Scientific Performance in Endocrinology and Metabolism

Original Article 149 Turk J Endocrinol Metab. 2020;24:149-162

Scientific Performance in Endocrinology and Metabolism Over the Past 45 Years: A Scientometrics Study in the Middle-East Countries Son 45 Yılda Endokrinoloji ve Metabolizmadaki Bilimsel Performans: Orta Doğu Ülkelerinde Bir Bilimmetri Çalışması

Hadi RAMEZANI, Nahid HASHEMIMADANI*, Zahra EMAMI*, Razieh SHAHROKHIFARID*, Fatemeh GOLGIRI*, Mohammad E. KHAMSEH*

Khoy University of Medical Sciences, Khoy, IRAN *Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, IRAN

Objective: This study aimed to explore the scientific perfor- Amaç: Bu çalışma, Orta Doğu ülkelerinde endokrinoloji ve mance in research of endocrinology and metabolism and its metabolizma araştırmalarındaki bilimsel performansı ve sos- correlation with the socioeconomic indicators in the Middle- yoekonomik göstergeler ile ilişkisini araştırmayı amaçlamış- East countries. Material and Methods: Scientometrics and tır. Gereç ve Yöntemler: Bu çalışmada bilimmetri ve sosyal social network analysis methods were used for this study. Data ağ analiz yöntemleri kullanılmıştır. Veriler; Web of Science, were extracted from the Web of Science, World Bank, and UIS Dünya Bankası ve UNESCO’nun UIS veri merkezinden alın- data center of UNESCO. Results: The majority of scientific mıştır. Bulgular: Bilimsel üretimin çoğu (%79,6) Türkiye, İs- productions (79.6%) were published by authors affiliated with rail ve İran'ı içeren üst-orta ve yüksek gelirli ülkelere bağlı upper-middle and high income countries which includes Tur- yazarlar tarafından yayınlanmıştır. Ortak yazarlık analizine key, Israel, and Iran. From co-authorship analysis, Saudi Ara- göre; merkezîliği en fazla olan Suudi Arabistan, Mısır ve Tür- bia, Egypt, and Turkey with most degree centrality, had the kiye, diğer Orta Doğu ülkeleri ile en yüksek iş birliği oranına highest collaborative ranking with other Middle-East countries. sahiptir. Orta Doğu ile iş birliği yapan ve bu alanda bilimsel The main Middle-East collaborators having scientific outputs in çıktıları olan başlıca araştırmacılar ABD, İngiltere ve Alman- this field were the researchers from the USA, England, and ya'dandır. D i ğer ülkelerle en fazla iş birliği (%63,8) yapan ül- Germany. Israel, Turkey, and Saudi Arabia had the most colla- keler İsrail, Türkiye ve Suudi Arabistan’dır. Ay r ıca küresel boration (63.8%) with other countries. Also, there was a ülkelerle yapılan toplam iş birliği ile atıf sayısı arasında güçlü strong positive correlation between total collaborations with bir pozitif korelasyon vardır. Sonuç: Bilimsel üretimler, atıflar, global countries and the number of citations. Conclusion: Due bilimsel iş birlikleri, araştırma ve geliştirme harcamalarının to the correlation among scientific productions, citations, sci- gayrisafi yurt içi hasılaya oranı ve uzman insan kaynakları entific collaborations, Gross domestic expenditure on research göstergeleri arasındaki korelasyon nedeni ile, ek bütçe ortak and development, and specialist human resources indicators, projeler yürütmek için Orta Doğu ülkelerindeki araştırmalara the supplementary budget should be directed toward research ve küresel ağlar kurmaya yönlendirilmelidir. Böylelikle bilim- in the Middle-East countries and establishing global networks sel üretim eğilimi artabilir, Web of Science’da daha yüksek to conduct joint projects. This could increase the trend of sci- atıflar elde edilebilir ve sonuç olarak bu eğilim bölgede bilim- entific productions and obtain higher citations in the Web of sel, sosyal ve ekonomik kalkınma sağlayabilir. Science, eventually leading to scientific, social as well as economic development in the region.

Keywords: Endocrinology; metabolism; Middle-East countries; Anahtar kelimeler: Endokrinoloji; metabolizma; social network analysis; scientometrics; Orta Doğu ülkeleri; sosyal ağ analizi; socioeconomic indicators; bilimmetri; sosyoekonomik göstergeler; scientific publications bilimsel yayınlar

Address for Correspondence: Zahra Emami, Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences (IUMS), Tehran, IRAN Phone: +98-21-88945435 E-mail: [email protected]

Peer review under responsibility of Turkish Journal of Endocrinology and Metabolism.

