enrollment, age, and the percentage of females were not found to have any significant effect. There were no differences between countries.

CONCLUSION

Patients are undergoing total hip arthroplasty at a similar preoperative physical functional status as in the past. Patient age, gender, and location do not influence the functional status at which patients are indicated for surgery.

Review of authorship for COVID-19 research conducted during the 2020 first-wave epidemic in Africa reveals emergence of promising African biomedical research and persisting asymmetry of international collaborations

OBJECTIVES

The contribution of African authors to the biomedical literature is small. We evaluated the African and non-African scientific production published in the international literature on the COVID-19 in Africa during the first year of the epidemic (2020).

METHODS

Papers on COVID-19 in Africa were extracted from the Medline (PubMed) database for bibliometric analysis including the proportions of three leading and last authors by study type, study country, authors' and laboratories/institutions' countries of affiliation and journal ranking.

RESULTS

A total of 160 articles fulfilling the inclusion criteria were analysed. The majority (91.3%) was produced by half (53.7%) of African countries, with important regional disparities, and generally without sources of funding mentioned. The majority (>85.0) of authors in lead positions (first, second, third and last authors) were Africans. Only a small number (8.7%) of studies on COVID-19 in Africa were carried out by laboratories not on the African continent (mainly Europe, USA and China) and generally received funding. The last and first authors were more frequently of non-African origin in journals with an Impact Factor ranking ≥1, and more frequently of African origin in journals with a lower ranking (< 1). The first and last non-African authors tended to report their studies in high ranking ≥1 journals.

CONCLUSIONS

Our study demonstrates that the emergence of promising African research capable of publishing in indexed but low-impact factor medical journals and reveals the persistence of a North-South asymmetry in international cooperation in biomedical research with Africa.

Authorship trends in infectious diseases society of America affiliated journal articles conducted in low-income countries, 1998-2018

An increasing amount of infectious diseases research is conducted in low-income countries (LIC) given their high burden of disease; however, the contribution of LIC investigators as measured by authorship metrics, specifically to infectious diseases research, has not been thoroughly studied. We performed a literature search for primary research conducted either within LICs or using samples from LIC participants published between 1998-2017 in the Infectious Disease Society of America-affiliated journals Clinical Infectious Diseases, Journal of Infectious Diseases, and Open Forum Infectious Diseases. Primary outcomes included proportion of LIC-affiliated first and last authors (i.e. lead authors) per year and authorship trends over time. Secondary outcomes included proportion of LIC-affiliated authorship by geographic distribution and disease focus. Among 1308 publications identified, 50% had either a first or last LIC-affiliated author. Among these authors, 48% of LIC-affiliated first authors and 52% of LIC-affiliated last authors also reported a non-LIC institutional affiliation. While the absolute number of articles by LIC-affiliated lead authors increased over the 20-year period, the proportion of articles with LIC-affiliated lead authors decreased. There is a growing literature for infectious disease research conducted in LICs yet authorship trends in a small subset of these publications demonstrate a pronounced and worsening exclusion of LIC-affiliated investigators from publishing as lead authors.

Publicación científica en acceso abierto: desafíos decoloniales para América Latina

A través de los conceptos de colonialidades, geopolítica y corpo-politica del conocimiento se reflexiona sobre algunos desafíos de la publicación científica latinoamericana en acceso abierto. Aunque América Latina es pionera en iniciativas de acceso abierto y en la creación de sistemas regionales cooperativos para compartir conocimiento como bien común, las revistas “internacionales”, refrendadas por factor de impacto, continúan a ser priorizadas en los sistemas de evaluación y financiamiento de la ciencia de la mayoría de los países de la región. Adicionalmente, estrategias de mercantilización del acceso abierto se hacen cada vez más penetrantes y amenazan con subvertir algunos de los propósitos iniciales del Movimiento de acceso abierto y crear brechas más profundas entre el Norte y el Sur. Por detrás de estos aspectos se sitúa la naturalización y perpetuación de jerarquías y exclusiones ontológicas y epistémicas con trasfondos de racismo sistémico que autores decoloniales caracterizan como colonialidades. Se requiere una desobediencia epistémica, como actitud decolonial, y una concertación de esfuerzos a nivel regional que transforme sistemas de evaluación, preserve el carácter público y académico de la ciencia y garantice equidad y justicia social

The impact of geographical bias when judging scientific studies

The beauty of science lies within its core assumption that it seeks to identify the truth, and as such, the truth stands alone and does not depend on the person who proclaims it. However, people's proclivity to succumb to various stereotypes is well known, and the scientific world may not be exceptionally immune to the tendency to judge a book by its cover. An interesting example is geographical bias, which includes distorted judgments based on the geographical origin of, inter alia, the given work and not its actual quality or value. Here, we tested whether both laypersons (N = 1532) and scientists (N = 480) are prone to geographical bias when rating scientific projects in one of three scientific fields (i.e., biology, philosophy, or psychology). We found that all participants favored more biological projects from the USA than China; in particular, expert biologists were more willing to grant further funding to Americans. In philosophy, however, laypersons rated Chinese projects as better than projects from the USA. Our findings indicate that geographical biases affect public perception of research and influence the results of grant competitions.

The gender and geography of publishing: a review of sex/gender reporting and author representation in leading general medical and global health journals

Introduction

Diverse gender and geographical representation matters in research. We aimed to review medical and global health journals’ sex/gender reporting, and the gender and geography of authorship.

Methods

542 research and non-research articles from 14 selected journals were reviewed using a retrospective survey design. Paper screening and systematic data extraction was conducted with descriptive statistics and regression analyses calculated from the coded data. Outcome measures were journal characteristics, the extent to which published articles met sex/gender reporting guidelines, plus author gender and location of their affiliated institution.

