Since its epilepsy awareness month, I wanted to share an interesting study about its connection to autism. According to the abstract:
Autism is more common in people with epilepsy, approximately 20%, and epilepsy is more common in people with autism with reported rates of approximately 20%.
However, these figures are likely to be affected by the current broader criteria for autism spectrum disorder (ASD), which have contributed to an increased prevalence of autism, with the result that the rate for ASD in epilepsy is likely to be higher and the figure for epilepsy in ASD is likely to be lower.
Some evidence suggests that there are two peaks of epilepsy onset in autism, in infancy and adolescence. The rate of autism in epilepsy is much higher in those with intellectual disability. In conditions such as the Landau–Kleffner syndrome and nonconvulsive status epilepticus, the epilepsy itself may present with autistic features. There is no plausible mechanism for autism causing epilepsy, however.
The co-occurrence of autism and epilepsy is almost certainly the result of underlying factors predisposing to both conditions, including both genetic and environmental factors. Conditions such as attention deficit hyperactivity disorder, anxiety and sleep disorders are common in both epilepsy and autism. Epilepsy is generally not a contraindication to treating these conditions with suitable medication, but it is important to take account of relevant drug interactions.
One of the greatest challenges in autism is to determine why early childhood regression occurs in perhaps 25%. Further research should focus on finding the cause for such regression. Whether epilepsy plays a role in the regression of a subgroup of children with autism who lose skills remains to be determined.
Autism is more common in people with epilepsy, approximately 20%, and epilepsy is more common in people with autism with reported rates of a
I put the text in paragraphs so it’s easier to read and not jumbled up. I hope you all find this informative and interesting. 💜
Endometriosis and irritable bowel syndrome: A systemic review and meta-analyses
Michelle Y. Nabi, Samal Nauhria, [...], and Prakash V. A. K. Ramdass
Abstract
Objective
To estimate the pooled odds ratio of endometriosis and irritable bowel syndrome, and to estimate the pooled prevalence of irritable bowel syndrome in patients with endometriosis.
Data sources
Using Cochrane Library, MEDLINE, Science Direct, ClinicalTrials.gov, Web of Science, and CINAHL, we conducted a systematic literature search through October 2021, using the key terms “endometriosis” and “irritable bowel syndrome.” Articles had to be published in English or Spanish. No restriction on geographical location was applied.
Methods of study selection
The following eligibility criteria were applied: full-text original articles; human studies; studies that investigated the association between endometriosis and irritable bowel syndrome. Two investigators screened and reviewed the studies. A total of 1,776 studies were identified in 6 separate databases. After screening and applying the eligibility criteria, a total of 17 studies were included for analyses. The meta-analysis of association between endometriosis and irritable bowel syndrome included 11 studies, and the meta-analysis on the prevalence of irritable bowel syndrome in endometriosis included 6 studies.
Tabulation, integration, and results
Overall 96,119 subjects were included in the main meta-analysis (11 studies) for endometriosis and irritable bowel syndrome, with 18,887 endometriosis patients and 77,171 controls. The odds of irritable bowel syndrome were approximately 3 times higher among patients with endometriosis compared with healthy controls (odds ratio 2.97; 95% confidence interval, 2.17 – 4.06). Similar results were obtained after subgroup analyses by endometriosis diagnosis, irritable bowel syndrome diagnostic criteria, and Newcastle-Ottawa Scale scores. Six studies reported prevalence rates of irritable bowel syndrome in people with endometriosis, ranging from 10.6 to 52%. The pooled prevalence of irritable bowel syndrome in people with endometriosis was 23.4% (95% confidence interval, 9.7 – 37.2).
Conclusion
Patients with endometriosis have an approximately threefold increased risk of developing irritable bowel syndrome. Development and recent update of Rome criteria has evolved the diagnosis of IBS, potential bias should still be considered as there are no specific tests available for diagnosis.
