www.jped.com.br
ORIGINAL
ARTICLE
Brazilian
pediatric
research
groups,
lines
of
research,
and
main
areas
of
activity
夽
Priscila
H.A.
Oliveira
a,∗,
Mariana
G.
Pinheiro
a,
Larissa
A.
Isquierdo
a,
Ricardo
Sukiennik
a,
Lucia
C.
Pellanda
a,baUniversidadeFederaldeCiênciasdaSaúdedePortoAlegre(UFCSPA),PortoAlegre,RS,Brazil
bInstitutodeCardiologia,Fundac¸ãoUniversitáriadeCardiologia,PortoAlegre,RS,Brazil
Received2June2014;accepted3September2014 Availableonline26November2014
KEYWORDS
Pediatric; Research; Researchgroups; Researchline
Abstract
Objectives: TheBrazilianscientificproductioninthepediatricsfieldhasbeenincreasing
sig-nificantly.Itisimportanttoidentifythedistributionandactivityofthesegroupsinthecountry
andthemainstudyareas,contributingwithdataforbetterresourceallocationbyinstitutions.
Methods: AnactiveresearchwasconductedintheNationalCouncilofTechnologicaland
Sci-entificDevelopment(ConselhoNacionaldeDesenvolvimentoCientíficoeTecnológico[CNPq])
website, using asfilters the macro area ofthe researchgroup (Health Sciences), thearea
(Medicine), anddescriptorsrelatedto pediatrics.Researchlinesandmainareaofpediatric
researchgroupswereclassifiedaccordingtothesubjectpredominantlystudiedbyeachgroup.
Thescientificproductionoftheleaderofthepediatricresearchgroupbetween2011and2014
wasalsoanalyzed.
Results: MostpediatricresearchgroupsinBrazilhavemorethanfiveyearsofactivityandare
concentrated intheSoutheastand Southregionsofthe country;São Paulo,Rio Grandedo
Sul,andMinasGeraisarethestateswithmostgroups.Ofthe132specificpediatricresearch
groupsanalyzed,14.4%havelinesofresearchinmultipleareasand11.4%inchildand
adoles-centhealth.Amongthe585linesofresearchofthesegroups,themostprevalentareaswere:
oncology,infectiousdiseases,epidemiology,andgastroenterology.
Conclusions: ThepediatricresearchgroupsinBrazilhaverelevantscientificproduction,
includ-ingworkspublishedininternationalpublications,andareconcentratedinregionswithhigher
socioeconomicindex.MostgroupsregisteredinCNPqstartedtheiractivityinthelastfiveyears
(46%),reflectingtherecentgrowthofscientificproductioninthisarea.
©2014SociedadeBrasileiradePediatria.PublishedbyElsevierEditoraLtda.Allrightsreserved.
夽 Pleasecitethisarticleas:OliveiraPH,PinheiroMG,IsquierdoLA,SukiennikR,PellandaLC.Brazilianpediatricresearchgroups,linesof
research,andmainareasofactivity.JPediatr(RioJ).2015;91:299---305.
∗Correspondingauthor.
E-mails:priscilaraujo@hotmail.com,priscilaraujoh@gmail.com(P.H.A.Oliveira).
http://dx.doi.org/10.1016/j.jped.2014.09.002
PALAVRAS-CHAVE
Pediatria; Pesquisa;
Gruposdepesquisa; Linhadepesquisa
GruposelinhasdepesquisapediátricanoBrasilesuasprincipaisáreasdeatuac¸ão
Resumo
Objetivos: Aproduc¸ãocientíficabrasileiranaáreadapediatriavemaumentando
significativa-mente.Diantedestequadro,éimportanteidentificaradistribuic¸ãoeatividadedestesgrupos
nopaíseasprincipaisáreasestudadas,contribuindocomdadosparaqueasinstituic¸õespossam
alocarmelhorseusrecursos.
Métodos: FoirealizadapesquisaativanositedoConselhoNacionaldeDesenvolvimento
Cien-tíficoeTecnológico(CNPq),utilizandocomofiltrosagrandeáreadogrupo-CiênciasdaSaúde,
área---Medicinaedescritoresrelacionadosàpediatria.Posteriormenteforamclassificadasas
lin-hasdepesquisaeáreadeatuac¸ãoprincipaldosgruposdeacordocomostemasprevalentemente
estudados.Avaliou-setambémaproduc¸ãocientíficaentre2011e2014doscoordenadoresdos
gruposdepesquisapediátricapelocurrículoLattes.
