versión impresa ISSN 0716-1018
Rev. chil. infectol. v.22 n.1 Santiago mar. 2005
| Rev Chil Infect 2005; 22 (1): 11-15 |
Regional journals in medicine and public health: A look to the future upon the indexing of the Revista Chilena de Infectología
STEN H. VERMUND, MD, PhD and GUILLERMO ACUÑA, MD
Schools of Public Health and Medicine, University of Alabama at Birmingham, USA (SHV).
Revista Chilena de Infectología has recently been accepted for index listing in the Index Medicus via the MEDLINE data base. This breakthrough prompts reflection on the nature of regionally focused subspecialty journals and what such a listing means for better dissemination of scientific and medical discoveries reported in such journals. There is a conscientious global effort at present to better represent regional journals in indexing systems and to make access easier for persons in less wealthy nations to medical and public health information via the internet. These trends are reviewed and discussed in the context of Chile's national medical and public health literature.
Key words: Medical publishing, Chile, bibliographic indexing, medical journals, public health journals, infectious diseases.
Revista Chilena de Infectología (Chilean Journal of Infectious Diseases) is an excellent example of a journal that has both a regional focus and a subspecialty audience. Similar journals are found worldwide, but a majority of them are not currently indexed in any major computerized internet-based data system such as the Index Medicus whose MEDLINE data base of the National Library of Medicine (National Institutes of Health, Bethesda, Maryland, USA) is accessed free of charge via the PubMed on line system (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi ). As of mid-2004, PubMed included over 15 million citations for biomedical articles, most dating from 1966 and later, but some of them now dating back to the 1950's. PubMed also includes references from other journals from the life science journals. Of special importance to busy doctors, scientists, and other health workers, PubMed provides links to sites that provide the full text of articles for those pioneering journals that have broadened their reach via the internet, such as the British Medical Journal. An exciting recent innovation is Pub Med Central, launched in 2000.This initiative is an electronic archive for selected full text journal articles (http://pubmedcentral. nih.gov/). It is hoped that all the major journals will participate eventually. Some journals provide full on-line publication for a time as does the Infectious Diseases Society of America (IDSA); IDSA makes its journals (Journal of Infectious Diseases and Clinical Infectious Diseases) available free, on-line, after one year after their publication. This satisfies the economic imperative of not creating a disincentive to join the IDSA and also satisfies advertisers. (There is also a very low cost membership to IDSA that includes "real-time" journal subscription on line only for health professionals in developing countries.) The World Health Organization (WHO) has been seeking arrangements with cooperating publishers for on line journal access, with developing countries in mind (http://www.who.int/tdr/kh/res_link.html# journals). Working with WHO to ensure developing country access without compromising their North American or European subscription base is a compromise that many organizations and editors are accepting.
Still, hundreds of journals published worldwide have not been included in MEDLINE, reflecting the large pool of publications in medicine and public health today that remain largely unknown to a global audience. Titles and, for most articles, English language abstracts, are easily accessed through the global internet at no charge only in those journals that are indexed; non-indexed journals remain obscure and uninfluential beyond the boundaries of their constituents. Not surprisingly, inclusion in computerized information databases like MEDLINE or EMBASE increases the utility of the scientific, clinical, or public health reports for a wider audience of users. Inpast time, Chilean journals have had considerable success at joining the well established Revista Medica de Chile in becoming indexed (Table 1).
In discussing the utility of regional publications in general and regional subspecialty journals in particular, there are at least three key issues that may be considered:
There are a limited number of pages available in the highest impact general medical journals such as The Lancet, the New England Journal of Medicine, the Journal of the American Medical Association, or the British Medical Journal.
