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Iranian research output in pediatr ics : 1975-2007

BACKGROUND: By providing a picture from published articles in a field, bibliometric studies can inform policy-makers in their challenging research funding decisions. In this regard, we applied bibliometric analysis to the Iranian pediatrics articles published in PubMed indexed journals between 1975 and 2007. METHODS: We evaluated all pediatric articles that had been published from Iran in different PubMed indexed journals from 1975 to 2007. Journal data (i.e. date of publishing, journal name, impact factor of the journal, language), authors data (i.e. number of authors, international collaboration, affiliation of the corresponding author), and paper characteristics [i.e. type of article, research design, study population (neonate, infant, child, and adolescent), and specialty] were registered. RESULTS: During this period of time, 819 articles from Iran had been published in PubMed indexed journals, with a sharp increasing trend after 2002. Impact factors were up to 25.8. Paper had an international co-author in 13.7%. Regarding study population, 24.1% of studies were published on neonates, 23.6% on infants, and the remaining 66.3% of studies were performed on children and adolescents from 2 to 18 years old. Infectious disease was the most frequent area of research, followed by public health and metabolic disease. Original articles were the most frequent type (89.7%) of the published articles. Study design was cross-sectional in 51.2%, retrospective in 36.3%, and prospective in 11.6%. Clinical trials made up 4.8% of the total papers. CONCLUSIONS: Contribution of Iran in production of pediatrics science is showing a sharp increase after 2002, this pattern is in parallel with other research fields.

ran is a country in the eastern Mediterranean region with an area of 1648195 square kilometers and a total population of 73650 in thousands in 2009. 1 Infrastructures of biomedical research in Iran have experienced a dramatic increase both in budget and human resources. 2 Scientometric indicators are increasingly employed to evaluate the pattern of research performed by researchers, institutes, and countries. 3 Since the 1960s and 1970s, when objective scientometric indices have defined for re-search evaluation, there is an increasing interest in bibliometric studies to monitor scientists' interests and efforts. 4 These studies monitor different aspects of scientific outputs from number of published articles in each discipline. 5,6 Common bibliometric databases which are being used in such studies include Scopus, Web of Science, Google Scholar, and PubMed. 7 However, there are also some limitations for bibliometric studies, including the inappropriate use of impact factors for between-field comparisons. 8 I

www.SID.ir
PubMed was launched by the National Library of Medicine in the United States in 1997, years after the introduction of the first interactive searchable database (Medline) in 1971. This database covers journals dating from 1950 and has become one of the most reliable web based resources for clinicians and researchers in health and medicine. PubMed is easy, quick, and free to use, it is the most frequently used resource for information for biomedical sciences. 7 In July 2010, 5485 journals were indexed by Pubmed. 9 Iran has become successful in its agenda to improve its international profile in biomedical sciences by constantly increasing the quantity and quality of articles published in peerreviewed biomedical journals that are indexed by either Medline or Excerpta Medica database (EMBASE). 2 One study reported a 19-fold increase in the number of Iranian articles indexed by PubMed from 1997 through 2006. 10 Some bibliometric studies have focused on particular fields, such as transplantation, 11 nephrology, 12 mental health, 13 and dentistry. 14 A study of Iranian biomedical publications in 2004 reported that University of Shiraz and Baqiyatollah have published papers with highest IF in the country. 15 Although pediatric bibliometric studies are available from other countries, based on our knowledge, there is a lack of international bibliometric report on Iran's contribution to the field of pediatrics. We sought to analyze Iran's scientific outputs appeared in PubMed between 1975 and 2007.

Methods
This was a descriptive bibliometric study conducted by the Medicine and Health Promotion institute, Tehran, Iran. The study was conducted in January to April 2009. In one domestic report from this data which was published in Persian, we ranked universities of Iran, and we showed that Tehran University of Medical Sciences has published 1 of 4 PubMed indexed pediatric articles in Iran. 16 All electronically available pediatric literature published in PubMed (a service of the Abstracts of all the articles were first downloaded, and a hard copy was utilized for data collection.

Search strategy
Our search strategy was based on two fields: MeSH (Medical Subject Headings) and AD (Affiliation). To find publications on pediatrics, the terms (pediatric or neonate or newborn or infant or child or children or adolescent or adolescence) were used in the MeSH field. To find Iranian publications, i.e. publications where the first author was of Iranian nationality, the following terms were used in the AD field: (

Data collection
A hard copy of abstracts from the pediatric articles was utilized to extract the following data from all the papers: title of journal and its impact factor (IF), year of publication, number of authors, first author's university, center or institution, paper language, existence of international collaboration, number of international collaborators, study population, paper type, study design, study type, and topic area.
The journals IF was extracted according to JCR (Journal Citation Report for 2006). Study population was categorized as neonate (age < 1 month), infant (1 month < age < 2 years), child (2 < age < 13), and adolescent (13 < age < 18). Study type was classified as original article, case report, case series, review article, and letter. Study design was divided into three categories: cross-sectional, retrospective, and prospective. Study design was categorized as test evaluation, interventional, descriptive, and analytic; and analytic study type itself was classified as cross-sectional, case-control, cohort, and randomized clinical trial (RCT). Topic areas were comprised of public health, infectious disease, nephrology, gastroenterology, neurology, hematology, oncology, asthma allergy immunology, nutrition, cardiology, neonatology, endocrinology, pediatric surgery, urology, orthopedic, radiology, ophthalmology, dentistry, dermatology, psychiatry, genetics, and toxicology.

