Liver disorders : A scientometric study of publication outputs from India during 2003-2012

Address for the Correspondence: Dr. B. M.Gupta, National Institute of Science, Technology and Development Studies, New Delhi 110 012, India. E-mail: bmgupta1@gmail.com Objectives: Analyses were done on the Indian publication outputs on liver disorder research during 2003-2012, on several parameters, including contribution and citation impact of the most productive countries, India’s overall contribution, its growth pattern, citation impact, the share of international collaboration, identifi cation of the signifi cant participating countries in India’s international collaboration, contribution and impact of different types of liver disorders, productivity and impact of leading Indian institutions and authors, and pattern of communication of Indian output in most productive journals. Materials and Methods: The Scopus Citation Database has been used to retrieve the data for 10 years (2003-2012) by searching with the keyword ‘liver,’ in the combined Title, Abstract, and


INTRODUCTION
The liver is one of the major metabolizing organs in the human body.It plays a pivotal role in providing important nutrients from the food to the blood.Changes in liver function due to infection or any other associated diseases, causes an imbalance in the above-mentioned functions leading to irreversible severe hepatic diseases/disorders, such as, liver cirrhosis, liver cancer, hepatitis, and the like. [1]][5] One of the most severe and common liver disease is attributed to Hepatitis, which occurs due to infl ammation caused by different types of hepatitis viruses.Hepatitis B and C lead to chronic disease in hundreds of millions of people; they are the most common cause of liver cirrhosis and cancer. [6]s per the World Health Organization (WHO) fact sheet, there are an estimated 1.4 million cases of hepatitis globally every year; [7] two billion people worldwide have been infected, and about 600 000 people die every year due to the consequences of Hepatitis B. [8] About 150 million people are chronically infected, and more than 350 000 people die every year from Hepatitis C-related liver diseases. [9]Every year there are 20 million Hepatitis E infections, over three million acute cases of Hepatitis E, and 70 000 hepatitis E-related deaths. [10]In India, about 250 000 people die of viral hepatitis, [11][12]  cirrhosis, about 20 000 liver cancers may be occurring annually, [13] and the community prevalence of nonalcoholic fatty liver diseases varies from 5 to 28%. [14]cording to the latest WHO data published in April 2011, liver disease deaths in India reached 208 185 or 2.31% of the total deaths.The age-adjusted death rate is 23.59 per 100 000 of the population, which ranks India as twenty-seventh in the world. [15]It is estimated that liver diseases are among the top ten killer diseases in India.Many studies have reported that liver-related diseases like Hepatitis B and Hepatitis C virus could multiply into an epidemic that is greater than HIV.
In India, few non-profi table organizations play a signifi cant role in the prevention and treatment of liver diseases.The Indian Association for Study of the Liver (INASL) [16] fulfi lls the educational and scientifi c needs of many health professionals, as well as, researchers and basic scientists.The National Liver Foundation (NLF) [17] is involved in promoting awareness about preventable hepatic diseases among people suffering from chronic or advanced diseases through various educational and training programs, including seminars, patient support groups, mobilizing funds for providing treatment to patients at considerably subsidized rates, campaigns for promoting organ donation, and other activities such as vaccinating all medical students and paramedical entrants with the Hepatitis B vaccine.The Liver Care Foundation [18] works at the national level with patients, caregivers, and professionals associated with a liver disease.
There are few studies conducted on hepatitis and liver transplantation.Miri, Raoofi , and Heidari [19] evaluated the citation parameters of 104 articles published in the Hepatitis Monthly, in 2010, and covered three databases, including Web of Science, Scopus, and Google Scholar.Carvalho and Araújo [20] made a bibliographic study of the thesis published during 2000-2006, focusing on Hepatitis B, to identify where the studies had been undertaken, their nature, type, and the emphasis of these studies.Trapero, Pérez, Pajares, and Moreno [21] analyzed 1051 scientifi c publications on Hepatitis C virus infection, derived from the Medline database of Spanish hospitals, from 1980-2002.It noticed that the number and impact factor of scientifi c publications on Hepatitis C virus had grown signifi cantly during the last two decades.Bas, Dayangac Yaprak, Yuzer, and Tokat [22] studied the Turkish publications on liver transplantation from 1980 to 2011, as covered by the Science Citation Index (SCI).Ramakrishnan and Babu [23] studied world literature on hepatitis during the period 1984-2003, as covered in three bibliographic databases.It found that 85.17% of the contributions were collaborative in nature, with different degrees of collaborations.However, no specifi c studies have been undertaken in India on liver disorder research.Nevertheless, authors have carried out similar studies on other diseases in the Indian context, such as, tuberculosis, [24] malaria, [25] asthma, [26] measles, [27] and diabetes. [28]

