Paediatric research in Canada: 2000–2004

The state of paediatric research in Canada in 2003 was analyzed in Paediatrics & Child Health one year ago (1). Because that analysis was limited to only 262 research articles published in one year, it seemed appropriate to repeat the analysis over a longer time period so that a more comprehensive look at paediatric research with a Canadian flavour or contribution could be obtained. The same method of retrieving research articles as that of the previous report was used (ie, the National Library of Medicine was searched [PubMed at ] for the period from 2000 to 2004). The search parameters were as follows: 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 from January 1, 2000, to December 31, 2004. The completeness of such a search was not evaluated by including other databases or by searching without age limitations. Such searches depend on the accuracy of the National Library of Medicine's data entry. Because of changes in the list of topics, the search for the year 2003 was repeated. Furthermore, by limiting the search to PubMed, research articles published in journals not included in this database, such as Paediatrics & Child Health, were missed. References for each year were retrieved and downloaded into EndNote for MacIntosh, Version 8.00 (Thomson Corporation, USA). A total of 3490 references were retrieved for the period from 2000 to 2004 and the abstracts of the articles were reviewed. Of the total number of articles retrieved, 1206 were research articles involving children and youth 18 years of age or younger that were performed by Canadian investigators (Table 1). Approximately two-thirds of the articles retrieved for each year were excluded from further consideration because they were not research studies (ie, review articles, editorials, letters or commentaries), the subjects were adults rather than children and youth, and/or the authors were not Canadian. The 1206 research articles were analyzed in terms of topics, journals and locations of where the research took place. Research studies involving adolescents, and First Nations and immigrant children and youth were analyzed separately. Results of search of the PubMed database for articles published from January 1, 2000, to December 31, 2004, using the following search terms: ‘Canada’, ‘newborns’, ‘infants’, ‘preschool children’, ‘children’ and ‘adolescents’ Excluded articles: nonresearch articles, such as reviews, editorials, commentaries and letters; articles with adult subjects rather than children and youth; and articles with non-Canadian investigators Results of search of the PubMed database for articles published from January 1, 2000, to December 31, 2004, using the following search terms: ‘Canada’, ‘newborns’, ‘infants’, ‘preschool children’, ‘children’ and ‘adolescents’ Excluded articles: nonresearch articles, such as reviews, editorials, commentaries and letters; articles with adult subjects rather than children and youth; and articles with non-Canadian investigators There was a trend toward an increasing numbers of articles being published each year (ie, from 198 articles in 2000 to a plateau of more than 250 articles/year between 2002 and 2004) (Table 1). Two-thirds of the increase between 2000 to 2001 and 2002 to 2004 was due to an increase in the frequency of publications of approximately 15 (of 115) topics. Neonatology was the subject with the largest increase, with 17 articles/year in the first two years compared with 27 articles/year in the final three years. Other topics that contributed to the increase included program evaluation, pollution, behaviour problems, street youth, laboratory, infant mortality, hospitalization rates, guideline adherence, folate supplements, suicide, dentistry, physician attitudes, eating disorder, surgery, depression, single mother and death. The 1206 articles covered 115 topics (Table 2). The topics listed in Table 2 were derived from the key words in the title and abstract. Infectious disease was the leading topic, accounting for 195 articles (16.2%); immunizations accounted for 48 of the infectious disease articles. Other infectious disease topics included HIV/AIDS (n=18), sexually transmitted diseases (n=8), nosocomial infections (n=9) and tuberculosis (n=9). Other common topics were neonatology (9.6%), accidents (6.6%), pregnancy (5.6%) and mental health (5.5%). Topics relating to health care, including health costs, nursing, quality of life, guideline adherence, patient education and medical errors, accounted for a combined total of 163 articles (13.5%). Certain topics with high media appeal, such as arthritis, pain, antibiotic use, autism, bullying, homosexuality, medical errors, fetal alcohol syndrome and