Resultados: AmaioriadosgruposdepesquisapediátricadoBrasilpossuimaisdecincoanosde
atividadeeestãoconcentradosnasregiõesSudesteeSuldopaís,sendoSãoPaulo,RioGrande
doSuleMinasGerais,osprincipaisEstados.Dos132gruposespecíficosdepesquisapediátrica
cadastrados,14,4%têmlinhasdepesquisaemmúltiplasárease11,4%emsaúdedacrianc¸ae
doadolescente.Entreas585linhasdepesquisadessesgrupos,sãopredominantesasáreas:
oncologia,infectologia,epidemiologiaegastroenterologia.
Conclusões: OsgruposdepesquisapediátricadoBrasiltêmproduc¸ãorelevante,inclusive
inter-nacional,eestãoconcentradosnasregiõesdemaioríndicesocioeconômico.Grandepartedos
gruposcadastradosnoCNPqentraramematividadenosúltimoscincoanos(46%),evidenciando
crescimentorecentedaproduc¸ãocientíficanestaárea.
©2014SociedadeBrasileiradePediatria.PublicadoporElsevierEditoraLtda.Todososdireitos
reservados.
Introduction
TheevolutionofthescientificproductionvolumeinBrazil in recent years can be easily verified based on indica-tors created to monitor this growth, which has attained internationalrecognition.1,2Thisscenarioisassociatedwith the modernization of research institutions and national funding agencies such as the National Council for Scien-tificandTechnologicalDevelopment(ConselhoNacionalde DesenvolvimentoCientífico e Tecnológico [CNPq]) andthe CoordinationofImprovementofHigherEducationPersonnel (Coordenac¸ãodeAperfeic¸oamentodePessoaldeNível Supe-rior[CAPES]),bothresponsibleforinvestmentsinresearch and post-graduate programs in all 27 Brazilian states, in additiontostateandinstitutionalagencies.3,4
Between 1990 and 2004, Brazilian indexed articles increasedby404%,whereasinthenumberofarticlesrelated topediatricsincreasedby61%,whichconstitutes encourage-mentforthecontinuedgrowthintheareaofpediatrics.5,6 Between1984and2004,therewasa5.6-foldincrease,i.e., more than three times the global increase (1.7-fold). In 2001, Brazil ranked 18th in the global ranking of Science andTechnology.7Particularlyinthefieldsofchildand ado-lescenthealth, thereis agrowingincrease inpublications andcitationsofarticlesfromBrazil.However,therearestill barrierstoconductingstudies in thisage group,a matter thathinderstheformationofnewresearchersandthearea growth.
Inthiscontext,thesystematicevaluationofgroupsand lines of research, researchers, universities, and regions, is an activity that has been relevant for scientists and
administrators.Furthermore,fundingagenciesforscientific production need methods to improve the distribution of resourcesandstrategiesregardingdifferentorgans, allow-ingfortherestructuringofresearchinspecificareasandthe increaseinscientificproductioninBrazil.
Thisstudyaimstodescribethedemographic character-isticsandthetopicsstudiedbymedicalresearchgroupsof BrazilregisteredinCNPqthathavepediatricsastheirarea of activity.This knowledgeis important toidentifyactive areas withgreater growth potential and those that need moreincentiveandfunding.
Methods
This study wasconductedthroughan activesearchin the Brazilian Research Group Directory on the CNPq website betweenthemonthsofMarchandAprilof2013,usingas fil-tersthemacroareaoftheresearchgroup(HealthSciences), and the area (Medicine). The search was also guided by thefollowingdescriptors:pediatrics,child,infantile, child-hood, neonate, adolescence, child’s health, neonatology, newborn, juvenile, young, perinatal, perinatology, fetal, infant,growth,puberty,andpubertal.
Based on the created database, all groups that did not have any line of research related to pediatrics were excluded. Then,a screening wasperformed basedon the titles of the research groups, and a separate table was created for those that did not have keywords related to pediatricsintheirtitles.Therefore,twotablesarecreated: one containing groups with specific pediatrics names and anotherthatincludedgroupswithoutspecificnames.