Results

Five of the fourteen journals explicitly encourage sex/gender analysis in their author instructions, but this did not lead to increased sex/gender reporting beyond the gender of study participants (OR=3.69; p=0.000 (CI 1.79 to 7.60)). Just over half of research articles presented some level of sex/gender analysis, while 40% mentioned sex/gender in their discussion. Articles with women first and last authors were 2.4 times more likely to discuss sex/gender than articles with men in those positions (p=0.035 (CI 1.062 to 5.348)). First and last authors from high-income countries (HICs) were 19 times as prevalent as authors from low-income countries; and women from low-income and middle-income countries were at a disadvantage in terms of the impact factor of the journals they published in.

Conclusion

Global health and medical research fails to consistently apply a sex/gender lens and remains largely the preserve of authors in HIC. Collaborative partnerships and funding support are needed to promote gender-sensitive research and dismantle historical power dynamics in authorship.

African based researchers' output on models for the transmission dynamics of infectious diseases and public health interventions: A scoping review

BACKGROUND

Applied epidemiological models are used in predicting future trends of diseases, for the basic understanding of disease and health dynamics, and to improve the measurement of health indicators. Mapping the research outputs of epidemiological modelling studies concerned with transmission dynamics of infectious diseases and public health interventions in Africa will help to identify the areas with substantial levels of research activities, areas with gaps, and research output trends.

METHODS

A scoping review of applied epidemiological models of infectious disease studies that involved first or last authors affiliated to African institutions was conducted. Eligible studies were those concerned with the transmission dynamics of infectious diseases and public health interventions. The review was consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) extension for scoping reviews. Four electronic databases were searched for peer-reviewed publications up to the end of April 2020.

RESULTS

Of the 5927 publications identified, 181 met the inclusion criteria. The review identified 143 publications with first authors having an African institutional affiliation (AIA), while 81 had both first and last authors with an AIA. The publication authors were found to be predominantly affiliated with institutions based in South Africa and Kenya. Furthermore, human immunodeficiency virus, malaria, tuberculosis, and Ebola virus disease were found to be the most researched infectious diseases. There has been a gradual increase in research productivity across Africa especially in the last ten years, with several collaborative efforts spread both within and beyond Africa.

CONCLUSIONS

Research productivity in applied epidemiological modelling studies of infectious diseases may have increased, but there remains an under-representation of African researchers as leading authors. The study findings indicate a need for the development of research capacity through supporting existing institutions in Africa and promoting research funding that will address local health priorities.

NIGERIA'S LOW CONTRIBUTION TO RECOGNIZED WORLD RESEARCH LITERATURE: CAUSES AND REMEDIES

We present a first-time study on identifying the causes and remedies to Nigeria's low contribution to globally recognized research literature. A mixed research approach involving 300 academic staff from several areas of specialization in southern Nigeria was adopted, using structured questionnaire and semi-structured interview schedule. Data obtained were analyzed using descriptive statistics and thematic technique. Furthermore, 43.7%, 28.6%, and 27.7% of the respondents were from the university, polytechnic, and college of education system, respectively. While 78.4% of the respondents agreed that the high cost of open access publication in top journals influenced Nigeria's low contribution to research literature, over 75% reported that the low contribution was due to high cost of attending international conferences. Other factors identified were stringent conditions for paper acceptance (89.7%), scarcity of relevant information about Africa (85.4%), and paucity of high-impact journals in the libraries of Nigerian tertiary institutions (6.7%). Others were poor funding, non-usage of research findings by policymakers, lack of adequate facilities, and high penchant for publication in predatory journals, informed by promotion criteria not supportive of quality. Participants advocated for increased funding, reduced conference fees, and entrenchment of collaboration between reputable publishers abroad and African publishers.

Desafíos y consideraciones bioéticas de la investigación para la salud en colaboración entre países del Norte y del Sur

La investigación para la salud es esencial para enfrentar los retos actuales y futuros mediante la generación de nuevos conocimientos, que a su vez deben ser traducidos en mejores formas de prevenir y tratar las enfermedades, todo con el fin de lograr un desarrollo humano global sostenible. La tan necesaria investigación colaborativa Norte-Sur para la salud ha ido en franco aumento en las últimas décadas como respuesta a lo anterior. Por diversas razones, en esta interacción han surgido desafíos y cuestionamientos bioéticos que deben ser afrontados. En el presente trabajo se identifican 1) la asimetría; 2) el colonialismo; 3) la explotación; 4) la información, y 5) los comités de ética en investigación como los principales desafíos y se revisan los aspectos bioéticos que son necesarios atender. Resulta evidente la urgencia de construir una bioética de la investigación para la salud en colaboración entre países del Norte y países del Sur.

Access to scientific literature by the conservation community

Access to the scientific literature is perceived to be a challenge to the biodiversity conservation community, but actual level of literature access relative to needs has never been assessed globally. We examined this question by surveying the constituency of the International Union for Conservation of Nature (IUCN) as a proxy for the conservation community, generating 2,285 responses. Of these respondents, ∼97% need to use the scientific literature in order to support their IUCN-related conservation work, with ∼50% needing to do so at least once per week. The crux of the survey revolved around the question, “How easy is it for you currently to obtain the scientific literature you need to carry out your IUCN-related work?” and revealed that roughly half (49%) of the respondents find it not easy or not at all easy to access scientific literature. We fitted a binary logistic regression model to explore factors predicting ease of literature access. Whether the respondent had institutional literature access (55% do) is the strongest predictor, with region (Western Europe, the United States, Canada, Australia and New Zealand) and sex (male) also significant predictors. Approximately 60% of respondents from Western Europe, the United States, Canada, Australia and New Zealand have institutional access compared to ∼50% in Asia and Latin America, and ∼40% in Eastern Europe and in Africa. Nevertheless, accessing free online material is a popular means of accessing literature for both those with and without institutional access. The four journals most frequently mentioned when asked which journal access would deliver the greatest improvements to the respondent’s IUCN-related work were Conservation Biology, Biological Conservation, Nature, and Science. The majority prefer to read journal articles on screen but books in hard copy. Overall, it is apparent that access to the literature is a challenge facing roughly half of the conservation community worldwide.

