Anesth Analg 1999;88:1175-1180
© 1999 International Anesthesia Research Society
GENERAL ARTICLES
Which Countries Publish in Important Anesthesia and Critical Care Journals?
J. Boldt, MD*,
W. Maleck, MD*, and
K. P. Koetter, MD
*Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Ludwigshafen; and
Neurological Intensive Care Unit, Leopoldina-Hospital, Schweinfurt, Germany
Address correspondence and reprint requests to Prof. Dr. Joachim Boldt, Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt, Ludwigshafen, Bremserstr. 79, D-67063 Ludwigshafen, Germany.
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Abstract
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Using a MEDLINE-based analysis, we studied the national origin of articles published in important anesthesia, pain, critical care, and emergency medicine journals. All journals in English listed in the Science Citation Index (SCI) of Journal Citation Reports under the subheadings Anesthesiology (n = 17) and Emergency Medicine & Critical Care (n = 13) were analyzed with the help of MEDLINE. Issues from 1996 and 1997 were included and summarized. Letters, abstracts, editorials, meeting reports, and news were not included. MEDLINE printouts were studied, and we classified the country of origin of the first author. The following subsets were defined: Anesthesia, Regional Anesthesia and Pain, Clinical Monitoring and Computing, Intensive Care Medicine and Resuscitation, and Emergency Medicine and Trauma. A total of 10,643 publications in 30 journals were published during 1996 and 1997. Of the 30 journals, 17 originate in the United States (US) and 8 from United Kingdom (UK). In 14 of the 17 US journals, >50% of the publications came from the US. The US was the most active nation, with a total of 4,283 articles (40.2% of all contributions), followed by the UK with 1,418 articles (13.3%). When looking at the number of publications with regard to inhabitants or impact factor per million inhabitants, small highly industrialized nations (Finland 35.41 and Sweden 33.9 articles/million inhabitants) were significantly more active than large highly industrialized countries (US 16.2, Germany 6.1, Japan 4.5 articles/million inhabitants). It is presumed that indicators of productivity in medical research are the number of articles published and the cumulative impact factor. During 1996 and 1997, the US was the most active nation with regard to publications in important journals in the areas of anesthesia, pain, critical care, and emergency medicine. Small highly industrialized nations, however, had a higher activity rate than larger countries.
Implications: In a MEDLINE-based analysis, we examined the number of publications in important anesthesia, pain, critical care, and emergency medicine journals (n = 30) for the years 1996 and 1997 and analyzed these with regard to national origin. The United States was by far the most active nation in this medical area (4283 articles [40.2%]), followed by the United Kingdom (13.3%). With regard to publications per million inhabitants, small highly industrialized nations contributed overproportionally to publications in this area.
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Introduction
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The recent development of information and communication technologies has greatly facilitated the exchange of ideas among nations. The continuous increase of knowledge in anesthesia and critical care creates an increasing number of publications in an increasing number of medical journals (1). The scientific productivity of a country in a particular medical area seems to be reflected by the number of published articles (2). Not only are articles published for the exchange of new ideas in research, recent developments in technology, and therapeutic strategies, but authors also receive greater academic credit through publication in highly ranked international journals, which can have a positive influence on individual careers (3). Publishing in international journals also confirms scientific qualifications, which is essential in obtaining funding from industry or independent scientific organizations. We designed the present study to examine the national origin of articles published in important anesthesia, critical care, and emergency medicine journals.
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Methods
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Journals were included when the following three criteria were met: 1) inclusion in the Science Citation Index (SCI) of Journal Citation Reports (4) in the categories of Anesthesiology or Emergency Medicine & Critical Care; 2) inclusion in MEDLINE; 3) English language. The journals were arbitrarily classified to one of the following subsets: Anesthesia, Regional Anesthesia and Pain, Clinical Monitoring and Computing, Intensive Care Medicine and Resuscitation, and Emergency Medicine and Trauma.