The linesof pediatricresearchofall groupswere clas-sifiedseparatelyaccordingtotheareaofactivity.Forthis classificationofresearchlines,twofactorsweretakeninto account:first, the nameof the researchgroup; secondly, eachlineofpediatricresearchhaditstitleanalyzedbythe authorsofthepresentstudy,andtheareasofactivitywere determinedthroughkeywordscontainedinit.
Subsequently,themainareasofactivityofthepediatric research groups in the country were classified accord-ing to their main subjects, as reported by the group. Activity areas were classified into large groups to facili-tategraphical analysis.The following areaswere grouped amongpediatricspecialties:cardiology,dermatology, imag-ingdiagnosis,endocrinology,gastroenterology,gynecology, medical genetics, hematology, hepatology, homeopathy, sports medicine, infectious diseases, immunology, critical care, nephrology, fetal medicine, neonatology, ophthal-mology, oncology, otolaryngology, pneumology, psychiatry, rheumatology, neurology, and urology. The broad group of general pediatrics included development and behav-ior, acuteand chronic diseases, child care, and child and adolescent health. The multidisciplinary areas included primary care and collective health, oral diseases, health policies,multipleareas,andnutrition.Other groupscould notbeincludedinanyoftheaforementionedgroups,such as epidemiology, medical education, quality of life, and bioethics.
The‘‘multipleareas’’classificationhadascriterionthe group’s involvement or line of researchin morethan two areas. The ‘‘child and adolescent health’’ classification includedgroupsandlinesofresearchthatwererelatedto differenttopics,suchas:factorsassociatedwithmorbidity andmortalityofchildrenandadolescents;safety;aspects of emotional, physical and intellectual care; and socio-environmental factors. The ‘‘epidemiology’’ classification involved several areas, among them: oncology, pneumol-ogy,infectiousdiseases, cardiology,primarycare,medical genetics, hematology, neonatology, neurology, nutrition, perinatology,psychiatry, andchild and adolescenthealth. Aftertheclassificationofallgroupsandlines,their quanti-tativeanddistributionanalysesinBrazilwereperformed.
To obtain data on the current activity of the selected groups, based on their scientific research production, a reviewoftheLattescurriculumofallgroups’coordinators wasperformedusingspecificnamesof pediatricresearch, assessingproduction indicatorsbetween 2011and2014. A databasewascreatedusingMicrosoftExcel2010containing informationgroupedbystate,informingthetotalnumberof researchersthatcoordinatepediatric researchgroups and thetotalnumberoffull-textmanuscriptspublishedin jour-nalsduringthatperiod.
This study was approved by the Ethics Committee in Research of Fundac¸ão Universitária de Cardiologia of Rio GrandedoSul(UP5011/14).
Results
TheflowchartinFig.1presentsthestudydesign.Atotalof 485groupswereretrievedfromtheCNPqdatabase accord-ingtothe specified criteria. Thesewere dividedinto two subgroups,onecontainingonlythosewithaspecifictitlein pediatricsandtheothercontaininggroupswithoutspecific names.Thelatterwasfurtherrefinedaccordingtoresearch lines,excludingthosewhosesubjectwasnotrelatedto pedi-atrics.
Ageneralanalysisofthegroupsclassifiedasspecificin pediatrics,showingthenumberofgroupsandresearchlines bystate,meannumberofresearcherspergroup,numberof students,timeofactivity,numberofpublicandprivate insti-tutions,andcompletearticlespublishedinindexedjournals isshowninTable1.
Based on the analysis of the Brazilian regions, it was observed that most groups of pediatric research in Brazil havemorethanfiveyearsofactivity(Fig.2)andare con-centratedintheSoutheast(50%)andSouth(27%)regionsof thecountry,withthestatesofSãoPaulo,RioGrandedoSul, andMinasGeraisaccountingformostofthesegroups.