DOHaD in low- and middle-income countries: a systematic review exploring gaps in DOHaD population studies

Low- and middle-income countries (LMICs) are disproportionately affected by non-communicable diseases (NCDs), accounting for more than 80% of NCD-related deaths globally. Research into early-life influences on these diseases via the developmental origins of health and disease (DOHaD) paradigm has informed health promotion interventions and policies focused on optimising early-life health. However, little is known about where this research occurs and whether it reaches and reflects the countries most affected by NCDs. This review searched for DOHaD studies that investigated relationships between factors during pregnancy and at birth, with later-life NCD incidence, risk and related mortality. The aim of this review was to identify where DOHaD research has been conducted and whether this focus is appropriate and relevant, given the differential burden of NCDs. Embase, MEDLINE and Scopus were searched, and eligibility screening processes identified 136 final articles. This review found that 49.7% of DOHaD research was conducted on populations within Western Europe, 15.9% in East Asia, 12.7% in North America, 8.3% in Latin America and the Caribbean, and fewer in Australasia, South Asia, the Middle East, the Africas, and Central Asia. When categorised by income, this review found that 76.4% of studies were based in high-income countries, 19.1% in upper-middle-income and 4.5% in lower-middle-income countries. No studies were based in low-income countries. There is therefore a marked disconnect between where DOHaD research is undertaken and where the greatest NCD disease burden exists. Increasing DOHaD research capacity in LMICs is crucial to informing local strategies that can contribute to reducing the incidence of NCDs.

Addressing power imbalances in global health: Pre-Publication Support Services (PREPSS) for authors in low-income and middle-income countries

The contextual knowledge and local expertise that researchers from low-income and middle-income countries (LMICs) contribute to studies in these settings enrich the research process and subsequent publications. However, health researchers from LMICs are under-represented in the scientific literature. Distally, power imbalances between LMICs and high-income countries, which provide funding and set priorities for research in LMICs, create structural inequities that inhibit these authors from publishing. More proximally, researchers from LMICs often lack formal training in research project management and in publishing peer-reviewed research. Though academic journals may value research from LMICs conducted by local researchers, they have limited time and financial resources to support writing, causing them to reject manuscripts with promising results if they lack development. Pre-Publication Support Service (PREPSS) is a non-profit, non-governmental organisation that works to meet this need. PREPSS provides onsite training, peer-review and copy editing services to researchers in LMICs who wish to publish their health research in peer-reviewed journals. Authors are not charged for these services. After receiving PREPSS services, authors submit their manuscript to a peer-reviewed journal. The PREPSS model is one of many interventions necessary to restructure global health research to better support health researchers in LMICs and reduce current power imbalances.

Improving Pediatric Academic Global Health Collaborative Research and Agenda Setting: A Mixed-Methods Study

Academic global health collaborations have the potential to improve joint understanding of health issues in low- and middle-income countries (LMICs). Our objective was to elucidate perceptions of benefits and challenges of academic global health collaborations as well as areas for improving collaborative research conducted in LMICs. This cross-sectional, mixed-methods study surveyed investigators' perceptions of benefits and challenges of pediatric academic global health collaborations. Authors of articles from four pediatric journals reporting pediatric research conducted in LMICs published between 2006 and 2015 were surveyed. Responses of LMIC investigators were compared with those of investigators in high-income countries (HICs). Responses to open-ended questions were analyzed using a combined thematic and content analysis approach. Of 1,420 potential respondents, 252 (17.7%) responded to the survey. Collaborative research with investigators from other countries was perceived as beneficial by 88.5% of respondents (n = 223), although this perception was more common among HIC respondents (n = 110, 94.0%) than LMIC respondents (n = 113, 83.7%) (p = 0.014). Sixty-seven percent (n = 170) of respondents perceived that HIC investigators had set the research agenda in work conducted in a LMIC. Respondents identified several critical factors to improve academic global health collaborations, including research capacity building, communication, and early involvement of LMIC investigators with shared decision-making during study conception and grant writing. Pediatric academic global health collaboration was widely perceived as positive. However, despite calls for capacity building and locally generated research ideas, many respondents felt that HIC investigators set the research agenda for work conducted in LMICs. This study provides suggestions for improving collaboration among pediatric academicians globally.

Building sustainable operational research capacity in Pakistan: starting with tuberculosis and expanding to other public health problems

Background: For many years, operational research capacity has been a challenge and has remained a low priority for the health sector in Pakistan. Building research capacity for developing a critical mass of researchers in Pakistan was done through Structured Operational Research and Training Initiative (SORT IT) courses in Paris and Asia between 2010 and 2016.

Objective: The aim of this paper is to describe the journey of SORT-IT in Pakistan from its inception to progressive expansion and discuss the challenges and ways forward.

Methods: The journey began with the training of the Pakistan NTP research team lead in 2010 in an international SORT IT course at Paris. This was followed by training of two team members in Asia SORT IT courses in 2014 and 2015. These three then worked together to conceive and implement the first national Pakistan SORT IT course supported by WHO/TDR and the Global Fund in 2016. This was facilitated by international facilitators and local trained SORT-IT participants from Paris and Asia. This was followed by two further national SORT IT courses in 2017 and 2018.

