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Parkinson's disease in India: An analysis of publications output during 2002-2011
BM Gupta1, Adarsh Bala2
1 National Institute of Science, Technology and Development Studies, New Delhi, India
2 Government Medical College and Hospital, Chandigarh, India
Adarsh Bala
Government Medical College and Hospital, B Block, Level V, Sector 32, Chandigarh
Objectives: This study analyzes the research output of India in Parkinson's disease (PD) during 2002-2011 on several parameters including the growth, rank, and global publications share, citation impact, share of international collaborative papers, contribution of major collaborative partner countries, contribution of various subject-fields, contribution and impact of most productive institutions and authors, media of communication, and characteristics of high-cited papers. Materials and Methods: The Scopus Citation Database has been used to retrieve the data for 10 years (2002-2011) by searching the keywords PD in the combined Title, Abstract, and Keywords fields. Results: Among the top 20 most productive countries in PD, India ranks 16 th (with 458 papers) with a global publication share of 1.47% and an annual average publication growth rate of 26.05% during 2002-2011. Its global publication share has increased over the years, rising from 1.08% during 2002-2006 to 1.74% during 2007-2011. Its citation impact per paper was 5.77 during 2002-2011, which decreased from 8.40 during 2002-2006 to 4.64 during 2007-2011. Its international collaborative publications share was 26.18% during 2002-2011, which marginally increased from 26.17% during 2002-2006 to 26.18% during 2007-2011. Conclusion: It can be concluded that India's research performance in PD is quite good in the global context, despite the low prevalence of PD in the country. However, India needs to intensify its innovative strategies and international collaboration to strengthen its research output, human resources, funds, public-health awareness through local campaigns, and initiatives for the prevention and treatment of PD.
Keywords: India, Parkinson′s disease, publications, scientometrics
Gupta B M, Bala A. Parkinson's disease in India: An analysis of publications output during 2002-2011. Int J Nutr Pharmacol Neurol Dis 2013;3:254-62
Gupta B M, Bala A. Parkinson's disease in India: An analysis of publications output during 2002-2011. Int J Nutr Pharmacol Neurol Dis [serial online] 2013 [cited 2022 Jan 22];3:254-62. Available from: https://www.ijnpnd.com/text.asp?2013/3/3/254/114849
Parkinson's disease (PD) is a degenerative disorder of the central nervous system. It was first described in 1817 by James Parkinson, a British physician who published a paper on what he called "the shaking palsy." In this paper, he set forth the major symptoms of the disease that would later bear his name. PD belongs to a group of conditions called movement disorders. The four main symptoms are tremor or trembling in hands, arms, legs, jaw, or head; rigidity, or stiffness of the limbs and trunk; bradykinesia, or slowness of movement; and postural instability, or impaired balance. These symptoms usually begin gradually and worsen with time. As they become more pronounced, patients may have difficulty in walking, talking, or completing other simple tasks. Not everyone with one or more of these symptoms has PD, as the symptoms sometimes appear in other diseases as well. PD occurs when the nerve cells, or neurons, in an area of the brain known as the substantia nigra die or become impaired. Normally, these neurons produce an important brain chemical known as dopamine. Dopamine is a chemical messenger responsible for transmitting signals between the substantia nigra and the next "relay station" of the brain, the corpus striatum, to produce smooth, purposeful movement. Loss of dopamine results in abnormal nerve firing patterns within the brain that cause impaired movement. Studies have shown that most Parkinson's patients have lost 60-80% or more of the dopamine-producing cells in the substantia nigra by the time the symptoms appear. Recent studies have shown that people with PD also have loss of the nerve endings that produce the neurotransmitter norepinephrine. Norepinephrine, which is closely related to dopamine, is the main chemical messenger of the sympathetic nervous system, the part of the nervous system that controls many automatic functions of the body, such as pulse and blood pressure. The loss of norepinephrine might help explain several of the non-motor features seen in PD, including fatigue and abnormalities of blood pressure regulation. [1]
It is estimated that 6.3 million people suffer from PD worldwide. The World Health Organization gives an "estimated crude prevalence" (the total number of existent cases each year, old and new) of 160 per 100,000, and an estimated incidence (the number of new cases each year) of 16-19 per 100,000. [2]
The incidence of PD varies across the globe. However, this distribution may not be as simple as a geographical or ethnic factor. It is known that the PD is more prevalent in North America and Europe than in Asia and West Africa. [3] However, research has been carried out to know the causes of PD [4],[5] and the use of medicinal plants for its treatment, prevention, and cure. [6]