Amongtheresearchgroupswithspecificnamesin pedi-atrics, therewas a predominance of those withpediatric specialty themes (n=73, 56%). Groups included in the ‘‘Others’’category(intowhichtopicssuchasepidemiology, medicaleducation,and bioethics wereallocated) totaled threegroups(2%).Regardingthesub-classificationofthese groups,therewasapredominanceofthoseinvolvedin mul-tipleareas, with14.4%; followed bygroups involved with childandadolescenthealth,with11.4%;5.3%in perinatol-ogy,gastroenterology,neonatology,andoncology;and4.5% incardiologyandneurology.
The distributionof pediatric areas in research lines is showninTable2.In the585researchlinesofgroups with specificnamesofpediatrics,itwasobservedthatthearea of oncology represented8.21% of the lines of this group; infectiousdiseasesrepresented7.35%,andepidemiological research,5.81%.Moreover,subdividingthelineof epidemi-ology,itwasobservedthatthethemeoncologyrepresented 14.7% of these lines, followed by infectious diseases and pneumology,with11.8%each.
Whenanalyzingthe85groupswithoutspecificnamesof pediatrics,atotalof 117 linesof pediatricresearchwere observed:21%comprisedchildandadolescenthealth;18%, fetalmedicine;and14%,endocrinology.
Regardingthescientificactivityoftheresearchgroups, thedata collected fromthe informationcontainedin the Lattescurriculumofthe groupcoordinatorsdemonstrated that,between 2011and April and2014, most researchers remainedactive(Table1).
Discussion
Search for pediatric research groups in Brazil on CNPq electronic database: 585 groups
368 groups eliminated for not having any line of research related to pediatrics
Total of 217 pediatric research groups
85 groups with nonspecific pediatric names
132 groups with specific pediatric names
Total of 117 lines of
pediatric research 585 lines of research
Lattes Curriculum research of leaders of the pediatric
research groups
Classification of the activity areas of the groups and
lines of research
2,331 full-text articles published between 2011 and April of 2014
198 researchers
Figure1 Studydesign.
46%
25%
14%
10%
5%
0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%
Time of activity of the pediatric research groups
0 to 5 years 6 to 10 years 11 to 20 years
21 to 30 years More than 30 years
Figure2 Timeofactivityofthepediatricresearchgroups.
However,asexpected,thesituationofinequality experi-encedbythecountryalsopermeatesthescientificscenario. Scientificresearchinthefieldofpediatricsisstill concen-tratedinareasofhighersocioeconomicindex,inthe South-Southeast regions. It is noteworthy that in the Southeast region,responsiblefor50%ofresearches,approximately25% correspondtothestateofSãoPaulo;andintheSouth(27%), 24%correspondtothestateofRioGrandedoSul.
Thisdistributionreflectspolitical,historical,andsocial determinants that significantly contribute to accentuate
the scenario of inequality in the country, far beyond the observed discrepancies in knowledge production. One of the negative consequences of this imbalance in research production is preciselytheperpetuation of inequalities in thepopulation’shealth,asstrongresearchinstitutionscan have a significant impactonthe communitieswhere they are located. The most extreme example is the neglected diseases,whichreceivefewerresourcesandlessattention from researchers, perpetuating the cycle of unfavorable outcomes.
The study found difficulties to assess the specific sci-entific production of pediatric research groups, as this informationisnotavailableintheCNPqdatabase.However, awaytoindirectlyevaluatethegroupactivitywasto col-lectinformationonthescientificproductionoftheresearch groupleadersthroughtheLattesPlatform.Ofthe2,331 arti-clespublishedinjournalsbetween2011andAprilof2014, 46.80%wereproducedintheStateofSãoPaulo;18.53%,in RioGrandedoSul; and14.58%,in Minas Gerais.The data demonstrate thatthescientificproduction inpediatricsin thecountryfollowstheconcentrationofgroups registered inCNPq,asthelargestnumberofpublicationsinthisperiod occurredintheSoutheastandSouthregions,whichhavethe highest numberofgroups withspecificnames in pediatric research.
Table1 Descriptionofthepediatricresearchgroupsandnumberofpublicationsabytheircoordinators.
