Abstract
Introduction: Borders do not only mean the existence of limits, but also of barriers. For example, despite the cultural and geographic proximity, there seems to be a considerable lack of awareness and ignorance among Portuguese and Spanish GP's of their Iberian neighbour's scientific production, particularly among the Spanish side, which is biased towards the work and publications of authors from Anglo-Saxon and Northern European countries. Methods: The authors thus carried out an analysis of the last 12 issues of both the Portuguese and Spanish General Practice flagship journals, counting back from the last issue of 2008. Results: The authors found out that only 3% of the citations in the Portuguese journal were from Spanish authors, and there were no citations of Portuguese authors in the Spanish journal.
Conclusion: These results highlight an important and common problem in Europe, namely the lack of awareness of the primary care reality in two neighbouring European countries, which results in low levels of scientific exchange, and few joint meetings and publications.
Introduction
Borders do not only mean the existence of limits, but also of barriers. When Spanish and Portuguese general practitioners (GP) work together on projects, they soon realize that they do not know each other as researchers and that they ignore most, if not all, of their partner's scientific production. In June 2009, one of the authors (JG) started an e-mail discussion with a few colleagues (which included GP's and GP trainees from Spain and from Portugal) about the apparent conceptual and scientific barriers between GP's in Spain and Portugal. JG mentioned that some years ago, a couple of Spanish colleagues performed a study where they looked at the number of citations of Spanish articles in Portuguese GP journals and vice-versa. They realized that both Portuguese and Spanish authors often cited American and British authors, but they never cited each other. The study was never published, and JG suggested that a group of colleagues take the initiative and repeat the study, as he considered the situation had not changed over the years.
Our hypotheses were that, (Citation1) both Portuguese and Spanish GP seem to be unaware of their colleagues' publications in the neighbouring country, and that can be tested taking into account the citation rates of each other; and that (Citation2) Portuguese GP cite Spanish authors more often than Spanish authors cite Portuguese authors, leading to the impression that in general, Spain is more important for Portugal than the opposite.
It is relevant to test these hypotheses because the problem might be general and important, at least in Europe, which has many borders that could be in fact barriers. In the case study, both Portuguese and Spanish GP's are aware that their respective flagship journals of Primary Care/General Practice publish good quality manuscripts that should be known by colleagues of other countries, especially by neighbouring GP's that share a common historical, cultural, social and scientific background.
Methods
To test our hypotheses, we carried out an analysis of the citation of both Portuguese and Spanish authors in the Spanish General Practice flagship journal Atención Primaria and in the Portuguese General Practice flagship journal Revista Portuguesa de Clínica Geral, the two main general practice journals in both countries. Both journals are peer-reviewed, even though only Atención Primaria is indexed on Pubmed (the Revista Portuguesa de Clínica Geral is currently just indexed on Scielo Portugal, a Portuguese language database). We analysed all the last 12 issues of both journals counting back from the last issue of 2008. This implied all 12 issues of the year 2008 in Atención Primaria, and all the issues from 2007 and 2008 from the Revista Portuguesa de Clínica Geral, since it is not a monthly journal like its Spanish counterpart.
Results
In the years of 2007 and 2008, 225 articles were published in the Revista Portuguesa de Clínica Geral. Of those, 23 are research articles and 202 are other types of articles. We counted 2,911 bibliographic citations, of which 516 belonged to research articles and 2,395 to other types of articles. The total number of Spanish citations in the Revista Portuguesa de Clínica Geral was 91 (3.1%). The total number of Spanish citations in research articles was 25 (4.8%), while the total number of Spanish citations in other types of articles was 66 (2.8%).
For comparison purposes, the number of Portuguese citations in the 23 research articles published in the Revista Portuguesa de Clínica Geral was 139, which corresponds to a citation rate of approximately 27% (139 out of 516).
In 2008, Atención Primaria published a total of 201 articles. Of those, 51 are research articles and 160 other types of articles. In total, we found 2,135 citations, of which 1,246 belonged to research articles and 889 to other types of articles. We did not find any citations of articles written by Portuguese authors. As such, the Spanish citation rate from Revista Portuguesa de Clínica Geral was 3.1% and the Portuguese citation rate from Atención Primaria was 0%. For comparison purposes, the number of Spanish citations in the 51 research articles published in Atención Primaria was 447, which corresponds to a citation rate of 36% (447 out of 1246).