Received: 01 Dec 2019 Received in revised form: 19 Apr 2020 Accepted: 29 Apr 2020 Available online: 19 May 2020

This is an open access article under the CC BY-NC-SA license (https://creativecommons.org/licenses/by-nc-sa/4.0/) DOI: 10.25179/tjem.2019-72325 150 Ramezani et al. Turk J Endocrinol Metab Scientific Performance in Endocrinology and Metabolism 2020;24:149-162

Introduction The size, economic, and political issues of a In the field of clinical sciences, endocrinology country, as well as migration and mobility, and metabolism (E&M) have considerable are factors that affect international research significance due to the high prevalence of re- collaboration (9). Moreover, national and in- lated diseases and the subsequent socio-eco- ternational research collaborations depend nomic burden. Endocrinology is a branch of on the government and individual interest, medical science that focuses on hormones scientist motivation, as well as an agree- and deals with the associated disorders ap- ment between institutions. It is also influ- plying multidisciplinary approaches (1). En- enced by similarities in regional conditions, docrine diseases fall into broad categories, lifestyle, and common health problems in including thyroid disorders, pituitary tumors, the countries (10). disorders of bone and calcium homeostasis, Studies have confirmed significant growth in and lipid and carbohydrate disorders. scientific productions on the E&M domain by In particular, among endocrine disorders, di- researchers from ME and the world (3,8,11). abetes mellitus is the most common cause Therefore, it is necessary to employ reliable of hospitalization and death that has integrated indicators to get an overview of reached an epidemic level in most countries the scientific status of a nation or region (5). (2,3). About 38.7 million individuals with di- In this respect, scientometrics is a method abetes live in the Middle-East (ME) and that help health policy-makers. Northern Africa. In 2017, diabetes was the Scientometrics can be applied to evaluate leading cause of death in the ME (4). More- and compare different levels of scientific over, other prevalent endocrine disorders output, including investigators, institutions, are metabolic syndrome, osteoporosis, ad- and countries at the national and interna- renal insufficiency, hyperthyroidism, hy- tional levels (12). One of the quantitative pothyroidism, panhypopituitarism, Cushing’ branches of scientometrics is mapping of syndrome, and acromegaly (1). scientific collaboration, which provides the Science, technology, and innovation (STI) scientific managers and researchers with are the three main components for sustain- objective information on the collaboration ability, adopted as a historical agenda for between researchers (13). Likewise, individ- sustainable development up to 2030 by the ual elements, related elements forming a United Nations General Assembly (5). network, and the interpretation of inter-ele- Moreover, the World Health Organization ment relations are the main components to (WHO), the Council on Health Research for be considered in the mapping of the scien- Development (COHRED) and the Global tific structure (12). Forum on Health Research have empha- Most studies in scientometrics and biblio- sized in order to improve health system metric are based on the number of scientific performance at both national and global publications on E&M and their citations. level, scientists should develop the capacity However, only a few studies deal with the of conducting health research and utilizing co-authorship subject specific to the branch the results (6). From this perspective, pro- of E&M. Thus, conducting comprehensive re- motion in the fields of STI to achieve a high search to evaluate the condition of scientific scientific level ranking globally and to be productions, citations, and the level of col- known as an active contributor to science laborations in the ME countries, as well as is the primary concern of all societies, es- their comparison with socio-economic indi- pecially the developing countries (7). On cators, is essential. The results of this study the other hand, the capability of different could be used to understand further the fa- countries concerning financial research re- vorable perspective and effective policy for sources, scientific research programs, and the management of E&M. utilizing research-generated knowledge dif- fers (8). Hence, scientific collaboration is Material and Methods often used by low- and middle-income This study utilized scientometrics and social countries as an effective way to access the network analysis (SNA) methods to show knowledge and technology of the developed national efforts in research productivity and countries. its correlation with the socio-economic indi-