Endometriosis and irritable bowel syndrome (IBS) are two common medical conditions that markedly affect a substantial proportion of adults and teenagers, and even some menopausal adults (1, 2). Even though they are two distinct conditions with different etiologies, a significant percentage of people experience both concurrently (3). Endometriosis, with an estimated worldwide prevalence ranging from 0.7 to 8.6%, (4) is characterized by the existence of endometrial-like tissue that has been disseminated beyond the uterine cavity. Patients with endometriosis commonly experience menstrual disturbance, infertility, abdominal and pelvic pain, and irregularities with bowel movements (5, 6).
Irritable bowel syndrome, which shares many clinical features with endometriosis, is a gastrointestinal disorder that primarily affects the large intestine, and is characterized by an array of symptoms such as alteration in bowel movements, abdominal discomfort, pain, and cramping (7). The prevalence of irritable bowel syndrome ranges from 0.4 (in India and Ghana) to 20.9% (in Singapore), with a pooled global prevalence of 5.9% (8). Moreover, approximately 61% of adults and teenagers who were assigned female at birth are affected by irritable bowel syndrome (9).
Irritable bowel syndrome and endometriosis have a significant overlap in symptom presentation due to chronic inflammation thus leading to chronic pelvic pain (10). Endometriosis may even masquerade as irritable bowel syndrome in some patients (11). However, despite these similarities in clinical presentation, a recent nationwide study in the U.S. has shown that endometriosis increases the risk of irritable bowel syndrome approximately threefold (3). Possible explanations for this increased risk include chronic low grade inflammation resulting from mast cell activation, neuronal inflammation, leaky gut, and dysbiosis (12).
It is unclear if endometriosis is an independent risk factor for irritable bowel syndrome. The main purpose of this study was to quantify the association between endometriosis and irritable bowel syndrome, and to estimate the prevalence of irritable bowel syndrome in patients with endometriosis through pooled analysis.
Materials and methods
Sources
This systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and protocols (PRISMA-P) statement (13). The study protocol was registered in the PROSPERO database (University of York, United Kingdom).1 A systematic search of the following electronic databases was conducted to identify peer-reviewed literature from inception until October 2021: MEDLINE, Science Direct, ClinicalTrials.gov, Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, CINAHL, and Web of Science. Key words or MeSH terms used were “irritable bowel syndrome” AND “endometriosis.”
Study selection
Citation files from the searched databases were imported into Endnote reference management software and duplicates were removed. Using the eligibility criteria, two investigators independently screened titles and abstracts of the studies for relevance. The potential full texts articles were further assessed to be included in the review. Any disagreements between the authors were resolved with a discussion. Inclusion criteria were any observational or experimental studies that investigated both endometriosis and irritable bowel syndrome. Studies were included if irritable bowel syndrome was diagnosed by pre established criteria. Endometriosis had to be confirmed surgically, by clinical inspection, or reported as the International Classification of Diseases code for endometriosis. Meta-analyses, reviews, conference summaries, abstracts, case reports, opinions, letters, and animal studies were excluded. There was no search restriction for year of publication or the age group of patients. Articles were restricted to English and Spanish.
Data extraction and quality assessment
Data were extracted into a standardized data-collection sheet using the following headings: first author name, date of publication, study site, study design, irritable bowel syndrome diagnosis criteria, endometriosis diagnostic criteria, sample size, event rate, and quality assessment score. Two investigators (MN and PR) assessed the quality of all included studies using the Newcastle-Ottawa Scale (NOS), and the overall scores were recorded (14). NOS scale is widely used for assessing quality of each included study in meta-analyses and is based on ranking studies on according to the selection criteria, group comparability and ascertainment of exposure.