Journals were evaluated using MEDLINE, and articles that met the following criteria were included: English language, publication year 1996 or 1997, publication type "Journal-Article" (this de facto excludes letters, editorials, meeting reports, news). MEDLINE printouts were examined, and country of origin was classified based on the following hierarchy: as stated by the original authors; as concluded from the address (such as province, city, or national institution); country via other articles by the same author(s); and using the original printed publication. If more than one country was mentioned, the first was selected. If the address was that of an international institution or working group, the country of the first author or—if no personal authors were listed—the origin of the institution was chosen. Population figures were taken from Fischer Weltalmanach 1998 (5). Publications per million population (PpM) was calculated by dividing the total number of publications by the population of each country. Details concerning the different journals were taken from Ulrich's International Periodicals Directory (6). The impact factor (IF) was taken from the SCI of Journal Citation Report (4). A nation's total IF of each subset was defined by multiplying each journal's IF by the number of articles.
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Results
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We analyzed 10,643 publications in 30 journals published during 1996 and 1997. Most articles came from the United States (US) (4,283 articles [40.2% of all contributions]), and 1,418 articles came from the United Kingdom (UK) (13.3%). With regard to the number of PpM, small highly industrialized nations (Finland 35.41 and Sweden 33.9 articles/million inhabitants) were significantly more active than large highly industrialized countries (US 16.2, Germany 6.1, Japan 4.5 articles/million inhabitants). Of the 30 journals, 17 originate in the US and 8 originate in the UK. In 14 of the 17 journals originating from the US, >50% of the publications came from the US. When the IF of the journals were taken into account, the total IF was highest for the US in all subsets (IF for all journals: 10,874), and the UK had the second highest accumulative IF (2,598). With regard to total IF/million inhabitants, other countries (e.g., Finland 72.6; Canada 61.4) were ranked before the US (41.6).
Anesthesia Journals
In 1996 and 1997, 4603 articles were published by 51 nations; 31.3% originate in the US. Of the 11 journals, 5 were dominated by the US (>50% of all publications in the journal). All of these journals originate in the US. The second most active nation was the UK (14.5% of all publications). The UK was most active in three journals (all European). Regarding the PpM in the smaller countries, the leading nations were Finland, then Sweden and Austria. Less industrialized countries play only a minor role in the selected anesthesia journals (Table 1).
Intensive Care and Resuscitation Journals
Thirty-nine nations published 2479 articles. Most articles came from the US (40%). Two of six journals were dominated by the US (>50% of publications), three markedly so. Canada and the UK were second in activity. Comparing larger (US, Japan, Germany) with smaller nations, the smaller highly industrialized countries were much more active (Sweden, then Canada). Less industrialized countries did not significantly contribute to these publications (Table 2).
Emergency Medicine and Trauma Journals
Fifty-five nations published 2665 articles in seven journals. Authors from the US (54%) and the UK (18%) were by far the most active contributors. Four journals originate in the US, and most articles were from the US (>50% of all publications). Three journals originate in the UK, and the UK was the most active nation in these journals. Nations that did not publish in other journals were often represented in this section of the publication (e.g., India, China, Yugoslavia) (Table 3).
Clinical Monitoring and Computing Journals
Only two journals specialize in monitoring and computing, and they include 148 articles from 21 nations. Both journals originate in the US, and one is dominated by the US (>50% of all publications of the journal). The Netherlands and Germany were the next best represented (Table 4).
Regional Anesthesia and Pain Journals
Thirty-two nations published 748 articles. Three journals originate in the US, and most articles were from the US (44% of all articles). The UK and Canada are the next most active nations. In reference to PpM, small highly industrialized countries were very active in these publications (Denmark, then Finland). Other large countries (e.g., Japan, Germany) did not contribute significantly with regard to PpM (Table 5).