150 Turk J Endocrinol Metab Ramezani et al. 151 2020;24:149-162 Scientific Performance in Endocrinology and Metabolism cators in E&M among ME countries. Social come. Low income economies were defined network analysts argue that networks oper- as those with a Gross National Income (GNI) ate on many levels, from friends up to the per capita, calculated using the World Bank level of nations (14). Co-authorship is con- Atlas method, of $995 or less in 2017 while sidered as an index for evaluation of scien- lower-middle income economies are those tific collaboration. Co-authorship among with a GNI per capita between $996 and researchers leads to the development of so- $3895. Upper-middle income economies are cial networks. These networks consist of those with a GNI per capita between $3896 network nodes and lines that show the au- and $12055, while high income economies thors and the relations between them, re- are those with a GNI per capita of $12056 or spectively. The nodes allocated specific more (16). places, and the number of links between HistCite software (for bibliographic analysis them are representative of their collabora- of citation linkage) was used to calculate the tion (15). production of documents and citations of the All scientific outputs on E&M from ME coun- countries. The working matrices (net files) tries indexed in the Web of Science database were built with Bibexcel scientometrics soft- (WoS) were included in this study. The most ware, and UCINet and Netdraw SNA soft- appropriate and related keywords were cho- ware were also applied for analysis (degree sen using a list from Medical Subject Head- centrality and ego network metrics) and vi- ings (MeSH) provided by the National sualization of the collaboration networks. Fi- Library of Medicine (NLM)/PubMed. Eleven nally, SPSS software was used to investigate main descriptors of endocrine system dis- the correlation between the research vari- eases (Adrenal Gland Diseases, Diseases of ables. As the studied variables showed a Bone-Endocrine, Diabetes Mellitus, normal distribution using the one-sample Dwarfism or Short Stature, Endocrine Gland Kolmogorov-Smirnov test, Pearson’s corre- Neoplasms, Gonadal Disorders, Parathyroid lation test was applied to evaluate the cor- Diseases, Pituitary Diseases, Autoimmune relation between the variables. The study Polyendocrinopathies, Thyroid Diseases, and adhered strictly to the principles of the Dec- Tuberculosis-Endocrine) were selected for laration of Helsinki, and approval from the the search. Descriptors of Metabolic and local ethics committee was also obtained. Bone Disorders were added separately. Key- words of “Entry Terms” and “see also” re- Results lated to our descriptors were also selected. In 1972, researchers from ME (Israel and Similar descriptors were deleted to avoid Iraq) indexed seven papers on E&M in the duplication. All of the keywords were WoS for the first time. Scientific productions searched from the Title (TI) in the advanced of the ME countries in this field showed an in- search of the WoS. The information re- creasing trend with the highest rate of pro- trieved from WoS were downloaded as files duction (3473 documents) in 2016 (Figure containing 500 documents in the plain text 1). Based on scientometrics criteria, impact format and all were merged for use in maturity time for a scientific document is at HistCite and Bibexcel software. It should be least two years (17). Since studied data have noted that 17 countries from the ME region been collected in December 2018, one can included in the analysis were Bahrain, certainly explain the fact that scientific pro- Cyprus, Egypt, Iran, Iraq, Israel, Jordan, ductions related to the initial years (espe- Kuwait, Lebanon, Oman, Palestine or Gaza, cially 3rd decade) have more opportunity to Qatar, Saudi Arabia, Syrian Arab Republic, receive citations and obviously the number of Turkey, United Arab Emirates, and Yemen. citations has been decreased within the time. World Bank Group and UIS data center of As expected the citations show a decreasing UNESCO were used to retrieve economic, trend in the recent decade and the highest social, and health information of the ME citations received in 2007 (26600 citations) countries as Microsoft Excel files. Categories and 2005 (26216 citations). set by the World Bank were applied to label As indicated in Table 1, Turkey, with 14920 the countries as high income, upper-middle documents, allocated 41.25% of scientific income, lower-middle income, and low in- productions in the ME. Israel and Iran with

151 152 Ramezani et al. Turk J Endocrinol Metab Scientific Performance in Endocrinology and Metabolism 2020;24:149-162

Figure 1: Historical trend of publications and citations on E&M in ME region (45 years).

26.67% and 11.71% scientific outcomes the color and size of nodes represent the achieved the second and third places in the number of countries with scientific collabo- ME, respectively. These countries con- rations among the ME countries. Moreover, tributed to 79.63% of ME scientific produc- the thickness of links indicates the number tions in this field. However, Palestine and of collaborations between authors from dif- Syria place at the bottom of the table due to ferent ME countries. The results demon- the lowest rate of scientific productions 2 strate 1872 scientific collaborations (links) and 51 documents, respectively. among 17 ME countries (nodes) that include Considering the number of citations, Israel the thickest link with 253 collaborations and (239832 citations) achieved the first rank- the thinnest link with one collaboration. Fur- ing, followed by Turkey and Iran. Con- thermore, countries with more scientific col- versely, Palestine and Yemen achieved the laborations are placed in the center of the lowest ranking due to the small number of network while isolated countries with few citations. The fact that Israel (24.86), United collaborations are far from the center. Arab Emirates (UAE) (23.96), and Syria In Table 2, ME countries are ranked based (23.45) received the largest number of cita- on degree centrality in the related network tions per publication indicated that they (Figure 2). “Degree” of a node is a measure present high-quality scientific productions to of local centrality. Moreover, the central the world. node is not necessarily at the center of the Concerning the scientific productions per network physically. A node in a position with gross domestic product (GDP), Israel, with high degree centrality can influence the 88.5 documents per one billion US$, group by withholding or distorting informa- achieved the first ranking, followed by tion during transmissions. Furthermore, Turkey (49.2), and Jordan (30.2). However, nodes with high degree centrality could be Palestine and UAE with 0.3 and 0.5 docu- identified as the informal leaders of the ments per GDP were placed at the bottom group (quoted in 14). Saudi Arabia (416), of the table, respectively. Moreover, Israel, Egypt (366), and Turkey (175) showed the with the average production of 1128.7 doc- highest degree centrality concerning the co- uments per one million people and a high authorships in the ME region (Table 2). life expectancy index (82.4), achieved the “Ego network is a network containing a cen- first ranking followed by Turkey (187.6) and tral node and all the nodes that collaborate Cyprus (153.8). Iran (52.7) was allocated with the central node in a defined time (col- the 9th ranking among the ME countries. laborations between the other nodes are not The collaboration network of ME countries in considered in the ego-network)” (18). In E&M is shown in Figure 2. In this network, this study the number of collaborator coun-