OBJECTIVES
The main objective of this study is to analyze the liver disorder research output in India during 2003-2012.The study has the following objectives: 1. To study the contribution and citation impact of 20 of the most productive countries, 2. To study India's overall contribution, its growth pattern, and citation impact, 3. To study the share of international collaboration in India's overall research output and the identifi cation and contribution of leading countries, 4. To study the Indian contribution and impact of different types of liver diseases, liver disorder researches by subfi elds and by different age groups, 5. To study the productivity and impact of leading Indian institutions and authors, and 6.To study the pattern of communication of the Indian output in the most productive journals.

Global publication share and rank
The

International collaboration in India's publication output
The In terms of the h-index, biochemistry, genetics, and molecular biology have achieved the highest h-index of 51, followed by medicine (44), pharmacology, toxicology, and pharmaceutics (35), immunology and microbiology (20), and so on.On the basis of high-cited articles, biochemistry, genetics, and molecular biology depict the highest number of high-cited articles as nine, followed by medicine (fi ve), pharmacology, toxicology, and pharmaceutics (three), and chemistry (one) [Table 4].

Indian research output by different types of liver disorder
Among the various types of liver disorders in India, the largest number of articles was on viral hepatitis (1286 articles, 54.03% publication share), followed by liver cancer (729 articles, 30.63% share), fatty liver disorder (496 articles, 20.84% share), autoimmune   ).Among liver cancer disorders, the maximum emphasis was on liver cell cancer (668 articles), squamous cell carcinoma (80 articles), cholangiocarcinoma and hepatoblastoma (28 articles each), angiosarcoma (11 articles), fi brolamellar carcinoma (six articles) and epithelial hemangioendothelioma (one article).Among autoimmune liver disorders, the largest emphasis was on autoimmune hepatitis (70 articles), followed by primary sclerosing cholanoitis (15 articles), and biliary cirrhosis (fi ve articles).Among genetic liver disorders, the largest emphasis was on Wilson disease (73 articles), followed by glycogen storage disease (30 articles), hemochromatosis (23 articles), tyrosinemia (eight articles) and alpha 1 antitrypsin defi ciency (seven articles) [Table 6].

Lliver disorder research in india by type of population group
In the liver disorder research in India on population by age group, the largest emphasis was on adults (740 articles, 31.09%share), followed by the middle-aged (365 articles, 15.34% share), aged (227 articles, 9.54% share), adolescent (223 articles, 9.37% share), and child (212 articles, 8.91% share) [Table 7].

Research profi le of the most productive indian institutions in liver disorder research in india
The top 15      In conclusion it can be stated that the liver diseases are among the top ten killer diseases in India.Besides, those who suffer from chronic liver problems need recurrent hospitalization and prolonged medical attention.There are millions of cases of hepatic diseases that go unreported.Moreover, increasing poverty coupled with lack of education and awareness prevents people from seeking medical advice until it is too late.In addition, the high cost of treatment causes major obstacles in convincing people about  taking treatment.Control strategies must include development of mass awareness programs, development of universal guidelines for immunization, and hygienic handling of food and water, which can reduce the liver disease burden substantially in our country.
There is a growing need for the government of India to focus on promoting partnerships, mobilizing resources, evidence-based policy, data for action, prevention of transmission, introduction of universal HBV vaccination, free testing and government funding for liver transplantation.Besides this, there is a need to undertake more R and D, develop trained manpower at different levels, and create suffi cient infrastructure to handle the problems associated with liver disorder.
300 000 of International Journal of Medicine and Public Health | Jan-Mar 2014 | Vol 4 | Issue 1 TP = Total articles, TC = Total citations, ACPP = Average citations per article, ICP = International collaborative articles TP = Total articles, TC = Total citations, ACPP = Average citations per article International Journal of Medicine and Public Health | Jan-Mar 2014 | Vol 4 | Issue 1 India ranks twelfth among the top 20 most productive countries in liver disorder research, with its global publication share of 2.19% during 2003-2012.China, South Korea, Taiwan, and Brazil rank second, ninth, tenth, and sixteenth, with global publication shares of 11.67, 3.14, 2.92, and 1.23%, respectively, during 2003-2012.India's global publication share increased from 0.86 to 2.44%, compared to China's, which rose from 8.83 to 13.75%, South Korea from 2.30 to 3.76%, Taiwan from 2.84 to 2.98%, and Brazil from 1.08 to 1.33%, from 2003-2007 to 2008-2012 [Table 1].articles during 2003-2007 to 1526 articles during 2008-2012, witnessing a growth of 78.69%.India's global publication share increased from 1.82% in 2003 to 2.85% in 2012.In terms of impact and citation quality, the average citation per article registered by India's publications was 4.68 during 2003-2012, which decreased from 6.43 during 2003-2007 to 3.71 during 2008-2012 [Table 2].
India's publication output in liver disorder researchThe world cumulative publication output in liver disorder consists of 108 623 articles during 2003-2012, increasing from 7874 articles in 2003 to 13200 articles in 2012, witnessing an annual average growth rate of 5.97%.India's cumulative publication output in liver disorder consists of 2380 articles, accounting for 2.44% of the share in the global publication output, during 2003-2012.It increased from 143 articles in 2003 to 378 articles in 2012, with an average number of articles per year at 238, and an annual average growth rate of 11.92%.The cumulative publication output of India in liver disorder research increased from 854