Hence, the vast pool of biomedical and public health literature appears in one type of subspecialty journal or another. There are a number of higher impact (as judged by the "citation index" or how often an article is referenced by another article) specialty journals, typically in journals of major societies with large subscription bases that cover an entire discipline, e.g, internal medicine. Publications in the United States dominate this second rung list of high impact journals (e.g., Annals of Internal Medicine, Pediatrics, and the American Journal of Obstetrics and Gynecology), almost certainly due to the large number of subscribing physicians and medical libraries in North America and the influence of the huge biomedical research budget from the United States Public Health Service, largely from NIH whose fiscal year 2005 budget is likely to be at least $28.8 billion. If most of the funding for global biomedical research comes from the NIH and goes to US-based investigators, then it is logical that most journal articles will be published in journals that other funded investigators will read. Of course, there is a large pool of European (nearly all the larger nations), Australian, Canadian, Japanese, and middle-income nation investigators (e.g., Brazil, Chile, Thailand, India, Russia, South Africa) that have their own national publication outlets. There are even nations with lower incomes that have a number of vibrant national journals, such as China, or at least one national journal (many, many nations). Regional journals that cover Europe or Southeast Asia, East Africa, Latin America, or others can provide national relevance but with multiple nations participating. These may focus on the region itself (e.g., East African Medical Journal) or may target a specific topic area as well as a specific area (e.g., Southeast Asia Journal of Tropical Medicine and Public Health). One journal, International Health and Tropical Medicine, was created in Europe with an intended global audience, but it subsumed four European-based tropical medicine journals (from Belgium, Britain, Germany, and the Netherlands, with additional participation from Switzerland) that were based in society memberships or were produced from schools of tropical medicine1. Hence, a larger readership was secured for an international journal that replaced national journals with smaller readerships1.
The scientific niche of a regional journal may be many-fold. First, a journal may link together doctors, nurses, public health professionals, or other scientists who wish to communicate locally relevant research, share regional administrative data, and/or communicate in the national tongue (e.g., Revista Medica de Chile, Puerto Rican Journal of Medical Sciences, Southern Medical Journal (focusing on the southern states in the USA), Zambian Medical Journal, Tidsskrift for Den norske laegeforening (from Norway, in Norwegian, typical of many national journals worldwide), and the Brazilian Journal of Medical and Biological Research). It is easy to see how a journal focused on the national medical interests of doctors in Czech Republic, Chile, Vietnam, or a hundred other countries would be useful, independent of any consideration of global impact. Second, a journal may bind together a subspecialty group in a national or regional context. Revista Chilena de Infectología, the family of journals that are the European Journal of [specialty], the Canadian Journal of Public Health, and many others are examples of this genre. Many represent societies and have base constituencies. Third, a journal may meet a specific language need (this overlaps with the above two niches, of course) such that a Thai, Chinese, or Russian journal might be published for those professionals who are not fluent English speakers. The Boletin Panamericano from the Pan American Health Organization publishes original work or reprinted translations for a Latin American audience that needs Spanish-language material, and is the sister journal to the English language Bulletin of the Pan American Health Organization. There should be no doubt that regional journals fill a valuable niche that less specifically focused journals would not accommodate.
Given the utility of regional journals, what is the best way to use them or to reform them?First of all, editors should distinguish news articles from biomedical research or clinical papers, insisting on a peer review system for the latter articles. For example, a regional journal might wish to communicate amongst its members and such a communication would need editorial oversight, but would not require peer review in most cases. However, there are no good reasons to forego peer review for any articles that claim to advance science. The authors and editors alone are not objective or expert enough to judge the merit of such work; each has an incentive for publishing. The objective peer reviewer, qualified in the field, is a complement to editorial expertise in making these judgments. A journal that does not conduct peer review will never been taken seriously in the biomedical arena. Second, a journal that seeks to encompass a particular discipline (e.g., internal medicine, surgery, infectious diseases, nephrology, and public health) should seriously consider a regional focus. For example, the Brazilian Journal of Infectious Diseases publishes in English to enable a wider global impact, presumably, and has been included in the Index Medicus. Revista Chilena de Infectología is published in English and Spanish, is provided on a CD-ROM as well, and based on the 2004 decision to include it in the Index Medicus, will similarly reach a global audience. The dilemma of the National Library of Medicine as it copes with a burgeoning global pool of biomedical journals is to include for indexing those journals that meet a global standard of editorial quality, including rigorous peer review. There may come a day that those indexed journals such as the Brazilian Journal of Infectious Diseases and the Revista Chilena de Infectología might merge as a "Latin American Journal of Infectious Diseases," much as the Scandinavian Journal of [subject] series functions or what the International Health and Tropical Medicine journal did in consolidating national journals in Europe1. Regional journals may make a larger impact, perhaps, than either the Brazilian or the Chilean journals on their own, but cross-national collaboration in medical publishing introduces language challenges and editorial complications, so this idea awaits a future day. In the internet era, publishing in three languages need not be too costly, because the internet could be used for the other two languages not preferred by the authors; for example, an article written in Spanish could be reviewed and published in Spanish, with Portuguese and English translations on the Internet. Fewer journals would be judged a boon by nearly all overwhelmed scientists and clinicians. But loss of regional focus and national specificity would be the negative "trade-off" for this kind of arrangement. Regional consolidation of similar topic journals could achieve goals of language and topic relevance as well as increasing the readership and influence of the journal. Even without consolidation, web sites can be created to enable better access of Latin American literature, as has been done to some extent with the "free medical journals" web site (http://www.freemedicaljournals.com/). A side benefit might be that regional collaborations would be facilitated by the shared editorial and publishing responsibilities.