In China alone, there are more than 1.7 million people with PD. The prevalence of PD per 100,000 of population varies from country to country, with highest in Albania (800) followed by Egypt (557), USA (329-107), Israel (256), Japan (193-76), Germany (183), Spain (170-122), Italy (168-104), Finland (166-120), Bulgaria (164-137), Estonia (152), Australia (146-104), England (139-121), Portugal (135), Cuba (135), Canada (125), China (119-57), Scotland (129), Norway (102), Thailand (95), Sweden (76), New Zealand (76), Nigeria (67), Poland (66), Jordan (59), etc., Its prevalence, however, differs within countries. The prevalence among Bulgarian Gypsies in only one-tenth of that found among Bulgarians. The prevalence in the USA tends to differ according to race, with Hispanics, then Whites, then Asians, then Blacks being more prone. The incident rate at which people with PD are newly diagnosed differs greatly according to the country. The incidence for each country, in which it is known, per 100,000 of population per year was highest in Sweden (22.5-7.9), USA (20.5-13.0), Japan (16.9-10.2), Estonia (16.8), Finland (16.6-14.9), Norway (12.6), England (12), Bulgaria (11.6), Netherlands (11.5), Italy (10.1), Russia (9.0) et al. [7]
The Parsi community in Mumbai has the world's highest incidences of PD where it affects about 328 out of every 100,000 people despite living in a country, India, with one of the world's lowest incidence of PD (70 out of 100,000). [3]
Only few quantitative studies analyzing world PD research literature has been carried out in the past. Li, et al.[8] using data on raw output of papers, citation and keywords from the Web of Science database from 1991 to 1996 studied the global trends of PD research, including its growth in its annual outputs, international collaborations trends, and author keywords analyses. Sorensen and Weedon [9] employed both traditional and innovative scientometric approaches to identify the top 100 PD investigators since 1985 and measured their scientific productivity as well as the citation impact of their contributions to the field. Kostoff [10] examined another route to linking disjoint literatures (shared references) through a process called bibliographic coupling. Two disjoint literatures were selected: PD (neurodegeneration) and Crohn's disease (CD) (autoimmune). Three cases were examined: Matching phrases in records with no shared references; shared references in records with no matching phrases; matching phrases in records with shared references. In addition, the main themes in the body of shared references were examined through grouping techniques to identify the myriad linkages between the two literatures.
No quantitative study analyzing Parkinson's literature focusing on specific countries/regions has been carried out in the past. However, the author has carried out similar studies in the Indian context on other diseases such as diabetes, [11] tuberculosis, [12] malaria, [13] asthma, [14] and AIDS/HIV. [15]
The main objective of this study was to analyze the research output of India in PD in the national and global contexts, as reflected in its publications output during 2002-2011. The study has the following objectives: (i) To study the Indian research output, its growth, rank, and global publications share and citation impact, (ii) to study the patterns of international collaboration and identification of major collaborators, (iii) to study the contribution by sub-fields, (iv) to study the publications productivity and impact of leading institutions and authors of India, and (v) to study the characteristics of high-cited papers.
Methodologies and Source of Data
This study used Scopus International Database ( http://www.scopus.com/search/ ) to extract relevant data on PD in India and other most productive countries for the 10 years (2002-2011). An advanced search strategy involving PD as the keyword was used to search and download data using Title, Abstract, and Keywords fields together, resulting in downloading of 458 records on India related to PD.
For citations data, 3 years, 2 years, 1 year, and 0 year citation windows have been used for computing average citations per paper in PD during 2002-2008, 2009, 2010, and 2011. For example, for papers published in 2002, citation window is 3 years from 2002 to 2005. For papers published in 2009, the citation window is 2 years, i.e. from 2009 to 2011, and for papers published in 2010, the citation window is 1 year, i.e. 2010 to 2011. For identifying India's international collaborative papers (ICP), a separate search strategy was prepared. For analyzing significant institutions, authors, and journals, separate search strategies were developed, which later combined with the main string, lead to the generation of the desired output. For generating high-cited papers, the main string was first run. Then, the tag "citation to" was ticked, to rearrange the entire output in the decreasing order of citations received by each paper with most high-cited papers at the top. Then the high-cited papers were marked and downloaded for analyses.