In both journals, most research papers refer to ‘specific problem-solving competency,’ according to the EGPRN classification as outlined in the EGPRN Research Agenda (see ) (Citation1). This means papers about the therapeutic process (67% of this rubric in Portugal, 11% in Spain), the diagnostic process (25% of this rubric in Portugal, 19% in Spain) and others (like incidence and prevalence of health problems, medical education and so on).
Table I. Topics of the research papers.
Discussion
These findings illustrate that there is a large mutual ignorance between Portugal and Spain in terms of scientific production in the field of General Practice. This implies that Portuguese and Spanish GP researchers may tend to form a distorted picture of the world literature of General Practice because they will fail to learn about important work and ideas conveyed by authors in the other neighbouring Iberian country. Failing to acknowledge important work developed in the neighbouring country could ultimately impoverish Portuguese and Spanish author's knowledge, skills, professional development, and of course, clinical practice.
Local researchers are well aware of the national production, according to our data about ‘language self-citation’ (27% in Portugal and 36% in Spain), which is in line with a previous study that demonstrated that Portuguese authors publishing in Revista Portuguesa de Clínica Geral cite Portuguese papers in 23% of total citations in research papers, and 18% in all papers (Citation2).
In some way the situation is ironic, as even the Portuguese speaking authors from Brazil have more presence in the Spanish journal Atención Primaria (we found 34 citations in nine articles, divided equitably among research articles and the others). Of course, the main body of citations are from Anglo-Saxon countries in Revista Portuguesa de Clínica Geral, and from Spain and Anglo-Saxon countries in Atención Primaria (data not shown).
Our hypothesis of mutual ignorance would be easy to explain if few people in Portugal and Spain bothered to publish. However, the scientific production in Spain in primary care today is highly prolific. There are several indexed Spanish journals having good impact factors. Spain also has one of the best primary health care systems in Europe (Citation3,Citation4).
Portugal is currently undergoing a massive overhaul of primary health care, and although the main general practice journal is not indexed, there are a lot of quality articles that would surely be of great interest to the scientific community of the neighbouring country (Citation5).
One possible explanation for this mutual ignorance is a considerable lack of awareness of the primary care reality in the neighbouring country, which results in low levels of scientific exchange, and few joint meetings and publications. For example, few Portuguese and Spanish GP trainees and GP's seem to be aware of how vocational training is organized in the neighbouring country (personal observation).
This lack of awareness reveals the lack of curiosity and conscious and unconscious interest in the reality of the neighbouring country. Few Portuguese physicians, even though they are perfectly capable of reading articles written in Spanish, seem to look for Spanish articles even when carrying out bibliographic searches in Pubmed or in other databases, and tend to use filters simply to find articles in English (personal experience).
Few Portuguese GP trainees and GP's are members of the Spanish Society of General Practice (SEMFYC) and take advantage of the impressive educational resources of this organization, like publications, workshops and congresses. The same happens to the Spanish participation in the activities of the Portuguese Association of General Practice (APMCG).
Just like it was previously mentioned, Revista Portuguesa de Clínica Geral is not indexed. Therefore, Pubmed searches, even by choosing the Portuguese language, do not retrieve quality material published in Portugal pertaining to primary care, which further contributes to this ignorance.
We must recognize that the concept of neighbouring country does not necessarily apply universally, but is well established between Spain and Portugal (owing to cultural, geographical and linguistic ties), and may apply to some countries in other regions of Europe sharing the same sort of ties.
Implications
We consider that our results highlight an important and common problem, relevant in Europe where the European Union is still mainly an economic association and where borders have a meaning beyond the mere existence of limits.
Since English is the new ‘Latin,’ and because of the stronger scientific position of the USA (with few borders, and having universities and journals known all around the world) European GP's find it easy to cite and comment publications in English (from Anglo-Saxon countries and others). These give an advantage to the UK and Commonwealth countries and decrease the scientific importance of any other country including Germany, with its strong economic position in the world.
It will be not easy to change the ignorance between GP researchers of neighbouring countries but we hope that our work will be a call for action. In the case of the European Journal of General Practice, we suggest that the journal's reviewers motivate writers to use not only references into English but also national and international references in languages other than English. We, European GP's, belong to a multilingual society, and our publications should reflect it. European GP's should not ignore the scientific production of neighbouring colleagues.
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
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