Results: Between 2010 and 2017, a total of 34 participants from Pakistan had been enrolled in national and international SORT IT courses. Of the 23 participants from completed courses, 18(78%) successfully completed the course. In total 18 papers were submitted and up until June 2018, 15(83%) have been published and 21 institutions in Pakistan involved with operational research as a result of the SORT IT initiative.

Conclusions: The SORT IT course has been an effective way to build operational research capacity at national level and this has resulted in a large number of published papers providing local evidence for decision making on TB and other disease control programmes. The experience from Pakistan should stimulate other countries to adopt the SORT-IT model.

Nursing and Midwifery Research Output in Africa: A Review of the Literature

BACKGROUND

Nurses and midwives form the backbone of health service delivery and satisfaction with care often depends on the competencies of nurses and midwives who provide the care (World Health Organization [WHO], 2002). Healthcare has become complex, challenging, and demanding across diverse sociocultural and socioeconomic changes and environments. To optimize their impact, nurses and midwives therefore need to be prepared with evidence-based competences. Nursing research therefore, is the cornerstone for evidence-based practice and for establishing the professional status of nursing and building research capacity. However, although nursing research began in the 19th century, it is limited in Africa, with little evidence generated to inform policy and practice. Although nursing and midwifery education in the region has advanced with graduate and postgraduate level education, little is known about nursing and midwifery research conducted in universities and where to find such research.

OBJECTIVES

The literature review aimed at quantifying and identifying the types and gaps in nursing and midwives' research and publications in Africa.

METHODS

Articles published between January 1, 2007 and January 31, 2017 were retrieved from PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) with a search strategy that employed four sets of terms: (a) terms identifying published research done by nurses or midwives, or both; (b) terms identifying types of publications; (c) terms identifying filters for African countries; and (d) filters for publication dates. We also searched Google Scholar to capture nonindexed sources.

RESULTS AND CONCLUSIONS

There is evidence of an increasing number of African nurses and midwives publishing research; however, much of this research may not be readily available. The promotion of nursing research and capacity building/mentorship in research for nurses and midwives is recommended to increase nurses' and midwives' skills to critically evaluate research and apply the best evidence to their practice.

How international are the editorial boards of leading spine journals? A STROBE-compliant study

Low- and middle-income countries contribute to only a small percentage of publications in multiple medical fields. Editorial bias was reported to be an important reason for this. However, whether this trend exists in leading spine journals remains unclear. This study determined the composition of the editorial boards of leading spine journals and analyzed the international representation of editorial boards.The editorial board members of four leading subspecialty spine journals, including The Spine Journal, Journal of Neurosurgery: Spine, European Spine Journal, and Spine were identified from the journals' websites. The countries of editorial board members were identified and analyzed according to the continent and country income categories classified by the World Bank.A total of 608 editorial board members were identified from the four leading spine journals. The majority (91.4%) of editorial board members were from high-income countries, followed by upper-middle income countries (7.2%), and lower-middle income countries (1.3%). No editorial board members were from low-income countries. Regarding the continent of residence, 46.5% of the editorial board members were from North America, followed by Europe (38.5%), Asia (9.9%), South America (2.8%), Oceania (1.6%), and Africa (0.7%). The editorial board members came from 40 different countries, which were concentrated in North America, Western Europe, and East Asia. The largest number of editorial board members came from the United States (42.3%), followed by Germany (6.9%), the United Kingdom (6.7%), Switzerland (5.8%), and Italy (5.1%).A lack of international representation on editorial boards exists in leading spine journals. Editorial board members from high-income countries are substantially overrepresented, while editorial board members from low- and middle-income countries are severely underrepresented. The United States is the most represented country on the editorial boards of leading spine journals.

Adapting operational research training to the Rwandan context: the Intermediate Operational Research Training programme

Background: Promoting national health research agendas in low- and middle-income countries (LMICs) requires adequate numbers of individuals with skills to initiate and conduct research. Recently, non-governmental organizations (NGOs) have joined research capacity building efforts to increase research leadership by LMIC nationals. Partners In Health, an international NGO operating in Rwanda, implemented its first Intermediate Operational Research Training (IORT) course to cultivate Rwandan research talent and generate evidence to improve health care delivery.

Objective: This paper describes the implementation of IORT to share experiences with other organizations interested in developing similar training programmes.

Methods: The Intermediate Operational Research Training utilized a deliverable-driven training model, using learning-by-doing pedagogy with intensive hands-on mentorship to build research skills from protocol development to scientific publication. The course had short (two-day) but frequent training sessions (seven sessions over eight months). Trainees were clinical and programme staff working at the district level who were paired to jointly lead a research project.

Results: Of 10 trainees admitted to the course from a pool of 24 applicants, nine trainees completed the course with five research projects published in peer-reviewed journals. Strengths of the course included supportive national and institutional research capacity guidelines, building from a successful training model, and trainee commitment. Challenges included delays in ethical review, high mentorship workload of up to 250 hours of practicum mentorship, lack of access to literature in subscription journals and high costs of open access publication.

Conclusions: The IORT course was an effective way to support the district-based government and NGO staff in gaining research skills, as well as answering research questions relevant to health service delivery at district hospitals. Other NGOs should build on successful programmes while adapting course elements to address context-specific challenges. Mentorship for LMIC trainees is critical for effectiveness of research capacity building initiatives.