Generalanalysisofthespecificgroupsofpediatricresearch
State Groups Linesof
research
Mean
numberof
researchers
pergroup
Mean
numberof
studentsper
group
Mean
numberof
yearsof
activity
Public Institutions
Private Institutions
Full-text articles
publishedin
journals
AL 1 7 12 24 14 1 0 0
AM 1 3 6 25 4 1 0 3
BA 6 38 12.8 7.6 9.3 5 1 75
DF 3 8 8 5 5.3 3 0 23
MA 3 16 20 16.3 10.6 3 0 104
MG 18 82 8 5.6 13.5 17 1 340
MS 1 15 7 4 9 1 0 21
PA 6 9 3.5 1.8 5.1 6 0 4
PB 2 5 5.5 9.5 4.5 2 0 4
PE 6 21 7.8 9.5 8.8 5 1 101
PR 3 25 10 23.3 6.6 3 0 24
RJ 11 53 10.2 8 12.6 11 0 83
RN 1 6 7 13 13 1 0 3
RS 31 142 6.1 6.3 10.4 24 7 432
SC 1 5 5 4 4 0 1 2
SE 1 3 11 9 9 1 0 21
SP 37 147 7.2 8.5 15.6 33 4 1091
Total 132 585 7.8 7.9 11.7 117 15 2331
a Full-textarticlespublishedinjournalsbytheleadersofthepediatricresearchgroupsbetween2011andMarchof2014.
Table2 Numberoflinesofpediatricresearchperareaofactivity.
Numberoflinesofpediatricresearchperareaofactivity
PediatricSpecialties GeneralPediatrics
Cardiology 22 DevelopmentandBehavior 19
Dermatology 13 Acuteandchronicdiseases 9
Imagingdiagnosis 4 Perinatology 21
Endocrinology 21 ChildCare 19
Gastroenterology 33 ChildandAdolescentHealth 30
Gynecology 1
MedicalGenetics 18 TOTAL 98
Hematology 5
Hepatology 3 Multidisciplinary
Homeopathy 1 PrimaryCareandCollectiveHealth 11
Infectology 43 Oraldisease 2
Immunology 18 HealthPolicies 9
SportsMedicine 1 Multipleareas 0
CriticalCareMedicine 8 Nutrition 20
FetalMedicine 21
Nephrology 11 TOTAL 42
Neonatology 23
Neurology 33 Others
Oncology 48 Bioethics 2
Otorhinolaryngology 5 MedicalEducation 3
Ophthalmology 13 Epidemiology 34
Psychiatry 15 Qualityoflife 7
Pneumology 23 TOTAL 46
Rheumatology 15
Urology 1
for research in more than one area, showing a broader involvement. The opposite was observed in the lines of researchthatfocusedononearea;oncologywasthemain topicof mostresearches,8.21%.It isnoteworthythatthe epidemiology classification included cardiology, oncology, infectiousdisease,pneumology,thusleavingtheseareasout ofthestatisticsofspecificareas.
Thestudyalsoverifiedadiscrepancybetweenthemain clinical specialty studied in the pediatric research lines (oncology)andtheapparentmain causeofdeathin child-hood in Brazil, which are conditions originating in the perinatal period (74%), according to Datasus 2011.8 The largeamountofresearchareasinvolvedinoncologycanbe explainedby the fact that this area is increasingly grow-ingandiscloselyrelatedwiththedevelopmentofdrugsand otherdevices,whichalsocontributeattractmorepublicand privateinvestmenttothearea.Theincidenceofneoplastic diseases is increasing, according toestimates of National CancerInstitute(InstitutoNacionaldoCâncer[INCA])and the Ministry of Health; in 2014, Brazil will have approxi-mately576,000newcasesofcancerdiagnosed.9
According todatafromINCA, between 2001 and2005, mortality due to cancer in Brazil was the fourth cause of deathin boys; external causes, ill-defined causes, and causesrelatedtotherespiratorysystemwerethethreemain causes.Ingirls,mortalityfromcancerwasthefifthcauseof death; external causes, causes related to the respiratory system,ill-definedcauses,andinfectious/parasiticdiseases werethefourmaincauses.Intheagegroupsof5-9yearsand 10-14years,neoplasmsarethesecondcauseofdeathamong boysandgirls;externalcausesarethemaincause.Thesame situationoccursforgirlsbetween15-18years.Thisfinding impliesinacorrelationbetweenthisdeathprofileandthe specificorganization of health services,which brings new challengestocancer careandtheBrazilianUnifiedHealth System(SistemaÚnicodeSaúde[SUS]).9
Itisalsoimportanttoobservethattheareasofprimary careandcollectivehealth,with11linesofresearchinthe multidisciplinaryarea(Table2),accountedforarelatively smallinsertionwhencomparedtospecialtiesingeneral.The sametrend was observed in the study ‘‘The medicaland biomedicalresearchinBrazil’’,7withlowerratesofcitation ofthekeywords‘‘collectivehealth’’.These data demon-stratethat the National Health Promotion Policy (Política NacionaldaPromoc¸ãodaSaúde[PNPS]),10whichincludesin itsspecificobjectives(itemI)theincorporationand imple-mentationofactionstopromotehealth,withemphasison primarycare,wasnotreflectedinthepediatricsscientific production.