enuresis were striking in their rarity, occurring in one article or less per year. Moreover, except for articles about genetics, microbiology and metabolic disorders, there was a striking shortage of basic science topics. The preponderance of clinical research topics undoubtedly reflects the search method used, rather than a lack of basic science research related to children and youth in Canada. (For example, it may be the case that basic science reports are not specific to a particular age window, which was one of the search parameters of the present article.) Topics covered in 1206 research articles on Canadian paediatrics published between 2000 and 2004 Please note that some articles relate to more than one subject area. ADHD Attention deficit hyperactivity syndrome; CAM Complementary/alternative medicine; ENT Ears, nose and throat; FAS Fetal alcohol syndrome; PICU Paediatric intensive care unit; SARS Severe acute respiratory syndrome; SIDS Sudden infant death syndrome; SES Socioeconomic status; SLE Systemic lupus erythematosus Topics covered in 1206 research articles on Canadian paediatrics published between 2000 and 2004 Please note that some articles relate to more than one subject area. ADHD Attention deficit hyperactivity syndrome; CAM Complementary/alternative medicine; ENT Ears, nose and throat; FAS Fetal alcohol syndrome; PICU Paediatric intensive care unit; SARS Severe acute respiratory syndrome; SIDS Sudden infant death syndrome; SES Socioeconomic status; SLE Systemic lupus erythematosus The research articles were published in 376 different journals, of which 180 (47.9%) were represented by only a single article (Table 3). An additional 141 journals (37.5%) had two to four articles in total, or less than one per year (Table 4). Only 55 journals published five or more articles (Table 5). The eight journals that published three or more articles per year were the Canadian Journal of Public Health, Canadian Medical Association Journal, Pediatrics, Archives of Pediatrics and Adolescent Medicine, Journal of Pediatrics, Canadian Communicable Disease Report, Injury Prevention and Pediatric Infectious Disease Journal. The Canadian Journal of Public Health was the top-ranked journal in each of the five years, with a total of 118 articles. The Canadian Medical Association Journal was a somewhat distant second with 40 articles. Similar to what was seen with the frequency of topics, the journals in which the retrieved articles were published are predominantly clinical rather than basic science journals. The lack of basic science journals suggests that the search method was skewed toward clinical rather than basic research. Journals in which only one research article was published on Canadian paediatrics between 2000 and 2004 Journals in which only one research article was published on Canadian paediatrics between 2000 and 2004 Journals in which two to four research articles on Canadian paediatrics were published between 2000 and 2004 Journals in which two to four research articles on Canadian paediatrics were published between 2000 and 2004 Journals in which five or more research articles on Canadian paediatrics were published between 2000 and 2004 (ie, one or more per year) The statistics for this journal are quite odd, because this reviewer was a contributing author (though not often the lead author) to 10 papers published in Developmental Medicine and Child Neurology during the period from 2000 to 2004. This raises questions about whether the relevant information about the ‘Canadianness’ of authors is, in fact, available in the way that the searches are done Journals in which five or more research articles on Canadian paediatrics were published between 2000 and 2004 (ie, one or more per year) The statistics for this journal are quite odd, because this reviewer was a contributing author (though not often the lead author) to 10 papers published in Developmental Medicine and Child Neurology during the period from 2000 to 2004. This raises questions about whether the relevant information about the ‘Canadianness’ of authors is, in fact, available in the way that the searches are done The locations of the articles are listed by city and province in Table 6. Locations were assigned on the basis of where the research took place. The geographical distribution of publications was quite skewed, with nearly one-half of the articles originating from three cities in central Canada: Toronto (22.1%), Montreal (16.9%) and Ottawa (9.9%). Nevertheless, publications appear from all provinces and the Yukon and from all cities with medical schools. Discussion about the reasons for the apparent skewed distribution are beyond the scope of the present article, but it is probably due to