Global capacity for clinical research in nephrology: a survey by the International Society of Nephrology

Due to the worldwide rising prevalence of chronic kidney disease (CKD), there is a need to develop strategies through well-designed clinical studies to guide decision making and improve delivery of care to CKD patients. A cross-sectional survey was conducted based on the International Society of Nephrology Global Kidney Health Atlas data. For this study, the survey assessed the capacity of various countries and world regions in participating in and conducting kidney research. Availability of national funding for clinical trials was low (27%, n = 31), with the lowest figures obtained from Africa (7%, n = 2) and South Asia (0%), whereas high-income countries in North America and Europe had the highest participation in clinical trials. Overall, formal training to conduct clinical trials was inadequate for physicians (46%, n = 53) and even lower for nonphysicians, research assistants, and associates in clinical trials (34%, n = 39). There was also diminished availability of workforce and funding to conduct observational cohort studies in nephrology, and participation in highly specialized transplant trials was low in many regions. Overall, the availability of infrastructure (bio-banking and facilities for storage of clinical trial medications) was low, and it was lowest in low-income and lower-middle-income countries. Ethics approval for study conduct was mandatory in 91% (n = 106) of countries and regions, and 62% (n = 66) were reported to have institutional committees. Challenges with obtaining timely approval for a study were reported in 53% (n = 61) of regions but the challenges were similar across these regions. A potential limitation is the possibility of over-reporting or under-reporting due to social desirability bias. This study highlights some of the major challenges for participating in and conducting kidney research and offers suggestions for improving global kidney research.

Measuring the bias against low-income country research: an Implicit Association Test

Background

With an increasing array of innovations and research emerging from low-income countries there is a growing recognition that even high-income countries could learn from these contexts. It is well known that the source of a product influences perception of that product, but little research has examined whether this applies also in evidence-based medicine and decision-making. In order to examine likely barriers to learning from low-income countries, this study uses established methods in cognitive psychology to explore whether healthcare professionals and researchers implicitly associate good research with rich countries more so than with poor countries.

Methods

Computer-based Implicit Association Test (IAT) distributed to healthcare professionals and researchers. Stimuli representing Rich Countries were chosen from OECD members in the top ten (>$36,000 per capita) World Bank rankings and Poor Countries were chosen from the bottom thirty (<$1000 per capita) countries by GDP per capita, in both cases giving attention to regional representation. Stimuli representing Research were descriptors of the motivation (objective/biased), value (useful/worthless), clarity (precise/vague), process (transparent/dishonest), and trustworthiness (credible/unreliable) of research. IAT results are presented as a Cohen’s d statistic. Quantile regression was used to assess the contribution of covariates (e.g. age, sex, country of origin) to different values of IAT responses that correspond to different levels of implicit bias. Poisson regression was used to model dichotomized responses to the explicit bias item.

Results

Three hundred twenty one tests were completed in a four-week period between March and April 2015. The mean Implicit Association Test result (a standardized mean relative latency between congruent and non-congruent categories) for the sample was 0.57 (95% CI 0.52 to 0.61) indicating that on average our sample exhibited moderately strong implicit associations between Rich Countries and Good Research. People over 40 years of age were less likely to exhibit pro-poor implicit associations, and being a peer reviewer contributes to a more pro-poor association.

Conclusions

The majority of our participants associate Good Research with Rich Countries, compared to Poor Countries. Implicit associations such as these might disfavor research from poor countries in research evaluation, evidence-based medicine and diffusion of innovations.

Evidence-informed decision making for nutrition: African experiences and way forward

Although substantial amount of nutrition research is conducted in Africa, the research agenda is mainly donor-driven. There is a clear need for a revised research agenda in Africa which is both driven by and responding to local priorities. The present paper summarises proceedings of a symposium on how evidence can guide decision makers towards context-appropriate priorities and decisions in nutrition. The paper focuses on lessons learnt from case studies by the Evidence Informed Decision Making in Nutrition and Health Network implemented between 2015 and 2016 in Benin, Ghana and South Africa. Activities within these countries were organised around problem-oriented evidence-informed decision-making (EIDM), capacity strengthening and leadership and horizontal collaboration. Using a combination of desk-reviews, stakeholder influence-mapping, semi-structured interviews and convening platforms, these country-level studies demonstrated strong interest for partnership between researchers and decision makers, and use of research evidence for prioritisation and decision making in nutrition. Identified capacity gaps were addressed through training workshops on EIDM, systematic reviews, cost-benefit evaluations and evidence contextualisation. Investing in knowledge partnerships and development of capacity and leadership are key to drive appropriate use of evidence in nutrition policy and programming in Africa.

Information needs of Botswana health care workers and perceptions of wikipedia

BACKGROUND

Since the UN Human Rights Council's recognition on the subject in 2011, the right to access the Internet and information is now considered one of the most basic human rights of global citizens [1,2]. Despite this, an information gap between developed and resource-limited countries remains, and there is scant research on actual information needs of workers themselves. The Republic of Botswana represents a fertile ground to address existing gaps in research, policy, and practice, due to its demonstrated gap in access to information and specialists among rural health care workers (HCWs), burgeoning mHealth capacity, and a timely offer from Orange Telecommunications to access Wikipedia for free on mobile platforms for Botswana subscribers.

OBJECTIVES

In this study, we sought to identify clinical information needs of HCWs of Botswana and their perception of Wikipedia as a clinical tool.

METHODS

Twenty-eight facilitated focus groups, consisting of 113 HCWs of various cadres based at district hospitals, clinics, and health posts around Botswana, were employed. Transcription and thematic analysis were performed for those groups.

RESULTS

Access to the Internet is limited at most facilities. Most HCWs placed high importance upon using Botswana Ministry of Health (MoH) resources for obtaining credible clinical information. However, the clinical applicability of these materials was limited due to discrepancies amongst sources, potentially outdated information, and poor optimization for time-sensitive circumstances. As a result, HCWs faced challenges, such as loss of patient trust and compromises in patient care. Potential solutions posed by HCWs to address these issues included: multifaceted improvements in Internet infrastructure, access to up-to-date information, transfer of knowledge from MoH to HCW, and improving content and applicability of currently available information. Topics of clinical information needs were broad and encompassed: HIV, TB (Tuberculosis), OB/GYN (Obstetrics and Gynecology), and Pediatrics. HCW attitudes towards Wikipedia were variable; some trusted Wikipedia as a reliable point of care information resource whereas others thought that its use should be restricted and monitored by the MoH.