Moreover, according toDATASUS 2011,8 causes of mor-talityrelated tothe perinatalperiod,respiratory system, andparasiticinfectionsconstitutethemaincausesofdeath inthefirst yearof life,alsoindicating aneed for greater researchinthesespecificareas.
Another point to be analyzed regarding these results is the importance of public institutions for the national scientific production. Public universities constitute the maininstitutionalsupportforresearchandthetrainingof researchersinBrazil.11Thisisduetothefactthat,inBrazil, theuniversitysystemhasdifferentiatedbetweenaprivate systemthatfocusonteachingandapublicsysteminwhich researchisencouraged,evenifitisnotimplementedinall
institutions.12Asshownintheresults(Table1),over85%of thepediatricresearchgroupsinBrazilarelinkedtopublic institutions.Thisalsoreflectsthelackofpartnershipswith privateinstitutionsin thecountry,which couldcontribute totheproductionofknowledge,technologyandinnovation. Currently,investmentsinresearchbyprivatecompaniesin Brazilareveryscarce,astheytendtoconcentrateonpublic universities,whereresearchisalreadyconsolidated.12
Researchintheareaofpediatricsisanessential founda-tionfortheimprovementofchildqualityoflifeandshould, in the long term, contribute tothe prevention of several diseasesinadultsandtheelderly.Despitethegreat impor-tance of this area in future adult health, pediatrics still facessignificant obstaclesduetoseveralethicaldilemmas thatpermeateresearchinthisgroup.Researchersandethics committeeshavetofacethechallengeofensuringthatthe risksofstudies inchildren areminimized. Thereare diffi-culties in the recruitment of children for participation in clinicaltrials,duetothereluctanceofparentsandalsoto thelowprevalenceofcertainclinicalconditionsineachage group.
Thedifficultyinrecruitmentcanalsobeobservedinthe fieldof neonatology, which hasgreat importancein pedi-atricresearch,with23linesofresearch(Table2),buthasa knowndifficultyinperformingrandomizedclinicaltrialsfor thisveryreason.Strategiestoreducethisdifficultyinclude the involvement of parents aspartners andsupporters of these trials, the establishment of research networks, the transformationofthenumberofpatientsrecruitedforthese clinicaltrialsintoaperformanceindicator,andthe distribu-tionofresourcesforhospitalstoincludethesedatatogether withtraditionalindicators.13
Althoughlimitedbytheclassificationcriteriadeveloped bytheauthorstomoreaccuratelydefinetheareasrelated toeachgroupandlinesofpediatricresearch,anddependon theupdateoftheLattesplatformresearchers,thepresent studyisrelevantforfutureresearchandtherestructuringof researchinspecificfields.Moreover,thestudydemonstrated that,whilethereisevidenceofincreasedproductivityand pursuitofBrazilianscientificmaturity,therearestillseveral difficultiestobeaddressed.
Accordingtotheresults obtainedin thepresent study, articlespublishedin thehealth andadolescenceareasare evidenceofascenariothatshouldbecelebrated.However, giventhescarcityofresourcesinrelationtothedemands, whichmakesitdifficulttoconductstudiesinpediatricsand totrainnewresearchers,thepresentresultsmaycontribute tothediscussionabouttheallocationofresourcestoareas ofimpactonthepopulationhealthandattractfundingfrom sourcesotherthanthegovernment.
Conflicts
of
interest
Theauthorsdeclarenoconflictsofinterest.
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