152 Turk J Endocrinol Metab Ramezani et al. 153 2020;24:149-162 Scientific Performance in Endocrinology and Metabolism Current health GDP/one Billion US$ Pop/million Life expectancy nd Development. Current Health Expenditure Per Capita GDP per capita US$ GERD per capita PPP$ expenditure% of GDP GERD% of GDP Categories set by the Comparison of resources and scientific outputs on E&M among ME countries. CountriesTurkeyIsraelIranSaudi Arabia PubEgyptLebanon 14920Kuwait 2582Jordan 9646Qatar % of Pub 4236OmanCyprus 2199 583 Cit 41.25Iraq 566Bahrain 26.67 7.14 129787 336UAE 11.71Yemen 277 239832 % of Cit 28322Syria 205 6.08 180Palestine 42363 1.61 25.69Mean 116 1.56 151 21318Total 12725 47.46 0.93 5.60 65 0.77 56 7094 Cit/Pub 8.38 0.57 5195 51 2 0.5 4.22 4737 2127.7 2.52 0.32 0.42 3323 8.69 36171 2584 1.4 (Mean 1972-2016) 24.86 0.18 2414 1.03 2159 0.15 10.96 0.94 0.14 0.006 10 0.66 1558 … 673 (2016) 0.51 100 9.69 21.82 1196 21 0.48 0.43 29723.59 303 505301 12.53 15.46 0.31 109 0.13 243 (2016) 17.1 0.24 0.0042 16.2 … 14.35 100 196 79.512426 20.81 14.29 22.6 92 8.546000 32.275687 52.1 23.96 12.01 11.1 23.45 10.5 80.277428 41.9 75.755 15.68 23.5 6.006668 95.688681 … 11 82.407 74.561 12.5 83.2 4.052584 9.455802 75.953 131 2.569804 17 79.584 71.484 4.424762 6.65 15 80.62 1.170125 37.202572 74.694 1.425171 74.329 1370.5 78.184 9.269612 77.029 27.584213 4.551566 80.508 18.430453 69.862 76.9 … 422.4436 77.256 64.953 73.473 70.31 … 75.13 CountriesTurkey Int$ (Mean 2000-2015)Israel Pub/PopIran Pub/GDPSaudi ArabiaEgypt (Mean 1972-2016) 410.8378LebanonKuwait (Mean 1996-2016) 1980.766 674.717Jordan 279.1565QatarOman (Mean 2000-2015) 97.36432 569.2503 187.6Cyprus 1128.7 (Mean 1996-2016)Iraq 993.8704 79.9Bahrain 244.3166 49.2 World Bank (2018) 52.7UAE 88.5 1328.722Yemen 10.6 22.9 432.7495 97.1 1553.471Syria 21.6 139.6Palestine 4527.61 701.8577 123.5336 23.9 35.5Mean 25.7 16643.57Total 107.7 10.8 11578.98 1169.068 54.62278 46.3 30.2 3120.82 153.8 Not available 72.44795 6.6 1221.73 5408.64 81.4 4.1 8.7 16.3 96.87756 22114.42 628.6324 1130.192 10686.751 7.01 167.3286 1995.83 2.03 0.44 9.2 1.8 34157.05 2.7 64.9727 14882.27 8860.08 0.5 Not available 3.3 34.75787 126.44 0.3 112.5699 … 3.4 13954.67 4.873 18.3 3463.69 30.74299 7.095 630.9721 4.022 32927.47 783.76 1852.73 110.2947 … 83.59843 6.318 8.295 1156.93 10508.84 4.889 46.71356 2.875 5.207714 0.64 3.89 524.5698 8.515 Not available Not available 0.35 2.285 … Not available Not available 5.962 233.7537 0.46 2.856 income Upper-middle 0.38 income Upper-middle 0.16 3.570 High income 3.187 Not available High income 0.37 income Upper-middle 5.030 3.112 0.49 income Lower-middle 4.051 0.37 0.19 … 4.808 High income income Upper-middle 0.33 0.10 Not available 0.04 High income 0.77 Not available High income High income income Lower-middle 0.61 income Upper-middle Low income High income Low income … High income … … … Table 1. Pub: Publications; Cit: Citations; GDP: Gross Domestic Product; Pop: Population; GERD: Gross Domestic Expenditure on Research a GERD: Gross Domestic Expenditure on Research Population; Pub: Publications; Cit: Citations; GDP: Gross Domestic Product; Pop:

153 154 Ramezani et al. Turk J Endocrinol Metab Scientific Performance in Endocrinology and Metabolism 2020;24:149-162

Figure 2: Co-authorship network of E&M field among the ME countries for the period 1972-2016.