CONCLUSIONS

There is a demonstrated need for accessible, reliable, and up-to-date information to aid clinical practice in Botswana. Attitudes towards Wikipedia as an open information resource tool are at best, split. Therefore, future studies are necessary to determine the accuracy, currency, and relevancy of Wikipedia articles on the health topics identified by health care workers as areas of information need. More broadly speaking, future efforts should be dedicated to configure a quality-controlled, readily accessible mobile platform based clinical information application tool fitting for Botswana.

Electronic Information Sources Access and Use for Healthcare Services in Governmental and Non-Governmental Hospitals of Western Oromia, Ethiopia: A Cross Sectional Study

BACKGROUND

Access to and use of electronic information sources for clinical decision is the key to the attainment of health related sustainable goals. Therefore, this study was to assess Electronic Information Sources (EIS) access and use for healthcare service among hospitals of Western Oromia, Ethiopia, 2013.

MATERIALS AND METHODS

A descriptive study design with quantitative and qualitative data collection methods was employed. Study subjects were selected by using simple random sampling technique. Quantitative data were entered and analyzed using SPSS version 16.0. Moreover, multiple logistic regression was fitted to identify independent predictors, and qualitative data were transcribed and analyzed thematically.

RESULTS

A total of 590 health professionals were participated in the study with response rate of 95%. Forty-two percent of health professionals had used Electronic Information Sources (EIS). Out of them, more than half used to get latest health information. About three-fourth of health professionals had no formal training on how to use EIS. Moreover, there is a significant association between use of electronic information source and information literacy training, computer literacy level, access to internet connection and access to computers.

CONCLUSION

In this study, it was determined that more than half of health professionals in the study area were not using EIS. Information literacy training, self-stated computer literacy level, access to internet connection and access to computers with in hospitals were found to be statistically significant factors affecting use of EIS.

The Impact of Information Technology on Health Information Access in Sub-Saharan Africa: the divide within the divide

In the beginning of the 21st century, there continues to be a health information access gap between users in industrialized and developing countries. Information Technology (IT) was viewed as a potential tool to bridge this ‘digital divide’. With reliable and cost effective access to the Internet, a significant body of health-related information would be accessible to users in developing and transitional countries. Currently, most of the information is produced in industrialized countries. Within sub-Saharan Africa, access to this information is limited. In 2002, the computer to user's ratio was 1:250-400 compared to a 1:15 world average and a 1:2 industrialized country average. Although there are examples of excellent projects, progress has been patchy, with the sub-Saharan Africa region falling behind due to the lack of physical access to information and training. Without the creation of a major organization with ample funding, pockets of progress will continue to be made, but the full potential of IT will not be reached.

The Health of Peoples: Predicaments Facing a Reasoned Utopia

How might nations cooperate to improve the health of their most vulnerable peoples? There is, presently, no coherent political, social, or ethical framework to answer this question. What progress there is remains piecemeal. Despite a long-term strategy to 2015 enshrining health as part of the process of human development—the Millennium Development Goals—existing institutions are struggling to meet these challenges. The WHO is underfunded and its work in countries is weak. The World Bank is rich but remains unable to free itself from a neoliberal Washington consensus. New institutions—such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria—distort efforts to build a coordinated international strategy for global health. And major policy initiatives (e.g., the Commission on Macroeconomics and Health) lack political commitment to invest in health. In this article, the author traces the beginnings of an answer to the question of what might constitute a political (specifically, foreign policy) approach to improving the health of peoples. A normative model for defining a just health system is urgently required. The author uses the framework of international relations provided by John Rawls to devise a series of policy principles for the health of peoples.

Does a research article's country of origin affect perception of its quality and relevance? A national trial of US public health researchers

OBJECTIVES

The source of research may influence one's interpretation of it in either negative or positive ways, however, there are no robust experiments to determine how source impacts on one's judgment of the research article. We determine the impact of source on respondents' assessment of the quality and relevance of selected research abstracts.

DESIGN

Web-based survey design using four healthcare research abstracts previously published and included in Cochrane Reviews.

SETTING

All Council on the Education of Public Health-accredited Schools and Programmes of Public Health in the USA.

PARTICIPANTS

899 core faculty members (full, associate and assistant professors)

INTERVENTION

Each of the four abstracts appeared with a high-income source half of the time, and low-income source half of the time. Participants each reviewed the same four abstracts, but were randomly allocated to receive two abstracts with high-income source, and two abstracts with low-income source, allowing for within-abstract comparison of quality and relevance

PRIMARY OUTCOME MEASURES

Within-abstract comparison of participants' rating scores on two measures--strength of the evidence, and likelihood of referral to a peer (1-10 rating scale). OR was calculated using a generalised ordered logit model adjusting for sociodemographic covariates.

RESULTS

Participants who received high income country source abstracts were equal in all known characteristics to the participants who received the abstracts with low income country sources. For one of the four abstracts (a randomised, controlled trial of a pharmaceutical intervention), likelihood of referral to a peer was greater if the source was a high income country (OR 1.28, 1.02 to 1.62, p<0.05).

CONCLUSIONS

All things being equal, in one of the four abstracts, the respondents were influenced by a high-income source in their rating of research abstracts. More research may be needed to explore how the origin of a research article may lead to stereotype activation and application in research evaluation.