differences across Canada in the size and number of medical schools and academic paediatric departments, the large number of publications from Health Canada and the unequal distribution of research resources. Place of origin of 1206 research articles on Canadian paediatrics Place of origin of 1206 research articles on Canadian paediatrics Nearly one-quarter of the 1206 research articles focused on adolescent health issues (Table 7). Substance abuse, drinking and smoking were discussed in 24.3% of the articles on adolescents, followed by mental health (15.8%, not including suicide), exercise (8.6%), suicide (8.2%), accidents (8.2%), obesity (6.2%) and street youth (5.8%). The cities of origin of the articles on adolescents was quite similar to those of the total sample, with Montreal (22.2%), Toronto (21.2%) and Ottawa (8.9%) accounting for slightly more than one-half of the articles. Topics involving adolescents in 292 research articles on Canadian paediatrics published between 2000 and 2004 Please note that some articles relate to more than one subject area. FAS Fetal alcohol syndrome; ID Infectious disease; SARS Severe acute respiratory syndrome; SES Socioeconomic status Topics involving adolescents in 292 research articles on Canadian paediatrics published between 2000 and 2004 Please note that some articles relate to more than one subject area. FAS Fetal alcohol syndrome; ID Infectious disease; SARS Severe acute respiratory syndrome; SES Socioeconomic status Seventy-one articles (5.9% of total) focused on health issues among First Nations children and youth (Table 8). Infectious disease was the leading topic (22.5%), followed by environmental pollution with lead, mercury and poly-chlorinated biphenyls (21.1%); mental health (11.3%); and neonatology (11.3%). Only two articles addressed suicide. Three-quarters of the articles on First Nations children and youth originated from the following five cities: Montreal (21.1%), Edmonton (16.9%), Quebec City (16.9%), Winnipeg (9.9%) and Saskatoon (8.5%). Topics involving First Nations and immigrant children and youth in research articles on Canadian paediatrics published in 2003 Please note that some articles relate to more than one subject area. CAM Complementary/alternative medicine; FAS Fetal alcohol syndrome; ID Infectious disease; SES Socioeconomic status; SIDS Sudden infant death syndrome; TB Tuberculosis Topics involving First Nations and immigrant children and youth in research articles on Canadian paediatrics published in 2003 Please note that some articles relate to more than one subject area. CAM Complementary/alternative medicine; FAS Fetal alcohol syndrome; ID Infectious disease; SES Socioeconomic status; SIDS Sudden infant death syndrome; TB Tuberculosis This distribution differed from that of the total sample and from the articles on adolescent health, reflecting the distribution of First Nations populations and the interest of investigators in these cities. Thirty-four articles on immigrant children and youth covered a wide range of topics (Table 8). The leading issues were mental health, development, violence, tuberculosis and socioeconomic status, each occurring in about 15% of articles. More than one-half of these articles originated from Montreal and Toronto, the cities with the largest recent immigrant populations. In summary, the geographical analysis of publications demonstrated that although articles appeared from coast to coast, there was a skewed distribution, with nearly one-half of articles originating from three cities in central Canada: Toronto (22.1%), Montreal (16.9%) and Ottawa (9.9%). A very wide range of topics was found in the 1206 articles reporting on paediatric research, with infectious diseases (not surprising, given the nature of paediatrics) ranking first. What was much more surprising than the frequency of publication of topics was the relative neglect of topics that would seem to be of great public interest, such as arthritis, pain management, antibiotic use, autism, bullying, homosexuality, medical errors, fetal alcohol syndrome and enuresis. Less than one article per year was found on any one of these topics. The ease of reviewing selected publications by means of Internet access to PubMed makes it possible to analyze the state of research in paediatrics. Such reviews can indicate not only what are regarded as important issues by researchers 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. Although the five-year period chosen for this review suggested an increase in the annual rate of publication on paediatric topics between 2000 and 2004, a longer time period will be necessary to determine whether this trend continues.

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