The global health community does not benefit equally from articles published in various journals. For example, if a health professional is based at a hospital, those journals available by personal or institutional subscription are all that are available; those available on the internet are most immediately useful when internet is readily available. Many more sophisticated libraries can send requests for interlibrary loans for articles that may not be in immediately available journals. Some, but not all, authors will provide reprints upon receipt of a postcard request. Least useful are those journals that are hard to access and whose articles are not available in an on-line service. And if the journal is not indexed, how does someone who does not have access to the journal know that the article of interest even exists? It is our view that regional journals have a vital role to play both regionally and internationally but that indexing be sought after once the journal meets the rigorous peer reviewing standards of the NLM2. An article on Streptococcus agalactiae (Group B streptococcal) disease in Chilean newborns may seem to be of regional interest until a Scandinavian investigator sees a remarkable similarity or difference between her/his own data and that of the Chilean study; a new risk factor is suggested and a new finding is facilitated. This will not occur if the Chilean article is unknown to the Scandinavian researcher. The reverse will not occur since all Scandinavian regional journals are included in the Index Medicus. Hence, Chileans benefit from the global literature but the international community benefits far less from the Chilean literature, a deficit corrected for the Revista Chilena de Infectología thanks to the recent National Library of Medicine decision to index the journal. The NLM has still not managed to index all the articles in relatively small medical journal pool prior to 1966, making older articles similarly elusive, depending on old-fashioned hand searches through Index Medicus annual summary indices. An Elsevier private indexing service (EMBASE; http://www.embase.com/) may expand its European-focused service to include other global journals. The preferred option of expanding the Index Medicus data base is happening now with an explicit effort by the NLM to index more journals through the OLDMEDLINE database that is accessed easily through the NLM Gateway as well as to be more inclusive in journals indexed3,4. The global medical community should attend to the matter -WHO in particular- by continuing to providing advocacy for on-line access, particularly for resource-limited countries. NLM continues to take responsibility for ongoing maintenance of the databases, a huge boon to the global medical, nursing, public health, and biology communities.
There are many articles that we have published over the years in regional journals with the specific goal of reaching a regional audience. Examples include those that published in journals that focus on a particular part of one large country such as the USA5-7, those that have a specific national focus such as Chile or Japan8-19, or those that focus on a particular global region such as southeast Asia or Latin America20-25. It is now gratifying that the impact of the Revista Chilena de Infectología publications will be greater in the future than for non-indexed articles. The global "win-win" would be to regionalize subspecialty journals to include countries of like interest and geographic coherence to increase the legitimacy for indexing. Once indexed and once crossing national borders, the journal's impact will rise with its broadened readership, especially if full articles can be accessed over the Internet. We are convinced that the advent of a Spanish language infectious disease journal listed on the Index Medicus, Med Line, and Pub Med, with additional access to the articles over the internet will improve information access for many physicians, nurses, and scientists in Latin America, the Caribbean, Spain, and even in other countries such as Equatorial Guinea and the USA where many physicians have been trained in Spanish or have Spanish as their mother tongue. The recent index inclusion of the Revista Chilena de Infectología will go a long way towards increasing global access to its valuable contents.
Acknowledgment: We would like to thank the Infectious Diseases Society of America for its written support in securing MEDLINE indexing status for the journal and for its excellent web links page (http://www.idsociety.org/Template.cfm?Section=Related_Links&Template=/ContentManagement/ContentDisplay.cfm&ContentID= 7031).
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Guillermo Acuña L.
Recibido: 10 diciembre 2004