Use of a bibliometric literature review to assess medical research capacity in post-conflict and developing countries: Somaliland 1991-2013

OBJECTIVES

Effective healthcare systems require high-quality research to guide evidence-based interventions and strategic planning. In low- and middle-income countries, especially those emerging from violent conflict, research capacity often lags behind other aspects of health system development. Here, we sought to bibliometrically review health-related research output in Somaliland, a post-conflict self-declared, autonomous nation on the Horn of Africa, as a means of assessing research capacity.

METHODS

We reviewed articles on health-related research conducted in Somaliland between 1991 and 2013 that included a description of the experimental design, and articles were published in either a peer-reviewed journal or as part of a scholarly programme receiving formal review. We did not include policy or social science research that did not enrol or interact with subjects from Somaliland. Using online databases, all studies meeting minimum eligibility criteria were reviewed in regard to Somaliland-based co-authorship, topic of research and specific measures of quality.

RESULTS

A total of 37 studies were included in this review. Of these, only 19 (51%) included co-authorship by Somaliland-based researchers. Of the 21 studies reporting ethical approval, 16 (64%) received approval from the Somalia or Somaliland Ministry of Health, while five received approval from a university or national commission. More than two-thirds of published research was limited to a few areas of investigation with most (19, 51%) following basic cross-sectional study designs. The number of articles published per year increased from 0 to 1 in the years 1991-2007 to a maximum of 8 in 2013.

CONCLUSIONS

Research activity in Somaliland is extremely limited. Investigators from high-income countries have largely directed the research agenda in Somaliland; only half of the included studies list co-authors from institutions in Somaliland. Leadership and governance of health research in Somaliland is required to define national priorities, promote scholarly activity and guide the responsible conduct of research. The methods used here to assess research capacity may be generalisable to other low- and middle-income countries and post-conflict settings to measure the impact of research capacity-building efforts.

Promotion and Reporting of Research from Resource-Limited Settings

Driven by global burden of disease and inequalities in health care, research activities in resource-poor settings have radically increased. However, a corresponding increase in reporting of research from these settings has not been observed. This article critically explores the importance of promoting and reporting of health research from resource-poor settings, current trends, and practices, and discusses the key challenges faced by researchers from such settings. These challenges include changing face of open-access (OA) and online publishing, the threat of predatory OA journals, authorship and international partnership ethics, attitudinal problems hindering research reporting, and a lack of alternative publishing spaces. A combined, decisive effort is needed to bridge the gap between research activity and reporting in resource-poor settings.

Attitudes towards the surgical safety checklist and factors associated with its use: A global survey of frontline medical professionals

BACKGROUND

The Surgical Safety Checklist (SSC) has been shown to reduce perioperative errors and complications and its implementation is recommended by the World Health Organisation (WHO). However, it is unknown how widely this intervention is used. We investigated attitudes and factors associated with use of WHO SSC in frontline medical professionals across the globe using a survey distributed through social networks.

METHODS

A survey of usage and opinions regarding the SSC was posted on the Facebook and Twitter pages of a not-for-profit surgical news website for one month (March 2013). Respondents were grouped into four groups based on their country's Gross National Income: high, upper middle, lower middle and low income. Univariate and multivariate analyses were performed to investigate how different factors were associated with the use of the SSC.

RESULTS

6269 medical professionals from 69 countries responded to the survey: most respondents were from lower middle (47.4%) countries, followed by: high (35.0%), upper middle (14.6%), and low (3.0%) income countries. In total, 57.5% reported that they used the WHO SSC perioperatively. Fewer respondents used the WHO SSC in upper middle, lower middle and low income countries (LMICs) compared to high income countries (43.5% vs. 83.5%, p < 0.001). Female (61.3% vs. 56.4% males, p = 0.001), consultant surgeons (59.6% vs. 53.2% interns, p < 0.001) and working in university hospitals (61.4% vs. 53.7% non-university hospitals, p < 0.001) were more likely to use the SSC. Believing the SSC was useful, did not work or caused delays was independently associated with the respondents reported use of the SSC (OR 1.22 95% CI 1.07-1.39; OR 0.47 95% CI 0.36-0.60; OR 0.64 95% CI 0.53-0.77, respectively).

CONCLUSION

This study suggests the use of the WHO SSC is variable across countries, especially in LMICs where it has the most potential to improve patient safety. Critical appraisal of the documented benefits of the WHO SSC may improve its adoption by those not currently using it.

Increasing the value of health research in the WHO African Region beyond 2015--reflecting on the past, celebrating the present and building the future: a bibliometric analysis

OBJECTIVE

To assess the profile and determinants of health research productivity in Africa since the onset of the new millennium.

DESIGN

Bibliometric analysis.

DATA COLLECTION AND SYNTHESIS

In November 2014, we searched PubMed for articles published between 2000 and 2014 from the WHO African Region, and obtained country-level indicators from World Bank data. We used Poisson regression to examine time trends in research publications and negative binomial regression to explore determinants of research publications.

RESULTS

We identified 107,662 publications, with a median of 727 per country (range 25-31,757). Three countries (South Africa, Nigeria and Kenya) contributed 52% of the publications. The number of publications increased from 3623 in 2000 to 12,709 in 2014 (relative growth 251%). Similarly, the per cent share of worldwide research publications per year increased from 0.7% in 2000 to 1.3% in 2014. The trend analysis was also significant to confirm a continuous increase in health research publications from Africa, with productivity increasing by 10.3% per year (95% CIs +10.1% to +10.5%). The only independent predictor of publication outputs was national gross domestic product. For every one log US$ billion increase in gross domestic product, research publications rose by 105%: incidence rate ratio (IRR=2.05, 95% CI 1.39 to 3.04). The association of private health expenditure with publications was only marginally significant (IRR=1.86, 95% CI 1.00 to 3.47).