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Discussion
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The present analysis shows that American publications dominate the subjects of anesthesia, pain, critical care, and emergency medicine. Our data also show that American physicians prefer to publish in journals of American origin, and British physicians prefer journals of British origin (e.g., Anaesthesia, British Journal of Anaesthesia), whereas articles from other European countries are found widely distributed among all journals. This is in agreement with a study evaluating international rank order of cardiology by de Jong and Schaper (7), which showed that Americans use American journals almost exclusively. In contrast, Europeans do not prefer to publish exclusively in European cardiology journals. With regard to citing behavior, it has been demonstrated that cardiology publications in American journals overwhelmingly cite articles in American journals (92% ± 1%), whereas only 67% ± 6% of the citations in non-American journals refer to articles in American journals (7). Comparable findings have also been demonstrated in other medical areas. Evaluating the internationalization of the American Journal of Roentgenology, Elster and Chen (8) concluded that manuscripts submitted from international sources are somewhat less likely to be accepted for publication than those originating in the US. In an analysis of reviewer bias in Gastroenterology, Link (9) demonstrated that US reviewers have a significant preference for US articles. It cannot be concluded from our analysis that Europeans who submit articles to American journals that were rejected then attempt to publish in non-American journals. It has been shown that editorial responsibility (e.g., editors, editorial board) in most American journals is American, whereas Americans are also responsible for the acceptance or rejection of publications in several non-American (European) journals (10). Editors, however, can maintain the reputation of a journal by keeping standards high and by publishing the best articles regardless of national origin (2).
Another result of the present study is that small highly industrialized countries markedly contribute to publications in the area of anesthesia, critical care and emergency medicine, pain, and computing. With regard to PpM, highly industrial nations such as Germany or Japan fall behind. This is in agreement with Pomaroli et al. (11) and Benzer et al. (12), who found that several small nations have a large medical publication output that exceeds that of large nations. This may be because in these countries there are no national, non-English journals and physicians are forced to publish in English-language, higher-ranked journals. Another reason may be differences in education, training, funding, and academic structures in the different countries.
Lesser industrialized countries contribute fewer articles in the area of anesthesia, pain, computing, and critical care medicine, which may be explained by the lack of research in these countries. They do, however, contribute to some extent to journals specializing in emergency medicine. This may be because they have experience and, therefore, interest in this area. Some objections may be raised by the results of our analysis. We analyzed data only from MEDLINE, and we decided to combine data from 1996 and 1997. We analyzed only English-language articles. However, because English is the dominate language in medicine, there is a tendency to publish research in English. We neglected anesthesia/critical care/pain/emergency medicine articles published in (high-impact) journals of general clinical medicine that are not listed under the subheadings Anesthesiology or Emergency Medicine & Critical Care (e.g., New England Journal of Medicine, Journal of the American Medical Association, Lancet, British Medical Journal). Our procedure is similar to that used in the study by de Jong and Schaper (7) in assessing international rank order in clinical cardiology. These authors found that few publications relevant to their study (<1% per year) appeared in these journals. Thus, it may be assumed that few articles from the areas of anesthesia, pain, critical care, and emergency medicine are published in journals of general clinical medicine.
Several objections to the IF as a measure of medical research have been formulated (13,14). Nevertheless, we have created a total IF by multiplying the journal's IF by the number of articles so that the quality and relevance of each nation in each area may be better assessed than by using only the numbers of publications. The total IF/million inhabitant value shows that some smaller nations produce high-quality research in anesthesia, pain, critical care, and emergency medicine.
We conclude that, with regard to publications in the areas of anesthesia, pain, critical care, and emergency medicine, the US is the most active nation. Stossel and Stossel (2) envisioned that the US may be becoming a consumer, rather than a producer, of medical research. This can be refuted with regard to research in anesthesia, pain, critical care, and emergency medicine. Analysis of PpM revealed that small highly industrialized countries overproportionately contribute to publications in these medical specialties.
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Accepted for publication January 21, 1999.
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Abstract
Introduction