tries (NCC) with each ME countries has been (743), and France (706) are the main col- considered. Regarding the Ego network, laborative countries of the ME countries on Saudi Arabia, Egypt, Turkey, Qatar, Oman, E&M. The strongest scientific link was ob- and Bahrain, each with 15 co-authorship served between Israel and the USA (1733 have the most scientific collaboration with collaborations), Turkey and the USA (601 other ME countries. Also, researchers from collaborations), as well as Israel and Ger- Saudi Arabia and Egypt (253 collaborations), many (403 collaborations) (Table 2). Israel and Turkey (55 collaborations), as We also evaluated the correlation between well as Saudi Arabia and UAE (28 collabora- scientific, economic, and social indicators of tions) are the most important scientific col- the ME countries on E&M. The results laborators. However, Palestine does not (Table 3) showed a significantly positive have any collaboration with other ME coun- correlation between the number of publica- tries (Figure 2, Table 2). tions and the number of citations (r=0.850; As shown in Figure 3, 126 countries from P=0.000), total collaborations with global different parts of the world collaborated with countries (r=0.803; P=0.000), GDP 17 ME countries on E&M. In this network, (r=0.746; P=0.001), GERD% of ME countries are shown in blue and other GDP (r=0.533; P=0.050) and population collaborative countries are shown in red. size (r=0.504; P=0.039). Moreover, the re- The size of the nodes based on degree cen- sults also showed a significantly positive trality is a representative of the international correlation between the number of citations scientific collaborations of the countries. Is- and other indicators, such as total collabo- rael (6523), Turkey (3121), and Saudi Ara- rations with global countries (r=0.980; bia (1890) have the most collaborations with P=0.000), GERD% of GDP (r=0.893; other countries (63.81%). These countries P=0.000) and GERD per capita (r=0.655; located in the center of the network are in P=0.015). Although a positive correlation the neighborhood with developed and was also observed between citations per renowned countries in this field of medical publications with GERD per capita (r=0.692; science. Turkey, Israel, and Saudi Arabia P=0.009) and GERD% of GDP (r=0.546; have 129, 127, and 124 scientific collabora- P=0.044), it showed a significantly negative tions with other countries, respectively. Re- correlation with the population of the ME searchers from the USA (3522), England countries (r=-0.589; P=0.013). There is (1273), Germany (922), Italy (783), Canada also a significant positive correlation be-

154 Turk J Endocrinol Metab Ramezani et al. 155 2020;24:149-162 Scientific Performance in Endocrinology and Metabolism

Table 2. Ranking of ME countries based on their co-authorship with each other and with other countries in the world on E&M research.

TC: Total Collaborations; NCC: Number of Collaborator Countries. tween total collaborations with ME countries tries on E&M during 1972-2016. About 36171 and GDP (r=0.596; P=0.012) and the pop- scientific productions have been indexed in ulation of these countries (r=0.504; the WoS from these countries. This finding is P=0.039). Total collaborations between ME consistent with that of Cavacini (19). More- and global countries also shows a significant over, Zhao et al. (8) indicated an increasing positive correlation with GERD% of GDP growth rate of 1.09 times in the scientific pro- (r=0.900; P=0.000), GERD per capita ductions on E&M worldwide (2010-2014). (r=0.678; P=0.011) and GDP (r=0.501; However, the amount of visibility or citations P=0.040). Besides, the scientific collabora- of these documents has decreased in the tion of ME countries with most countries in world. It can be concluded that despite an in- the world showed a significant association creasing trend in the production of the scien- with the life expectancy index of the ME tific documents in this field in the ME countries (r=0.527; P=0.030). countries, its quality has significantly decreased in the recent decade. This finding is Discussion somewhat similar to the result of a study by The results of this study showed an increas- Emami et al. (12). Turkey with 41.2% of the ing trend in scientific productions in ME coun- documents, is on the top, followed by Israel

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Figure 3: Co-authorship network of collaborative countries with the ME countries in E&M field for the period 1972- 2016. and Iran standing with a significant difference diabetes, indicated that Saudi Arabia and in the second and third places in the ME, re- Egypt have the highest rank while Syria, spectively. Collectively, the scientific produc- Yemen, and Palestine have the lowest rank. tions of these countries consist of 79.6% of Considering the number of received citations, the ME documents on E&M which somewhat the fact that Israel achieved the first rank, is follows Pareto Principles (80/20 rule). This indicative of Israel’s high-quality scientific productivity can be attributed to the popula- production, similar to the ranking of ME coun- tion, national income, or overall scientific ac- tries in different fields of science (19). Similar tivity of a country (20). Other studies suggest to the results of previous studies, Israel that the increasing trend of research outputs achieved the first rank due to the highest re- in the field of medicine in Iran is mainly due ceived citations per document (10,19). More- to the indexing of Iranian journals in interna- over, Cavacini (19) showed that Syria and the tional bibliographic databases. Additionally, UAE achieved the next ranks in this respect the enhancement of the scientific perform- following Israel. On the other hand, the aver- ance of Turkey is due to a several-folds in- age citations per document in this field of crease in the budget allocated by the medical science received by China, Southern government towards research and develop- Korea, and Japan are reported between 19.4 ment (R&D). In addition, Iran and Turkey and 23.8 (3). Only five ME countries received have been successful in the development of more than 19.4 citations per document. De- their universities in the ME (19,21-23). spite a large number of scientific productions, Azizi’s study (11) indicated that Iran Iran and Turkey received the 15th and 17th achieved 18th world ranking in endocrinology ranks, respectively, regarding the number of and placed before Turkey and Israel. Com- citations per document. Moreover, Peykari et paratively, our results compared to the re- al. (10) showed an increasing trend in scien- sults of Azizi (11) showed a 2-level decrease tific productions and citations on diabetes in in the ranking of Iran. Which is consistent Iran compared to ME countries. with results from a previous study Israel achieved the best rank compared to (2,10,13,24). Similarly, Sweileh et al. (20) the other ME countries, followed by Turkey in their study regarding the scientific pro- and Jordan with regard to the GDP, and pub- ductions of ME Arab countries in the field of lished 88.5 documents per one Billion US$.

