Public health and epidemiology journals published in Brazil and other Portuguese speaking countries

It is well known that papers written in languages other than English have a great risk of being ignored simply because these languages are not accessible to the international scientific community. The objective of this paper is to facilitate the access to the public health and epidemiology literature available in Portuguese speaking countries. It was found that it is particularly concentrated in Brazil, with some few examples in Portugal and none in other Portuguese speaking countries. This literature is predominantly written in Portuguese, but also in other languages such as English or Spanish. The paper describes the several journals, as well as the bibliographic databases that index these journals and how to access them. Most journals provide open-access with direct links in the indexing databases. The importance of this scientific production for the development of epidemiology as a scientific discipline and as a basic discipline for public health practice is discussed. To marginalize these publications has implications for a more balanced knowledge and understanding of the health problems and their determinants at a world-wide level.


Introduction
It is well known that papers written in languages other than English have a great risk of being ignored simply because these languages are not accessible to the international scientific community. This general observation must not be different regarding the epidemiological and public health scientific literature. The objective of this paper is to facilitate the access to the public health and epidemiology literature available in Portuguese speaking countries by present the journals, as well as the bibliographic databases that index these journals and how to access them. It was found that it is particularly concentrated in Brazil with some few examples from Portugal and none in other Portuguese speaking countries.
In Brazil, public health and epidemiological studies gained momentum in the 1970's, with the implementation of the first postgraduate programs in Public Health (or Collective Health, as it called in Brazil). By the end of the decade, the creation of the Brazilian Association of Collective Health (ABRASCO) and the constitution of its epidemiology commission played an important role in the strengthening of this area of knowledge. As of the 1990's, Brazilian Epidemiology Congresses held at triennial intervals opened room to promote the training of teachers and researchers, as well as of healthcare workers.
These facts had an impact on scientific production and, in the period from 1973 to 1992, Brazil already accounted for 60.7% of the papers on public health produced by researchers from Latin America, and published in indexed journals of the database ISI/Thomson Scientific [1]. This fact becomes more relevant when we note that with regard to clinical and biomedical research, the percentage of Brazilian production was 26.6% and 38.7%, respectively.
Currently, Brazil has 39 postgraduate programs in Collective Health, three of which are exclusively in Epidemiology and great part of them include epidemiology. The directory of research groups of the Brazilian National Research Council includes, as per the 2004 census, 506 groups with at least one line of research in epidemiology. The average composition of each group is 6.1 researchers [2].
Research funding in epidemiology is fundamentally raised from national agencies: National Research Council (CNPq), Agency for the Financing of Studies and Projects (FINEP), Department of Science and Technology of the Ministry of Health (DECIT/MS), and state-based research funding agencies in most of the country's 27 States. A small share of projects receives foreign funds from international funding agencies and bodies of the United Nations system. The past years recorded substantial increase of financial resources directed to health research [3].

LILACS-Latin American and Caribbean Literature in Health Sciences
LILACS database is produced in a cooperative manner by the institutions that integrate the ...Latin-American and Caribbean System of Information in Health Sciences. LILACS registers scientific-technical literature in health produced by Latin American and Caribbean authors as of 1982 [4].
The main objectives of this database are bibliographic control and dissemination of Latin American and Caribbean technical and scientific literature in Health, not included in international databases. LILACS describes and indexes theses, books, book chapters, annals of congresses or conferences, technical-scientific reports, journal papers, and other publications related to Health [4].
Access to LILACS database can be obtained through a compact disc LILACS/CD-ROM and also at the Virtual Health Library [5] in the item ...Scientific Literature, with links to sources of complementary information, particularly with a database of full versions of texts and online services that supplies document copies. LILACS/CD-ROM is issued every four months and may be purchased upon subscription by any user or library. LILACS database gathers up to 432,093 documents, 77.8% of which correspond to papers published in journals, 16.1% are monographs, 4.7% are thesis, and 1.4% constitutes what is called "grey literature", because it cannot be found easily through con-ventional channels such as publishers. Approximately 50% of the documents registered in the database are in Spanish and 40% in Portuguese. The rest corresponds to documents in English, French, Italian, and German. Brazilian productions account for 54% of documents and, of these, 68.5% were published inside the country. The remainder Brazilian production is distributed across different Latin American countries, particularly Argentina (4.4%), Mexico (2.2%), and Chile (1.9%) [4]. SciELO portal search system provides queries per journal, author, title, issue, type of research, and access to full text in html or pdf. For journals in its database, SciELO designs and makes available typical bibliometric information, such as impact factor, number of citations, number of accesses, and others.