CONCLUSIONS

There has been a significant improvement in health research in the WHO African Region since 2000, with some individual countries already having strong research profiles. Countries of the region should implement the WHO Strategy on Research for Health: reinforcing the research culture (organisation); focusing research on key health challenges (priorities); strengthening national health research systems (capacity); encouraging good research practice (standards); and consolidating linkages between health research and action (translation).

Medical education in India: current challenges and the way forward

Medical education in India is suffering from various shortcomings at conceptual as well as implementation level. With the expansion in medical education, the doctor to patient ratio has increased but these numbers do not align well with the overall quality of medical care in the country. To address this issue, a comprehensive analysis of various associated factors is essential. Indian medical education is suffering from a maldistribution of resources, unregulated growth in the private sector, lack of uniform admission procedures and traditional curricula lacking innovative approaches. To achieve higher standards of medical education, our goal should be to re-evaluate each and every aspect; create an efficient accreditation system; promote an equal distribution of resources, redesign curricula with stricter implementation and improved assessment methodologies; all of which will generate efficient medical graduates and consequently better health care delivery, and resulting in desired change within the system.

Building public health capacity in Madhya Pradesh through academic partnership

Engaging in partnerships is a strategic means of achieving objectives common to each partner. The Post Graduate Diploma in Public Health Management (PGDPHM) partners in consultation with the government and aims to strengthen the public health managerial capacity. This case study examines the PGDPHM program conducted jointly by the Public Health Foundation of India and the Government of Madhya Pradesh (GoMP) at the State Institute of Health Management and Communication, Gwalior, which is the apex training and research institute of the state government for health professionals. This is an example of collaborative partnership between an academic institution and the Department of Public Health and Family Welfare, GoMP. PGDPHM is a 1-year, fully residential course with a strong component of field-based project work, and aims to bridge the gap in public health managerial capacity of the health system through training of health professionals. The program is uniquely designed in the context of the National Rural Health Mission and uses a multidisciplinary approach with a focus on inter-professional education. The curriculum is competency driven and health systems connected and the pedagogy uses a problem-solving approach with multidisciplinary faculty from different programs and practice backgrounds that bring rich field experience to the classroom. This case study presents the successful example of the interface between academia and the health system and of common goals achieved through this partnership for building capacity of health professionals in the state of Madhya Pradesh over the past 3 years.

Global search demand for varicose vein information on the internet

BACKGROUND

Changes in internet search trends can provide healthcare professionals detailed information on prevalence of disease and symptoms. Chronic venous disease, more commonly known as varicose veins, is a common symptomatic disease among the adult population. This study aims to measure the change in global search demand for varicose vein information using Google over the past 8 years.

METHODS

The Google Trends instrument was used to measure the change in demand for the use of the local name for varicose veins in several countries across the world between January 2006 and December 2012. The measurements were normalised onto a scale relative to the largest volume of search requests received during a designated time and geographical location. Comparison of national levels of private healthcare and healthcare spending per capita to search demand was also undertaken using Organisation for Economic Co-operation and development economic measurements.

RESULTS

Global interest has increased significantly, with linear regression demonstrating a 3.72% year-on-year increase in demand over the 8-year time period (r(2 )= 0.385, p < 0.001). Annual demand significantly increased in the northern hemisphere (p < 0.001 Friedman) yet decreased in the southern hemisphere (p < 0.001 Friedman). Significant seasonality was observed, with warmer months experiencing greater search demand compared to cooler winter months (<0.001 Kruskal-Wallis). National levels of private healthcare did not appear to correlate in search demand (r(2 )= 0.120 p = 0.306). Healthcare spending per capita did not relate to search demand (r(2 )= 0.450 p = 0.077).

CONCLUSION

There is increasing demand for information about varicose veins on the internet, especially during the warmer months of the year. Online search demand does not appear to be related to healthcare spending.

Authorship ethics in global health research partnerships between researchers from low or middle income countries and high income countries

BACKGROUND

Over the past two decades, the promotion of collaborative partnerships involving researchers from low and middle income countries with those from high income countries has been a major development in global health research. Ideally, these partnerships would lead to more equitable collaboration including the sharing of research responsibilities and rewards. While collaborative partnership initiatives have shown promise and attracted growing interest, there has been little scholarly debate regarding the fair distribution of authorship credit within these partnerships.

DISCUSSION

In this paper, we identify four key authorship issues relevant to global health research and discuss their ethical and practical implications. First, we argue that authorship guidance may not adequately apply to global health research because it requires authors to write or substantially revise the manuscript. Since most journals of international reputation in global health are written in English, this would systematically and unjustly exclude non-English speaking researchers even if they have substantially contributed to the research project. Second, current guidance on authorship order does not address or mitigate unfair practices which can occur in global health research due to power differences between researchers from high and low-middle income countries. It also provides insufficient recognition of "technical tasks" such as local participant recruitment. Third, we consider the potential for real or perceived editorial bias in medical science journals in favour of prominent western researchers, and the risk of promoting misplaced credit and/or prestige authorship. Finally, we explore how diverse cultural practices and expectations regarding authorship may create conflict between researchers from low-middle and high income countries and contribute to unethical authorship practices. To effectively deal with these issues, we suggest: 1) undertaking further empirical and conceptual research regarding authorship in global health research; 2) raising awareness on authorship issues in global health research; and 3) developing specific standards of practice that reflect relevant considerations of authorship in global health research.

SUMMARY

Through review of the bioethics and global health literatures, and examination of guidance documents on ethical authorship, we identified a set of issues regarding authorship in collaborative partnerships between researchers from low-middle income countries and high income countries. We propose several recommendations to address these concerns.