Global publication share and rank
The global publication share of the top 20 most productive countries in PD varies from 1.12% to 30.76% during 2002-2011. The United States tops the list, with a share of 30.76% during 2002-2011. The UK ranks second (with 9.79% share), followed by Germany (9.39%), Italy (7.03%), Japan (6.79%), China, France, Canada, and Spain (with publications share ranging from 4.64% to 5.14%). The Netherlands, Australia, Sweden, and South Korea rank at 10 th -13 th positions (their global publications share ranging from 2.11% to 2.79%). The countries that fall between 14 th and 20 th positions are Israel, Switzerland, India, Austria, Brazil, Poland, and Belgium with their global publications share ranging from 1.12% to 1.82% [Table 1].
Table 1: Publications output, share, and rank of top 20 countries in Parkinson's disease, 2002-2011
The developed countries showing decrease in their publications share are United States by 1.60%, followed by Japan (1.25%), France (1.02%), Germany (0.37%), Austria (0.26%), UK (0.24%), and Poland (0.12%) from 2002-2006 to 2007-2011. In contrast, the developed countries showing increase in their publications share are Spain (1.09%), Australia (0.72%), Netherlands (0.37%), Italy (0.36%), Sweden (0.30%), Belgium (0.25%), Canada (0.17%), and Switzerland (0.15%) during the same period. On the other hand, all developing countries except Israel have shown rise in their publications share in PD: China by 3.03%, followed by South Korea (1.32%), Brazil (0.83%), and India (0.66%) from 2002-2006 to 2007-2011 [Table 1].
India ranks 16 th among the top 20 most productive countries in PD with its global publications share of 1.47% during 2002-2011. India's global publications share increased from 1.08% to 1.74% from 2002-2006 to 2007-2011 [Table 1].
In terms of citations impact, measured in terms of average citation per paper (ACPP), over a 3-year citation window, the highest, 15.57 was achieved by Austria, followed by Israel (15.45), USA, (15.35), Sweden (15.02), UK (15.00), Canada (14.25), Netherlands (13.80), France (13.66), Switzerland (12.45), Australia (12.20), Italy (12.07), Germany (11.99), Belgium (11.99), Spain (11.02), South Korea (9.67), Japan (9.62), Brazil (6.95), Poland (5.87), India (5.77), and China (4.91).
India's publication output in Parkinson's disease
India's cumulative publication output in PD consists of 458 papers during 2002-2011, with an average number of 45.8 papers per year and an annual average growth rate of 26.05%. The cumulative publications output of India in PD increased from 137 during 2002-2006 to 321 papers during 2007-2011, witnessing a growth of 134.31% [Table 2].
Table 2: Growth and impact of Indian Parkinson's disease publications, 2002-2011
In terms of impact and citation quality, the ACPP registered by India's publication output was 5.77 during 2002-2011. The ACPP of cumulative publications in PD of India has decreased from 8.40 during 2002-2006 to 4.64 during 2007-2011 [Table 2].
International collaboration in India's publication output
The total number of Indian papers involved in international collaboration during 2002-2011 is 97, accounting for 21.18% share in the cumulative publications output of India in PD. India witnessed a marginal increase in the share of its ICP from 21.17% during 2002-2006 to 21.18% during 2007-2011 [Table 3].
Among the major international collaborators (30 countries), nine countries have published two or more collaborative papers with India during 2002-2011 [Table 4]. United States was the major collaborating partner of India during 2002-2011 accounting for 51.55% of collaborative publications, followed by UK (with 13.40% share), Canada (9.28% share), Italy (7.22%), Germany (6.19%), Japan and South Africa (4.12% each), Saudi Arabia (3.09%), and Argentina (2.06%). The collaborating country share has increase in UK by 9.28%, followed by Saudi Arabia (4.41%), Canada (3.39%), Argentina (2.94%), Japan (0.96%), and Italy (0.45%), as against decrease: By 5.17% in USA, followed by South Africa (3.96%) and Germany (1.02%) from 2002 to 2006 to 2007-2011 [Table 4].