SciELO -Scientific Electronic Library Online
The Public Health collection only comprises journals indexed in Medline. As of August 2007, the Managing Committee changed the rule, defining that Public Health journals entitled to be included in the collection should publish chiefly papers related to disciplines in the field of Public Health, including health politics, management, and planning, social sciences and public health, health promotion and interventions, and epidemiology.

Epidemiology and public health Brazilian journals
In Brazil, there are approximately 839 scientific journals [8] that can be classified in the different fields of Health Sciences. In the SciELO database, there are 57 Brazilian journals on Health Sciences, being three in Tropical Medicine and eight in Public Health and Epidemiology. In many of the other journals papers of interest to Public health and Epidemiology are also eventually published (Table 1).
Two journals centered on epidemiology are regularly published in Brazil (Revista Brasileira de Epidemiologia and Epidemiologia e Services de Saúde) and 16 other journals on Collective Health, many of which with a large share of papers published on epidemiology. Of these 18 journals, 8 are in the SciELO database, one of which is on epidemiology. Table 2 presents the list of 18 journals on Epidemiology or Collective Health published in Brazil, indicating the indexation bases in which they are found, the language in which papers are published, and their frequency. All have a peer-review process to select the papers they publish. In general, funding for these journals is provided by Brazilian (National or State based) science and technology agencies.
With the exception of Revista de Saúde Pública, all journals publish texts in a single language, most typically Portuguese, followed by English. However, all papers have abstracts in English, in addition to Portuguese. A brief summary of the characteristics of each of these journals is provided in Appendix 1.

Epidemiology and public health journals in Portugal
In Portugal SciELO database makes available for free access papers published by six journals on health sciences, none of them exclusively dedicated to the field of Public Health or specifically to epidemiology (Table 3). A brief summary of the characteristics of some of these journals is provided in Appendix 2. Table 4 presents some scientometric data for the journals in SciELO database [6]. The average number of citations per paper published in the period ranged between 0.52 for the journal História, Ciência, Saúde and 2.87 for the journal Physis. The average half-life of citations was more homogeneous, with values around three years. The length of seven years for the average half-life of citations to papers of the journal Physis, probably is a result of the predominance of theoretical essays in this publication. Although Revista de Saúde Pública publishes predominantly the results empirical research, it also has a length above the average getting to almost 5 years.

Indexation, performance and evaluation of journals
Another interesting piece of information presented in Table 4 is the percentage of citations received originating from papers published by the same journal. In this item, the two journals indexed in JCR are the ones that have the highest proportion of self-citations, corresponding to slightly more than half of the quotes in each journal. The low rate of self-citation of the journal Physis stands out. The proportion of self-citations granted is considerably lower; that is, out of the group of papers cited by the papers published in these journals, a small share corresponds to citations of papers published in the same journal. For any journal this number does not exceed 10 percent. Figure 1 shows the average of citations per paper over the past five years until mid-2007. The number is quite higher than that in Table 4, showing that the trend in recent years has been to increase the average number of citations per paper published. The numbers for 2007 also exceed the average of the period for most journals.   Table 6 presents some data pertaining to statistics produced by SciELO, relative to eight selected journals. Even though each of them was included in the database at dif-ferent times, it is possible to see that all of them are very frequently accessed with downloads of full papers. The number of downloads of the most accessed paper in each of them ranged between 300 and 27,900. A large number of papers received more than 500 downloads in each journal and the number of papers downloaded in full version was expressive in all journals, varying mainly due to the time of inclusion of the Journal in the database [5].