Data synthesis and analysis
Forest plots were generated with Review Manager version 5.4 (Nordic Cochrane Centre, Cochrane Collaboration, Denmark) and funnel plots were created with JASP statistical software. The primary outcome of the association of irritable bowel syndrome and endometriosis in this meta-analysis was performed using the random effects model to produce odds ratios (OR) with 95% confidence interval (CI). We conducted subgroup analyses based on diagnosis of endometriosis (surgical versus ICD-9-CM 617.x codes), method of diagnosis of irritable bowel syndrome, NOS scores (>6 vs. <6), and a combination of all criteria (endometriosis diagnosis; irritable bowel syndrome criteria; NOS score; and study design). In the subgroup analysis based on all criteria, studies were grouped as having met all criteria (surgical diagnosis of endometriosis, irritable bowel syndrome diagnosed with Rome criteria (15–17), NOS score > 6, and longitudinal studies), or not. This allowed for strong epidemiological evidence for the association between endometriosis and irritable bowel syndrome.
According to Rome III criteria, IBS patients can be classified into four subtypes and can be useful for treating specific symptoms of the patient. The subtypes include: IBS with diarrhea (IBS-D), IBS with constipation (IBS-C), IBS with mixed features (IBS-M) or IBS, unsubtyped. Whereas Rome IV criteria defined IBS as a functional bowel disorder in which recurrent abdominal pain is associated with defecation or a change in bowel habits.
A separate forest plot was generated for the prevalence of irritable bowel syndrome in patients with endometriosis, for studies that provided only prevalence data. The random effects model account for between-study heterogeneity by weighting studies similarly. Heterogeneity was assessed using the I2 statistic. Values of I2 > 50% were considered as indicative of large heterogeneity (18). We used the Begg’s and Egger’s funnel plot, which is a subjective visual method, to estimate risk of publication bias. A funnel plot that appears asymmetrical suggests publication bias. A p-value of <0.05 for all analyses was considered statistically significant. Although p-values are poor predictors of outcome, all quantitative studies included in our analyses mention p-values in accordance to the AM Stat recommendation.
Results
Search results and study inclusion
A total of 1,776 studies were identified in 6 separate databases. After removal of 168 duplicates, there were 1,608 eligible studies (titles/abstracts) which were independently screened by two reviewers. Of the 1,608 screened studies, 1,573 did not meet inclusion criteria and 35 full-text articles were reviewed. A total of 17 studies met criteria to be included in the systematic review. Eighteen studies were excluded for the following reasons: did not meet criteria; conference abstracts; reviews; letters; case series; and registered trials. The meta-analysis of the association of endometriosis and irritable bowel syndrome included 11 studies, and the meta-analysis on the prevalence of irritable bowel syndrome in endometriosis included 6 studies (see flow chart in Figure 1).
Study characteristics
Overall 96,119 subjects were included in the main meta-analysis (11 studies) for endometriosis and irritable bowel syndrome association, with 18,887 endometriosis patients and 77,171 controls (patients without symptoms). The participants in the study by Ballard et al. (19) were already reported in the study by Seaman et al. (2), thus they were not added to the main meta-analysis twice. The meta-analysis on the prevalence of irritable bowel syndrome in endometriosis included 6,395 subjects. Almost all articles were published during the last decade, with two exceptions, which were published in 2005 and 2008. Of the 17 studies in this review, the majority were conducted in the United States, the United Kingdom, and Sweden. Table 1 describes the key characteristics of the included studies. Most studies used either Rome II (15), Rome III (16), Rome IV (17), or the visual analog scale for irritable bowel syndrome (VAS-IBS) (20) questionnaires to diagnose irritable bowel syndrome. Endometriosis diagnosis was confirmed either by laparoscopy or laparotomy. Each study had a quality assessment score between 5 and 10 on the Newcastle-Ottawa Scale (14), with most studies having a score of 7 or greater.
Meta-analysis of studies
Of the 11 studies in the main meta-analysis (1–3, 10, 21–27), most were cohort and case control. Studies were conducted from 2005 to 2020, and sample sizes ranged from 80 to 36,456. In this meta-analysis the pooled odds ratio of endometriosis and irritable bowel syndrome was 2.97 (95% CI = 2.17 – 4.06), based on all selected criteria (see details in Figure 2). Odds ratio for the individual studies ranged from 1.69 (26) to 5.65 (10). There was a large heterogeneity in this study (I2 = 91%, [P < 0.00001]). In our subgroup analyses, the odds ratio for each subgroup was approximately 3, regarding endometriosis diagnosis (see Figure 3), criteria used for irritable bowel syndrome (see Figure 4), and NOS score (see Figure 5). Visual inspection of the funnel plot appears asymmetrical, suggesting the presence of publication bias (see Figure 7).