Statistical analysis
The data that was obtained from the literature search were statistically analyzed using SPSS for Windows version 13 Statistical Package. The quantitative data were presented using mean and standard deviation, and the qualitative data were described using frequency tables.  Figure 1). The number of authors ranged from 1 to 24 with a mean (±SD) of 4 ± 3; with the first and third quartiles of 2 and 5, respectively. In terms of affiliations, 112 (13.7%) articles were published by contribution of an author affiliated with another country. The journal with highest number of papers was Eastern Mediterranean Health Journal (n = 48, 5.9%), followed by Journal of Tropical Pediatrics (n = 27, 3.3%) and Archive of Iranian Medicine (n = 22, 2.7%) ( Table 1).

Results
With respect to language, full text was English in 784 (95.7%) articles, French in 11 (1.3%), German in 3 (0.4%), and Russian in 1 (0.1%). Due to lack of access to the paper, language of full text could not be determined in the remaining 20 papers (2.5%).
Regarding the study population, subjects were neonates in 197 (24.1%) article, infants in 193 (23.6%) and children or adolescents (age from 2 to 18 years) in 543 (66.3%) article. In 114 (14%) papers, more than one of the above age groups was enrolled.
The three main research fields were infectious diseases (n = 153, 18.7%), public health (n = 70, 8.5%), and metabolic disease (n = 68, 8.3%). All other fields composed less than 5% of the publications, however, that data is not shown here.  ward movement in the research. 10 Striking increase also has been reported for Iranian papers indexed in the ISI Web of Knowledge. 17 A bibliometric study illustrated that nearly half of the articles published in a 20-year period  in the field of psychology were published during the previous four years. 17 Similar pattern was also reported for nonmedical research scholarly output. 18 Iran had the highest pace in growth of research publications among Middle Eastern countries in 2005. 19 The recent rapid increasing trend in research output of the country can be attributed to the attention to research by country policy makers up to the highest level of leadership, which has caused a national commitment by research policy change which in turn has came with a drastic rise in research resources. 20 The research budget allocated to the health sector doubled between 1997 and 2005 and there was a considerable increase in health research faculty members from 1999 to 2002. The number of biomedical research centers in the country was boosted from 4 in 1997 to 64 in 2006. 10 Such achievements were a result of a national movement in Iran to upscale research in general. 10 Be that as it may, two points must be taken into consideration in this regard. The first point is that our reported trend in publications is not necessarily parallel to the changes in research itself, given the time lag of publication. The second point is related to the initiatives inside Iran to promote peer-reviewed journals to increase their chance of being read and cited internationally. Within our study period, some domestic journals have been recently covered by PubMed; some of them are Archives of Iranian Medicine, Iranian Journal of Kidney Disease and Urology International which also publish pediatric papers.
Quantitative and qualitative developments in research centers involved in tissue transplantation 11, 21 nephrology, 11 and diabetes mellitus 22 are reported. Similarly, we believe that the trend of published articles in pediatrics is parallel to the rising number of clinical and research centers in pediatrics. In general, the increasing trend in scientific visibility of pedia-trics research should be regarded as a proxy of development of this scientific field in Iran. 23 According to the present study, the topic of infectious diseases account for the highest number of pediatric articles published from Iran. As Iran is a developing country with a high population of children, high proportion of pediatric health care goes to infectious diseases both in outpatient and inpatient setting. This may result in high research in this area. There is also a high demand for research based information in the country, based on high mortality of children due to infectious diseases. 24,25 Availability of clinical data in infectious disease and ease of research in infectious disease may also contribute to the interest of researchers.
Among Iranian articles published in the field of pediatrics, randomized clinical trials represent a small proportion. This low proportion of trials from all publications is not a phenomenon limited to this field. 10, 1 For instance, one study could not find any clinical trial among articles having been internationally published in the field of renal transplantation over a relatively long period of time. 21 This might be related to the challenges and difficulties in designing and conducting such studies. 26,27 The ultimate objective of research publication is informing clinicians and policy-makers. Many pediatricians utilize the internet as their first "port of call". They believe that web-based resources are essential to their medical practice and will improve their quality of practice. 28 These publications, albeit important in international science production, might have little direct effect on health promotion and clinical improvement inside the country; because most of them have been written in English and most Iranian pediatricians do not have access to their full texts. Therefore, the myriad publications indexed in Iranian journals are of special significance.
Our study had some limitations. The focus of the present study was on PubMed publications, which are indeed only a minor portion of the numerous research studies carried out hitherto in Iran. The present study also did not include citation analysis. In this study, impact factor was extracted according to the JCR report at the time of our study, not the impact factor of the journal on the year that the article was published.
To conclude, during this period of time, we can see a sharp increasing trend after 2002, in publications in PubMed indexed journals. Less than 5% were clinical trials, and most research was cross sectional in design. This information is believed to help policy makers to improve pediatric research in Iran.