Table 3: International collaborative publications share of India in Parkinson's disease, 2002-2011
Table 4: Contribution of major collaborative partners of India in Parkinson's disease during 2002-2011
Indian Parkinson's disease output in context of different subjects
India's publication output in PD during 2002-2011 has been published in context of 7 subjects (as reflected in database classification based on journal subject content), with highest publications output coming from Biochemistry, Genetics, and Molecular Biology (191 papers and 41.70% publications share), followed by Neurosciences (188 papers and 41.05% publications share), Medicine (182 papers and 39.74% publications share), Pharmacology, Toxicology and Pharmaceutics (91 papers and 19.87% publications share), Chemistry (21 papers and 4.59% publications share), Agricultural and Biological Sciences (16 papers and 3.49% publications share) and Immunology and Microbiology (12 papers and 2.62% publications share). On analyzing the quality and citation impact of PD under different subjects, it was found that Immunology and Microbiology had scored the highest impact (7.92 citations per paper), followed by Biochemistry, Genetics, and Microbiology (6.91 citations per paper), Neurosciences (6.70 citations per paper), Pharmacology, Toxicology, and Pharmaceutics (6.12 citations per paper), Agricultural and Biological Sciences (6.00), Medicine (4.85 citations per paper), and Chemistry (2.57 citations per paper) [Table 5].
Table 5: Subject-wise break-up of Indian publications in Parkinson's disease during 2002-2011
Research profile of most productive Indian institutions in Parkinson's disease
The top 15 most productive Indian institutions involved in PD have published eight or more papers each during 2002-2011. The publication profiles of these 15 Indian institutions along with their research output, citations received, and h-index values are presented in [Table 6]. These 15 Indian institutions account for 60.92% (279 papers) of the publications output of India with an average output per institution of 18.6. Four Indian institutions have registered higher publications share than the group average. These are National Institute of Mental Health and Neurosciences, Bangalore with 47 papers during 2002-2011, followed by Indian Institute of Chemical Biology, Kolkata (38 papers), All India Institute of Medical Sciences, New Delhi (36 papers), and Indian Institute of Toxicological Research, Lucknow (35 papers). The ACPP registered by the total papers of these 15 Indian institutions is 5.49 on a 3-year citation window. Six Indian institutions have registered comparatively higher impact than the group average. The highest impact of 9.14 citations per paper was scored by the National Brain Research Centre, Manesar, Gurgaon, followed by the Indian Institute of Chemical Biology, Kolkata (8.16 citations per paper), Central Drug Research Institute, Lucknow (7.60 citations per paper), Jamia Hamdard University, Delhi (7.07 citations per paper), Central Food Technological Research Institute, Mysore (6.75 citations per paper), and the Indian Institute of Toxicological Research, Lucknow (5.80). Measuring the performance of these institutions on the basis of the h-index, seven institutions have achieved a higher h-index value than the group average of 7.53. These are the Indian Institute of Toxicological Research, Lucknow with the h-index of 15, followed by the Indian Institute of Chemical Biology, Kolkata, [13] Central Drug Research Institute, Lucknow, and the National Institute of Mental Health and Neurosciences, Bangalore (11 each), All India Institute of Medical Sciences, New Delhi, [9] National Brain Research Centre, Manesar, Gurgaon, and The Central Food Technological Research Institute, Mysore (eight each) [Table 6].
Table 6: Productivity and impact of top 15 Indian institutions in Parkinson's disease research, 2002-2011
Contributions and impact of most productive authors in Indian Parkinson's disease
Fifteen authors have been identified as productive authors who have published seven or more papers in PD. These 15 authors together contributed 202 papers with an average of 13.47 papers per author and account for 44.10% of the publications output of India during 2002-2011. Three authors have published higher number of papers than the group average (13.47). These are: M. Behari and K.P. Mohankumar (29 papers each) and U.B. Muthane (22 papers). Considering the quality/impact of papers, these productive authors have received a total of 1398 citations for 202 papers with an average of 6.92 citations per paper. Seven authors have registered higher impact than the average. These are: K.S. Saravanan with ACPP of 13.23, followed by V. Ravindranath (12.44), F. Islam (11.36), A.K. Agarwal (10.83), K.P. Mohankumar (10.28), M.M.S. Bharath (9.63), and M.P. Singh (8.0). Measuring the performance of these authors on the basis of h-index, seven authors have achieved a higher h-index value than the group average of 6.53. These are K.P. Mohankumar, [13] followed by M. Behari and A.K. Agarwal (10 each), K.S. Saravanan, [8] U.B. Muthane, [7] M.P. Singh, and F. Islam (seven each) [Table 7].