Endometriosis diagnosis
There were 9 studies (28,888 patients) in the meta-analysis that confirmed endometriosis surgically, and 2 studies (67,161 patients) that used the ICD-9-CM 617.x codes to diagnosis endometriosis. The random effects model showed a significant association between endometriosis and irritable bowel syndrome with a pooled odds ratio of 3.0 (95% CI = 2.18, 4.11) (see Figure 3).
Irritable bowel syndrome diagnostic criteria
Four studies (67,699 patients) did not state what criteria were used to diagnose irritable bowel syndrome, three studies (667 patients) used the Rome III criteria, and one study each used the following as their criteria: history (26,779 patients); VAS-IBS (289 patients); Rome II (362 patients), and Rome IV (323 patients). The random effects model shows a significant association between endometriosis and irritable bowel syndrome, with a combined odds ratio of 2.96 (95% CI = 2.16, 4.06) (see Figure 4).
Pooled prevalence of irritable bowel syndrome
There were six studies (6, 19, 28–31) that estimated the prevalence of irritable bowel syndrome in people with endometriosis. These studies ranged in sample size from 101 to 5,540. The prevalence of irritable bowel syndrome in patients with endometriosis ranged from 10.6 to 52%, with a pooled estimate of 23.4% (95% CI = 9.7%, 37.2%) (see Figure 6).
Discussion
This systematic review and meta-analysis was designed to estimate the association of endometriosis and irritable bowel syndrome. Our literature search included all available original studies investigating irritable bowel syndrome and endometriosis, thereby allowing us to include a large number of subjects (17 studies; n = 96,974).
The most significant finding of our study is that the pooled analysis showed endometriosis was associated with an almost three-fold increase in risk of irritable bowel syndrome, and that more than 1 in 5 people with endometriosis have irritable bowel syndrome. Of particular significance, all 11 studies in the main meta-analysis showed a positive association of irritable bowel syndrome and endometriosis. Moreover, almost all subjects in this analysis were followed longitudinally, either retrospectively or prospectively, thus allowing for inference on temporality vis-à-vis risk factor and disease. In addition, five studies (n = 68,129) included in this meta-analysis showed a positive association of endometriosis and irritable bowel syndrome, even after adjustments were made for potential confounding variables (3, 10, 21, 25, 26). Furthermore, there were significant findings in our subgroup analyses based on diagnostic method for endometriosis, diagnostic criteria for irritable bowel syndrome, and NOS scores. More importantly, after the studies in the main meta-analysis were categorized based on the following criteria: longitudinal study design; surgical confirmation of endometriosis; Rome diagnostic criteria for irritable bowel syndrome; and NOS scores > 6, the pooled odds ratio was 2.77 (95% CI = 1.37, 5.60). Thus, this provides strong epidemiological evidence for the increased association of endometriosis and irritable bowel syndrome.
Endometriosis is characterized as a chronic, estrogen-dependent inflammatory disorder with the presence of endometrial tissue outside the uterine cavity (3). Affected areas encompass the pelvic peritoneum, ovaries, rectovaginal septum, the abdominal cavity, and the gastrointestinal tract.
Histologically, endometriosis can be characterized into superficial endometriosis, ovarian endometrioma (OE) and deep infiltrating endometriosis (DIE). DIE can present with severe symptoms as the lesions penetrate deeper into the peritoneum and thus produce more pain as compared to the superficial. DIE also tends to involve the uterine ligaments, pouch of Douglas, rectum, or vagina. OE on the other hand, is the most common type of endometriosis and located in the pelvic areas or along the intestines. Multifocality of such a variably distributed lesion thus, predisposes to a variable clinical presentation the patients.