The Internet and Open Access
Teachers, researchers, students and employees of 188 higher education and research institutions throughout Brazil have immediate access to a considerable part of global scientific production updated through CAPES' journal portal, maintained by the government of Brazil at the annual cost of US$ 20 million.  CAPES' journal portal [9] provides free access to full versions of papers of more than 11,419 international, national and foreign journals, and to more than 90 databases with abstracts of documents in all areas of knowledge. It also includes a selection of important sources of academic information with free Internet access. The use of the portal is free for the users from participating institutions, that is, all public, philanthropic or for-profit universities whose graduate programs are credentialed through the three-yearly evaluation of their post-graduation courses. Access is provided through any terminal connected to the Internet located in the institutions or authorized by them [9].
All graduate, research and undergraduate programs of the Country gain in quality, productivity and competitiveness by using the Portal that is in constant development. Between January and June 2007, the number of accesses with request of full versions in the Portal was 7.4 million, which means an average cost of US$ 2.50 per paper.

Discussion
Although English has been increasingly regarded as the lingua franca to communicate in sciences, Brazilian researchers, as it usually happens with researchers of other nationalities whose mother tongue is not English, normally face the dilemma between publishing their work in English, trying to increase their visibility in the international scientific community or publish in the native language seeking to have greater social impact, that is, using the results of their research to solve real local problems. This dilemma is very present in professional and applied areas such as Public Health [12].
Parker [13], analyzing the indexation structure of Latin American and Caribbean health science journals noted  that there are about 1,000 journals in this area in the different countries. Of these, only 690 are indexed in LILACS database, whereas this number goes down to 141 for Sci-ELO's portal. Only 65 can be found in Medline and just 28 in ISI-JCR. In this manner, it is quite clear that looking up less inclusive databases may lead to missing a significant part of the production. Considering that the indexation criteria for journals in LILACS database follow the same standards required by Medline, it is possible to conclude that 90% of the Latin American and Caribbean scientific production does not circulate in the international scientific community, probably due to the language barrier.
Clark and Castro [14] verified the impact that a search in LILACS database could have on the choice of papers for systematic reviews published in five medical journals with the highest impact factor. In 70% of the cases analyzed (62 systematic reviews), the search in LILACS identified new papers that could have been included and which had not been identified by authors.
Another important aspect that results in the exclusion of the literature published in languages other than English is emphasized by Freitas and collaborators [15]. A systematic review about maternal morbidity and mortality searched scientific papers in eleven different databases, and about 20% of the papers included were published in languages other than English [16]. The authors concluded that for this type of systematic review, based on observational studies on the prevalence or incidence of a given health event, the search for evidence in regional databases that index the production of local journals not indexed in Medline is especially relevant.
Previous studies have documented that papers published in languages other than English have a great risk of being ignored, simply because they were written in languages that are not accessible to the international scientific community. However, "authors usually want to attract interest to their work both domestically and internationally" as Meneghini and Packer said [12]. While most Brazilian Epidemiology and Public Health journals accept papers in Spanish and English, in addition to Portuguese, Revista de Saúde Pública has recently adopted the alternative of continuing to publish its papers, in Portuguese Spanish or English in its printed version, but to have for all of them originally published in Portuguese a translation into English in its electronic version. With this measure, the Journal intends to keep its social commitment with disseminating the Brazilian scientific production for healthcare workers in the country without failing to participate, as much as possible, in the international scientific debate.
In short, epidemiological research in Brazil is consolidating itself at the same speed as other scientific fields in the country. It seeks a higher degree of globalization, as it usually happens in other scientific arenas, but without neglecting its commitment with the social practice meant to expand the knowledge on the health situation and its determinants.

Summary
1. In Brazil, scientific production in epidemiology has grown substantially in the past decade. 5. The indexation of the leading Brazilian journals in MedLine has provided a greater degree of globalization of the epidemiological research produced in the country.
6. The social commitment of the community of Brazilian epidemiologists with the improvement of the health of the Brazilian population and the development and enhancement of the National Health System is the cause for a substantial share of the production to continue to be published in Portuguese.

Full text in Portuguese
The full text translation of this paper in Portuguese is provided as Additional File 1.

Abstracts in alternative languages
The abstract of this editorial has been translated into the following languages by the following translators (names in brackets): •