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Table 3. Pearson’s correlation coefficient between the scientific, economic and social indicators of the ME countries in E&M.

Variables Pub Cit Cit/Pub TC (ME) NCC (ME) TC (G) NCC (G) Pub Correlation 1 0.850** -0.175 0.294 0.221 0.803** 0.424 Sig. 0.000 0.502 0.252 0.393 0.000 0.090 N 17 17 17 17 17 17 17 Cit Correlation 0.850** 1 0.161 0.198 0.177 0.980** 0.391 Sig. 0.000 0.537 0.446 0.496 0.000 0.121 N 17 17 17 17 17 17 17 Cit/Pub Correlation -0.175 0.161 1 -0.289 0.242 0.161 0.246 Sig. 0.502 0.537 0.261 0.350 0.538 0.342 N 17 17 17 17 17 17 17 TC (ME) Correlation 0.294 0.198 -0.289 1 0.409 0.357 0.475 Sig. 0.252 0.446 0.261 0.103 0.160 0.054 N 17 17 17 17 17 17 17 NCC (ME) Correlation 0.221 0.177 0.242 0.409 1 0.248 0.878** Sig. 0.393 0.496 0.350 0.103 0.337 0.000 N 17 17 17 17 17 17 17 TC (G) Correlation 0.803** 0.980** 0.161 0.357 0.248 1 0.466 Sig. 0.000 0.000 0.538 0.160 0.337 0.059 N 17 17 17 17 17 17 17 NCC (G) Correlation 0.424 0.391 0.246 0.475 0.878** 0.466 1 Sig. 0.090 0.121 0.342 0.054 0.000 0.059 N 17 17 17 17 17 17 17 Pop Correlation 0.504* 0.210 -0.589* 0.504* 0.214 0.222 0.280 Sig. 0.039 0.420 0.013 0.039 0.409 0.391 0.277 N 17 17 17 17 17 17 17 Life expectancy Correlation 0.271 0.426 0.407 0.054 0.306 0.454 0.527* Sig. 0.292 0.088 0.105 0.837 0.232 0.067 0.030 N 17 17 17 17 17 17 17 GDP Correlation 0.746** 0.481 -0.365 0.596* 0.331 0.501* 0.480 Sig. 0.001 0.051 0.150 0.012 0.194 0.040 0.051 N 17 17 17 17 17 17 17 GDP per capita Correlation -0.101 0.029 0.398 0.020 0.277 0.062 0.171 Sig. 0.699 0.911 0.113 0.940 0.283 0.813 0.512 N 17 17 17 17 17 17 17 GERD per capita Correlation 0.285 0.655* 0.692** -0.045 -0.033 0.678* 0.249 Sig. 0.345 0.015 0.009 0.885 0.916 0.011 0.412 N 13 13 13 13 13 13 13 GERD % of GDP Correlation 0.533* 0.893** 0.546* 0.041 0.064 0.900** 0.276 Sig. 0.050 0.000 0.044 0.890 0.829 0.000 0.340 N 14 14 14 14 14 14 14 Current Health Correlation 0.166 0.454 0.425 -0.033 0.159 0.482 0.236 Expenditure Per Capita Sig. 0.538 0.077 0.101 0.904 0.556 0.059 0.379 N 16 16 16 16 16 16 16 Current health Correlation 0.231 0.333 0.069 -0.032 -0.135 0.333 0.228 expenditure% of GDP Sig. 0.390 0.207 0.801 0.905 0.618 0.208 0.395 N16161616161616

**. Correlation is significant at the 0.01 level (2-tailed), *. Correlation is significant at the 0.05 level (2-tailed). Pub: Publications; Cit: Citations; TC (ME): Total Collaborations (Middle-East); NCC (ME): Number of Collaborator Countries (Middle-East); TC (G): Total Collaborations (Global); NCC (G): Number of Collaborator Countries (Global); Pop: Population; GDP: Gross Domestic Product; GERD: Gross Domestic Ex- penditure on Research and Development. 157 158 Ramezani et al. Turk J Endocrinol Metab Scientific Performance in Endocrinology and Metabolism 2020;24:149-162