The relationship between endometriosis and irritable bowel syndrome has not yet been fully elucidated, and multiple theories have been proposed. One such theory is the immunological linkage through increased mast cell activation seen in both conditions (32). The major hallmarks postulated in this immunological linkage are the abnormal levels of inflammatory cytokines and immune cell activation in the peritoneal cavity (33). Retrograde menstruation has been a plausible explanation, which causes the dissemination of menstrual blood containing endometrial cells into the pelvic cavity, thus triggering symptoms of irritable bowel syndrome (34). Specifically, in endometriosis, the activated mast cells have been activated near nerve endings within the pelvic and abdominal regions, and in irritable bowel syndrome they have been shown to be activated near the bowel mucosa (35). Moreover, Remorgida et al. (22) have found that the severity of gastrointestinal symptoms was directly related to the extent of infiltration of endometriotic foci in the bowel, and reversal of symptoms occurred after removal of those lesions. However, they did not find any conclusive evidence regarding endometriosis and predisposition to a specific subtype of irritable bowel syndrome.
Another theory for the increased association between these two disorders is through a hormonal linkage. This hormonal connection involves the presence of gonadotropin releasing hormone-containing neurons (36) and receptors for luteinizing hormone within the pelvic organs (37) and the enteric nervous system (38). It is hypothesized that the pain experienced in some people with irritable bowel syndrome could be as a result of the sex hormones found in afab people, as reports have shown a fluctuating exacerbation of symptoms of irritable bowel syndrome during menstruation (39). Likewise, it was observed that patients with endometriosis had worsening of gastrointestinal symptoms during the time of menstruation (30). It is posited that patients with endometriosis and irritable bowel syndrome both experience visceral hypersensitivity, which is likely to contribute to the severity of gastrointestinal symptoms (24). A large population-based study reported that the highest prevalence rate for endometriosis was for the 40–44-year age group (40), and Oka et al. reported that afab people between the ages of 30–39 years were more likely to have irritable bowel syndrome when compared to those less than 30 years old (8). Thus, the prevalence for both conditions peak at approximately the same age range, just around the beginning of the menopausal period. Moreover, postmenopausal patients with irritable bowel syndrome experience symptoms more severely than premenopausal patients with irritable bowel syndrome, most likely due to modulation in the brain-gut axis as a result of hormonal changes (41). Our study was not analyzed according the age of the patient.
Furthermore, a meta-analysis on the sex differences of irritable bowel syndrome reveals that afab people are more likely to experience abdominal pain when compared to amab people, and this may be because of sex hormonal differences (42).
Other important factors to consider when examining the relationship between endometriosis and irritable bowel syndrome are race/ethnicity and geographical region. In their study, Bougie et al. showed that Black people were less likely than White people to have endometriosis, and that Asian people were more likely than White people to have endometriosis (43). Similarly, Wigington et al. reported that Black people were less likely than White people to have irritable bowel syndrome (44). Thus, White people were more likely to have both endometriosis and irritable bowel syndrome when compared to Black people. Interestingly, of the 11 studies in our meta-analysis, only two studies stated the race of the participants (10, 27), and of these, the study by Schink investigated only Caucasian people (27).
As discussed previously, endometriosis is a chronic and multifactorial (genes, hormones, immune and environmental) and multi risk factor (family history, long menstrual cycle, low parity, and poor physical activity) associated disease (45, 46). An association between endometriosis and heavy metal sensitivity has been discussed in research that can potentially play a role in producing produce an IBS-like syndrome. Specifically, heavy metal nickel has been shown to interfere with estrogen and its receptors and thus plays a role in the pathogenesis of IBS. Researchers have even demonstrated a higher nickel level in endometriosis tissue (46, 47).