Table 7: Productivity and impact of 15 most productive Indian authors in Parkinson's disease, 2002-2011
Patterns of research communication
The 15 most productive Indian and foreign journals publishing Indian research papers together contributed 141 papers in PD, which accounts for 30.79% of the total output of India during 2002-2011. The cumulative publications share of these 15 most productive journals showed a decrease in India's publications output from 45.99% during 2002-2006 to 24.30% during 2007-2011 [Table 8].
Table 8: List of most productive journals publishing Indian papers in Parkinson's disease, 2002-2011
High-cited papers
India has published 17 high-cited papers in PD research in last 10 years (2002-2011) and these have received from 51 to 128 citations per paper. Of these 17 high-cited papers, 11 appeared as articles and 6 as review papers. Of these 17 papers, 6 were international collaborative (6 bilateral), 2 were national collaborative, and remaining 9 have no collaboration. Of the ICP, Indian institutions were first author in 16 papers and foreign authors in 1 paper. In overall, Indian participation in these 17 papers was from 12 institutions including 3 papers each from All India Institute of Medical Sciences, New Delhi and Jamia Hamdard University, New Delhi, 2 papers from Indian Institute of Chemical Biology, Calcutta, and 1 paper each from nine other institutions. These 17 papers appeared in 14 journals including 3 papers in Movement Disorders and 2 papers in the Journal of Neurochemistry and 1 paper each in 12 other journals [Table 9].
Table 9: High-cited papers in Parkinson's disease research during 2002-2011
Summary and Discussion
Indian scientists together have published 458 papers on PD during 2002-2011. India ranked 16 th among the top 20 countries with PD, with a share of 1.47% during 2002-2011. India has witnessed increase in its global publications share, from 1.08% during in 2002-2006 to 1.74% during 2007-2011. It witnessed an annual average publication growth rate of 26.05% and registered an average of 5.77 citations per paper during 2002-2011, which has decreased from 8.40 during 2002-2006 to 4.64 during 2007-2011. International collaboration of India in PD accounts for 21.18% share during 2002-2011, which has marginally increased from 21.17% during 2002-2006 to 21.18% during 2007-2011. USA is India's major collaborative partner during 2002-2011 with a share of 51.55%, followed by UK (with 13.40% share), Canada (9.28%), Italy (7.22% share), Germany (6.19% share), Japan and South Africa (4.12% each), Saudi Arabia (3.09%), and Argentina (2.06%). The collaborating country share has increase in UK by 9.28%, followed by Saudi Arabia (4.41%), Canada (3.39%), Argentina (2.94%), Japan (0.96%), and Italy (0.45%), as against decrease: by 5.17% in USA, followed by South Africa (3.96%) and Germany (1.02%) from 2002-2006 to 2007-2011.
The distribution of Indian PD under different subjects shows that the highest research output (191 papers) comes from Biochemistry, Genetics, and Molecular Biology with 41.70% publications share and Immunology and Microbiology had scored the highest impact of 7.92 citations per paper during 2002-2011.
The 279 cumulative publications from 15 most productive Indian institutions in PD accounts for 60.92% share in India's total publications output, registered an average impact of 5.49 citations per paper and an average h-index value of 7.67 during 2002-2011. The 15 most productive Indian authors on PD together contributed 202 papers, which accounted for 44.10% publications share and registered an average impact of 6.92 citations per paper and an average h-index of 6.53 per author during 2002-2011. The 15 most productive journals publishing Indian research papers in PD together accounts for 30.79% (141 papers) share of the total output of India during 2002-2011, which decreased from 45.99% during 2002-2006 to 24.30% during 2007-2011.
Despite the low prevalence of PD in India (except the high prevalence found in the small Parsi community in Mumbai), the country's research performance in this neurological disorder is quite good in the global context. However, the country needs to intensify the quality and quantity of its research in PD carried out by different organizations including government institutions, government-supported research laboratories, and as a part of R and D programs of pharmaceutical industry with international collaboration. Although millions are invested every year in the country in different areas of research, significant funds should be assigned for research in PD with proper supervision and clearly defined goals. To provide the comprehensive knowledge, information, and the best standard of care for this disorder, comprehensive management programs, various campaigns related to awareness, and education among people should be launched by the government. Besides this, innovative strategies and policies should be formulated to strengthen the neurological care within the existing health systems.
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Gupta B M
Bala A
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