The results showed that the economic and Hassan (9). On the other hand, among the political tensions, war, and poverty are ME countries, Turkey has the most collabora- causes of inadequate allocation of the tions with Israel that may be due to the mu- budget toward R&D in medical sciences in tual relationship between them as a regional some countries such as Palestine, Iraq, strategic ally. Moreover, Turkey is known as Yemen, and Syria, consistent with a study the main scientific collaborator of Iran in the by Cavacini (19). The Israeli researchers al- ME (26). The geographic proximity of Turkey located an average of 3.89% of GDP toward and Iran, the same language and oral com- R&D. Consequently, producing the highest munication as the residents of some number of documents per population and provinces of Iran, the emigration of Iranian promoting the standards of life and index of students for taking of sabbatical in Turkey (or life expectancy in the country. This study vice-versa), and concluding the scientific showed that despite having considerable memorandums between research centers of economic indices involved in research, some two countries have had a considerable effect of the ME countries like UAE, Qatar, and on producing a joint scientific compilation. somewhat Bahrain and Oman did not have The results also showed the collaboration of an appropriate ranking in the field of E&M researchers from ME with 126 countries in similar to that reported by Peykari et al. E&M. Israel, Turkey, and Saudi Arabia had (19). Moreover, Iran achieved 9th place in the most partnerships (63.8%) with other scientific productions in E&M proportion to countries in the world. Moreover, the USA, the population size. However, it is unfavor- England, Germany, Italy, Canada, and able considering the human resource spe- France, the world-leading nations in E&M cialists (10) and allocation of an average of (8), are the most important scientific collab- 0.46% of GDP to R&D. Overall, the results orator of ME countries in this field of medical suggested that most research on E&M in the science. Previous studies also reported the ME are carried out in the upper-middle and robust scientific relationship between these high income countries which are partly in and the ME countries in the field of en- line with that reported by Zhao et al. (8) docrinology (10,13,20,27,28). The most ro- The analysis of collaboration networks of ME bust relationship is reported between the countries based on the degree centrality of USA and Israel as well as Turkey. Israel is a social networks suggested that Saudi Arabia, multinational country, with most of its re- Egypt, and Turkey are at the high rank of co- searchers immigrated from other countries. authorship with other ME countries. It is rep- It is considered the main ally for the USA resentative of the adherence of the above and European countries, which explains the countries to the power-law distribution be- collaboration of scholars in E&M and their cause these three countries have performed native countries. about 51.12% of the collaborations existing Iran has had moderate ranking regarding in the ME countries network. Saudi Arabia, the international collaborations (9), and is in Egypt, Turkey, Qatar, Oman, and Bahrain the 5th place among ME countries. However, have collaborated with most ME countries, Iran has the most robust scientific collabo- which supported the results from Moed’s ration with the USA, England, and Canada, study (25), emphasizing the mediation role consistent with the results of other studies of Saudi Arabia among Islamic countries. Re- (25,28-30). Mansoori believed that the ma- searchers from Saudi Arabia have the most jority of international collaborations with collaboration with Egypt and the UAE. This these three countries is interestingly, al- could be asserted by their membership in the though all the three have had fairly chal- “Gulf Cooperation Council," “League of Arab lenging international relations with Iran over States," “Organization of Islamic Coopera- the last four decades. While the negative tion,” in which cultural, linguistic, and re- impacts that the imposed trade sanctions gional ceremonies, as well as the have had on Iran’s research activities should economic-political relationship between not be overlooked, it seems that interna- them, also facilitate scientific collaboration tional scientific collaborations had been es- among researchers. This finding is consistent tablished and/or maintained regardless of with the results of the study by Sarwar and the political atmosphere (30).

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Pearson’s correlation coefficient=between their well-known collaborators in the collab- scientific, social, and economic indicators re- orative publications. lated to ME countries on E&M indicated that Besides, increased expenditure on R&D UAE and Syria have better performance (GERD% of GDP and GERD per capita indi- compared to Israel, Turkey, and Iran, due to cators) leads to an improvement in the re- the average received citations per publica- search quality (number of citations and tions. Overall, it can be said that the most citations per publication indicators) in the productive ME countries in this field of med- ME countries. This is essential for the pro- ical science have also been the most cited motion of this field of medical science and countries. Previous studies (24,30) also decreasing the load of the related diseases. showed a significant correlation between the A negative correlation between ME countries’ number of scientific documents and the populations and citations per publications in- number of received citations. As previously dicated that an increase in population is as- shown by Meo et al. (22), Zhao et al. (8) sociated with a decrease in the quality of the and Lyu et al. (3), the positive correlation scientific productions as well as the number between the number of publications and in- of received citations. Thus, suggesting that dices such as total collaborations with global in most ME countries, the number of special- countries, GDP, GERD% of GDP and popula- ist scholars is lower in proportion to the num- tion size can be explained by an increase in ber of population. Furthermore, an increase the GDP of ME countries and allocation of a in the general population leads to restriction higher proportion GDP to the R&D (GERD). in research opportunities and a decrease in The correlation between the population size the allocation of research capitation to schol- and scientific productions in ME countries is ars. Thus, the majority of research in highly due to the increase in the number of scholars populated countries is the result of less im- and professional specialists of E&M similar to portant projects published in low Impact fac- that reported by Zhao et al. (2015). Further- tor journals (30). However, highly populated more, similar to the study by Meo et al. (22), ME countries with upper-middle income such our results did not show a significant positive as Iran and Turkey are trying to promote correlation between GDP per capita and re- their scientific ranking in the world through search outcomes. Although our findings differ an increase in the quality of the scientific out- from a study conducted by Lyu et al. (3) for comes by increasing the number of universi- China and South Korea countries regarding ties and research centers. Nevertheless, the lack of correlation between expenditure Israel, a high income country with consider- on health care and the number of publica- able research capitation, is a serious com- tions, it is in-line with that of a Japanese’s petitor of these countries (19,23,25,31). study. It is evident that an increase in the The positive correlation between the eco- number of scholars, as well as the budget of nomic indicators and total collaborations with R&D, will positively affect scientific produc- the ME and the world suggested that the al- tions (3). However, the current study did not location of research budgets toward scientific show any significant correlation between in- diplomacy is essential for such international dicators of current health expenditure per collaboration. The results showed that the capita and current health expenditure% of number of collaborations with ME countries GDP with other indicators in the ME coun- and the number of ME collaborator countries tries. This might be due to over-consumption did not affect scientific productions and the of health budget on care and treatment, thus number of citations. Moreover, like the cur- over-looking R&D in E&M. rent study, Rostami Dovom et al. (13) and A very strong positive correlations between Nasli-Esfahani et al. (28) indicated the ME total collaborations with global countries and scholars do not desire to collaborate with the the number of citations is representative of regional countries but they are interested in the fact that the top ME countries benefit collaboration with the Western Europe and from the ideas and facilities of scholars in northern America countries to increase the other countries through collaboration. They quality and quantity of their scientific pro- increase the total citations of their country ductions. To summarize, with an exception by receiving a large number of citations by for Israel, none of the ME counties could im-