Recent global studies showed that the prevalence of irritable bowel syndrome varies from country to country, ranging from 0.2% in India to 29.2% in Croatia, using the Rome III criteria, and ranging from 0.4% in India and Ghana to 21.3% in United States, using the Rome IV criteria (8). Similarly, the global prevalence rates for endometriosis in the general population ranged from 0.7 to 8.6% (4). This highlights the importance of recognizing that irritable bowel syndrome and endometriosis can burden people of any race and from any country of origin, even though they can vary widely regarding presentation and response to treatment (43). Studies investigating endometriosis or irritable bowel syndrome individually were sparse for the geographical regions of South America, Central America, Africa, and Asia (8). However, the studies conducted in the United States reported the highest prevalence rate of endometriosis (48), and the highest prevalence rate of irritable bowel syndrome when using the Rome IV diagnostic criteria (11). Moreover, the studies conducted in the United States showed that people with endometriosis had the highest odds (5.65, 5.30) of having irritable bowel syndrome (see Figure 2). Thus, this points to further evidence that endometriosis is a significant contributory factor leading to irritable bowel syndrome. Needless to say, more investigation is needed regarding race/ethnicity and the association between endometriosis and irritable bowel syndrome.
Studies included in our meta-analysis used the Rome II, Rome III, and Rome IV criteria. The odds of irritable bowel syndrome in endometriosis increased with each subsequent updated version of the Rome criteria (odds ratio from 1.86 to 3.45 to 5.65), respectively. However, when interpreting these differences, one should also consider the significant heterogeneity that exists regarding study design and sample size. Moreover, recent studies have shown that the diagnostic outcomes for Rome II and Rome III criteria differ significantly (49), whereas there were comparable findings for Rome III and Rome IV criteria (50). Nevertheless, there is a markedly increased risk associated with endometriosis and irritable bowel syndrome, regardless of the criteria used to diagnose irritable bowel syndrome. The basis of the Rome criteria relies on its definition of irritable bowel syndrome in which recurrent abdominal pain is associated with defecation or a change in bowel habits (17). Thus, the Rome criteria classifies patients as different subtypes based on bowel habits: irritable bowel syndrome with predominant constipation (IBS-C), irritable bowel syndrome with predominant diarrhea (IBS-D), irritable bowel syndrome with mixed bowel habits (IBS-M) or irritable bowel syndrome, unclassified (IBS-U) (17). However, our data does not include information on these subtypes. Therefore, we cannot conclusively state whether endometriosis increases the risk of a specific subtype of irritable bowel syndrome over another, or if it increases the risk of all subtypes of irritable bowel syndrome.
Our meta-analysis included one study that used the visual analog scale for irritable bowel syndrome (VAS-IBS) to diagnose patients with irritable bowel syndrome. The VAS-IBS is a patient-centered questionnaire comprised of six categories: Abdominal Pain, Diarrhea, Constipation, Bloating and Flatulence, Abnormal bowel passage, and Vomiting and Nausea (20). The items in the VAS-IBS capture the main physical concerns people with irritable bowel syndrome might experience. All symptoms, except vomiting and nausea, support the diagnosis of irritable bowel syndrome. Even though the majority of studies in our meta-analysis used the Rome criteria to establish a diagnosis of irritable bowel syndrome, the VAS-IBS was shown to be an accurate and reliable questionnaire to diagnose irritable bowel syndrome (20).
Our literature search found two meta-analyses on endometriosis and irritable bowel syndrome (51, 52). Even though they had similar findings to ours regarding the increased association of endometriosis and irritable bowel syndrome, we believe that our review provides a more detailed analysis on various factors such as endometriosis diagnosis and irritable bowel syndrome diagnosis, and the pooled prevalence of irritable bowel syndrome in patients with endometriosis.
Strengths and limitations
Strengths of this meta-analysis include incorporation of all available studies, with subsequent sub-analyses. Both observational and interventional studies were included. In addition, most studies included in the meta-analysis have a quality assessment rating greater than 6. Moreover, by independently reviewing articles and selecting those that fit our criteria, we concluded with a large-scale study from various geographic regions of the world that include North America, Europe, Asia, Africa, and Oceana. This allowed us to interpret the risk of irritable bowel syndrome in people with endometriosis from an extensive and multiethnic perspective. In addition, this is the first meta-analysis to include a pooled estimate of the prevalence of irritable bowel syndrome in people with endometriosis.