Table 1 : Publications output, share, and rank of top 20 countries in liver disorder, 2003-2012 Country Number of articles Share of articles 2003-2007 2008-2012 2003-2012 2003-2007 2008-2012 2003-2012
total number of Indian articles on liver disorder involving international collaboration during 2003-2012 was 365, which accounted for a 15.34% share in the cumulative publication output of India in research.The share of India's international collaborative publications increased from 12.65% during 2003-2007 to 16.84% during 2008-2012 [Table 3].

Table 3 : Indian collaboration with different countries in liver disorder, 2003-2012 Collaborating Country Number of international collaborative articles Share of international collaborative articles 2003-2007 2008
International Journal of Medicine and Public Health | Jan-Mar 2014 | Vol 4 | Issue 1

Table 5 : Type of liver disorder research in India, 2003-2012
TP = Total articles, TC = Total citations, ACPP = Average citations per article Research

communication in high productive journals
92%.The average citation impact per article registered by the Indian publications in liver disorders research was 4.68 during 2003-2012, which has decreased from 6.43 during 2003-2007 to 3.71 during 2008-2012.India is ranked in the twelfth position among the top 20 most productive countries in liver disorder research, with

Table 6 : Research output in India under various liver disorders, 2003-2012
Note.There is an overlapping of literature in sub-categories under each type of liver disorder, TP = Total articles

Table 7 : Liver disorder research in india by type of population group, 2003-2012
The international collaborative share of India in the overall liver disorder research was 15.34% during 2003-2012, which increased from 12.65% during 2003-2007 to 16.84% during 2008-2012.Among the international collaborator's, United States was India's major collaborator with 54.79% share of the international collaborative articles.Among the various types of liver diseases in India during 2003-2012, the largest contribution (1286 articles, 54.03% share) was from viral hepatitis and the highest citation impact (5.69 citations per article) was made by fatty liver disorder.The major focus of Indian liver disorder research by population age groups in terms of research output during 2003-2012 was on adults (740 articles, 31.09%share).Among the subfi eld-wise distribution of Indian liver disorder research during 2003-2012, the largest contribution (67.56% share) came from medicine.Immunology and microbiology had scored the highest citation impact (6.22 citations per article), and biochemistry, genetics, and molecular biology had achieved the highest h-index of 51 and maximum high-cited articles (nine).The top 15 most productive Indian institutions involved in liver disorder research have together contributed 38.61% of the share in the cumulative Indian publication output, with an average of 61.26 articles per institution and registered the average citation per article and h-index as 6.17 and 12.4, respectively, during 2003-2012.The 15 most productive Indian authors together contributed 20.13% of the share in the cumulative Indian publication output of India during 2003-2012, with an average of 31.93 articles per author, average citation per article at 9.04, and h-index at 10.47, during 2003-2012.The 15 most productive journals publishing Indian research articles on liver disorder research together account for 18.53% of the share of the total Indian output during 2003-2012, which decreased from 24.82% during 2003-2007 to 15.01% during 2008-2012.