Paediatric research in Canada: 2003

What is the state of paediatric research in Canada? What is being studied? What is being neglected? Who is publishing? Where are they published? To get a snapshot view of paediatric research in Canada, the National Library of Medicine was searched (PubMed at ) for the year 2003. The search was limited to: Medical Subject Headings term “Canada”; age limited to newborn (birth to one month), infant (one to 23 months), preschool child (two to five years), child (six to 12 years) and adolescent (13 to 18 years); and publication date between January 1, 2003, and December 31, 2003. A total of 614 references were retrieved and downloaded into EndNote for MacIntosh, Version 7.0.0 (ISI ResearchSoft, USA). To avoid missing any articles not coded by the above age groups, a separate search was done limited to the Medical Subject Headings term “Canada” and publication dates between January 1, 2003, and December 31, 2003, but without age limits. A total of 3389 references were retrieved with the larger search, of which 38 were not duplicated in the initial search and were related to paediatrics. The combined total of 652 references was reviewed and 246 were excluded from consideration because the topic did not involve children or the authors were not based in Canada. Of the remaining 406, 262 were research articles and form the basis for this analysis. The articles were analyzed in terms of topic, journal and location of the principal author. Research studies involving First Nations and immigrant children were analyzed separately. The articles covered 62 major topics (Table 1). Infectious disease was the leading topic, occurring in 59 articles (22.5%). Vaccination was the focus in nearly one-third (18 of 59) of the infectious disease articles, and HIV in 13.6% (8 of 59) of the articles. Other common topics were mental health (9.5%), accidents (8.0%), research methods (6.9%) and neonatology (6.1%). Topics relating to health care, including delivery of care, acute care issues, costs, health promotion, nursing, quality of life, guideline adherence, patient education and medical errors, accounted for a combined total of 78 articles (29.8%). Certain topics which might be assumed to be of great interest to researchers because of their high media profile such as anorexia nervosa, arthritis, attention deficit/hyperactivity disorder, cystic fibrosis, enuresis, pain management and medical errors were striking in their rarity, occurring in one or two articles, or not at all. To see if this rarity reflected the sampling error resulting from examining a period of only one year, PubMed was searched for Canadian paediatric research articles on these eight topics for the past 10 years. The numbers were: six studies on anorexia nervosa, 22 studies on arthritis, 23 studies on attention deficit/hyperactivity disorder, 21 studies on cystic fibrosis; one study on enuresis, two studies on medical errors and 12 studies on pain management. Thus, the infrequent occurrence of these topics in 2003 was indeed representative of the past 10 years. Topics covered in 262 research articles on Canadian paediatrics published in 2003 Topics covered in 262 research articles on Canadian paediatrics published in 2003 The 262 articles were published in 148 different journals, of which 111 were represented by only a single article (Table 2). The journals in which two or more articles were published are tabulated in Table 3. The Canadian Journal of Public Health was the top ranked journal with 30 articles, followed by the Canadian Medical Association Journal with 14 articles. Journals in which only one of the 262 research articles on Canadian paediatrics was published in 2003 Journals in which only one of the 262 research articles on Canadian paediatrics was published in 2003 Journals in which two or more of the 262 research articles on Canadian paediatrics were published in 2003 Journals in which two or more of the 262 research articles on Canadian paediatrics were published in 2003 The locations of the principal author of each of the articles are summarized by city and province in Table 4. Nearly 90% of the publications originated in Ontario, Quebec, British Columbia and Alberta. The skewed distribution of publication is related to the top three cities being Toronto (21.0%), Montreal (16.0%) and Ottawa (11.8%). These three cities, which contain 31% of the total population, produced nearly 50% of the research publications. Location of principal author of 262 research articles on Canadian paediatrics published in 2003 Location of principal author of 262 research articles on Canadian paediatrics published in 2003 Sixty-three articles focused on adolescent health issues (Table 5). The combined proportion for substance abuse, drinking and smoking accounted for 34.9% of topics, followed by mental health (25.4%), exercise (11.1%) and accidents (7.9%). Only three articles were on adolescent suicide. Twenty-eight research articles were published on adolescent suicide between 1994 and 2003; therefore, in spite of the epidemic nature of the problem, the number of research publications has been small. Topics involving adolescents in 63 research articles on Canadian paediatrics published in 2003 Topics involving adolescents in 63 research articles on Canadian paediatrics published in 2003 Twenty articles (5.4% of total) focused on paediatric issues among First Nations children (Table 6). Pollution (lead, mercury, polychlorinated biphenyls and indoor smoke) and infectious diseases were the leading topics, each with 35%. Three articles on immigrant children were on the epidemiology of aplastic anemia in children of Asian descent, health status and mental health of survivors of violence. Topics involving First Nations and Immigrant children in research articles on Canadian paediatrics published in 2003 Topics involving First Nations and Immigrant children in research articles on Canadian paediatrics published in 2003 In summary, the geographic analysis of publications demonstrated a skewed distribution with nearly half of the articles originating from three cities in central Canada: Toronto (21.0%), Montreal (16.0%) and Ottawa (11.8%). The causes of the apparent skewed distribution are beyond the scope of this article, but may represent the size and number of medical schools, distribution of research resources and the total population base in each area. The ease of reviewing selected publications by means of internet access to PubMed makes it possible to analyze the state of research in paediatrics and can indicate not only what are regarded as important issues but also reveal topics that are unduly neglected. Reviews such as this may become an important tool in assessing the state of paediatric research in Canada.

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