159 160 Ramezani et al. Turk J Endocrinol Metab Scientific Performance in Endocrinology and Metabolism 2020;24:149-162 prove the index of life expectancy by using scientific collaborations of the ME countries their scientific publications and research po- with each other and with other countries tential. The results also suggested that sci- leads to the distribution of the existing re- entific collaboration of the ME countries with sources between low and high income coun- more countries globally and the subsequent tries. As a result, more scientific productions transfer of science from those countries have with high quality could be published. a positive impact on methods of treatment of The results of the present study suggest endocrine diseases and increasing longevity that more collaboration between scholars is of the populations of the ME countries. Simi- needed for regional health promotion. Ac- larly, Moghadami et al. (32) demonstrated a cordingly, we recommend the R&D policy- positive correlation between the scientific makers in the field of E&M in the ME productions in the field of psychiatry and the countries to hold regional and international index of life expectancy in the scientific lead- conferences, encourage the scholars, and fi- ing countries (USA, England, and Germany) nancially support them to attend interna- from the Scopus database. tional conferences. Also, encourage the scholars to take a sabbatical in scientific Conclusion leading countries to achieve a superior posi- Overall, considering the normalization of in- tion in the ranking systems of science. dicators of publications, citations, and collaborations, few ME countries such as Israel, Source of Finance Turkey, Iran, Saudi Arabia, and Egypt com- During this study, no financial or spiritual petitively publish a large number of scientific support was received neither from any phar- productions. Moreover, these countries com- maceutical company that has a direct con- pensate for the defect of other regional coun- nection with the research subject, nor from tries through co-authorship with different a company that provides or produces med- countries in the world to promote the scien- ical instruments and materials which may tific level of ME in the field of E&M. On the negatively affect the evaluation process of other hand, citations of scientific documents this study. in the ME countries, which decreased qualita- tively over time, required the health authori- Conflict of Interest ties to adequately support the researchers to No conflicts of interest between the authors publish high-quality scientific documents in and / or family members of the scientific and international valid journals. In addition, at- medical committee members or members of tempt to familiarize and encourage re- the potential conflicts of interest, counsel- searchers to establish more English specialist journals in the E&M field, possibly in collabo- ing, expertise, working conditions, share ration with the prominent international edito- holding and similar situations in any firm. rial board. Our study showed that the ME countries spend more on R&D with a signifi- Acknowledgements cant volume of research papers published in We do appreciate the staff of the Endocrine WoS indexed journals. As a result, the scien- Research Center at Iran University of Med- tific productions of the scholars in this region ical Sciences (IUMS). will rapidly increase, and the visibility of their research will rise that could provide the schol- Authors’ Contributions ars and researchers with the facilities of col- Idea/Concept: Zahra Emami, Hadi laboration with other countries. Considering Ramezani; Control/Supervision: Mohammad the allocation of a small percentage of the E. Khamseh; Data Collection and/or Pro- budget of ME countries toward R&D in the cessing: Razieh Shahrokhifarid, Fatemeh E&M field, health policy-makers should gather Golgiri; Analysis and/or Interpretation: Hadi networks of the ME scholars in groups and as- Ramezani; Literature Review: Hadi sociations and share the costs and facilities Ramezani; Writing the Article: Nahid by designing joint projects. Consequently, the Hashemimadani, Hadi Ramezani, Zahra researchers of the low income countries will Emami; Critical Review: Mohammad E. be attracted to the networks. Increasing the Khamseh and Zahra Emami.

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