Our study has a number of potential limitations. While select studies employed either the Rome II, Rome III, Rome IV, or the visual analog scale for irritable bowel syndrome (VAS-IBS) as their criteria to gather symptomatic data on irritable bowel syndrome, the majority of studies in this meta-analysis did not state what criteria were used to diagnose irritable bowel syndrome. The anatomical location of endometriosis and the IBS subtypes was not described as relevant description was not available in the included studies. Nonetheless, after subgroup analysis by whether criteria was used or not, pooled estimates revealed similar results in these groups. These estimates were also reflected in the overall combined odds ratio for all studies. Thus, omitting the criteria used for establishing irritable bowel syndrome did not pose any significant error in this analysis. Another limitation of this study is that data from the two largest retrospective cohort studies identified patients with endometriosis using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) 617.x codes, whereas all other studies stated that laparoscopy/laparotomy/clinical inspection was used as the mode of diagnosis. There is a significant variation in clinical diagnosis of endometriosis due to the costs and invasive diagnostic techniques including laparoscopic or surgical diagnosis. This has led to more reliance on radiological diagnosis for the same. Nevertheless, the surgical diagnostic methods are still considered the gold standard. Additionally, IBS diagnostic criteria are not based on standard guidelines or criteria. Most commonly used are the Manning and the Rome criteria which are possibly too general and vague for a specific diagnosis. Thus, an inevitable overlap occurs in the diagnosis of endometriosis and IBS (53).
Therefore, there was some inconsistency regarding identification of endometriosis. Nevertheless, our subgroup analysis regarding endometriosis diagnosis showed similar pooled estimates. However, despite these limitations, the diagnosis of irritable bowel syndrome remains a challenge with the fluctuation in symptoms and its symptoms mimicking other disorders like endometriosis (17).
Recommendations
Our database search revealed that no studies were conducted in Central America or South America, and only a solitary study each arose out of Africa and Asia. Thus, we recommend that studies be conducted in these regions of the world to give globally representative estimates of the risk associated with these conditions. Furthermore, since the majority of participants were investigated in retrospective cohort studies, we recommend that researchers conduct large-scale prospective cohort studies to investigate the risk of irritable bowel syndrome (preferably using the Rome IV criteria) in people with endometriosis (with diagnosis confirmed surgically). Moreover, we suggest that studies be conducted to investigate whether endometriosis predisposes to any specific subtypes of irritable bowel syndrome.
Conclusion
This review provides significant epidemiological evidence for the association between endometriosis and irritable bowel syndrome. People with endometriosis are three times more likely to have irritable bowel syndrome compared to people without endometriosis. Doctors should be mindful that patients with endometriosis can also have irritable bowel syndrome.
Data availability statement
The original contributions presented in this study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.
Author contributions
MN, MR, and SL contributed to the conception and design of the study. ME organized the database. PR and SN performed the statistical analysis. AV wrote the first draft of the manuscript. MN, MR, AV, and ME wrote the sections of the manuscript. All authors contributed to manuscript revision, read, and approved the submitted version.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
To estimate the pooled odds ratio of endometriosis and irritable bowel syndrome, and to estimate the pooled prevalence of irritable bowel sy
Children’s visits to the ICU are still restricted, and more focus on the child’s own needs and experiences are needed. The aim of this study
The phenomenon [“being a visiting child of a seriously ill parent receiving care at the ICU”] is revealed in perceptions of being needed and a need to help out with concrete things. The meaning of being needed is described as a mutual dependence revealed by the ill parent’s helplessness, and both the child’s and the parent’s need for closeness.
The need is concretized by being close to and present with the parent, as quickly and for as long a time as possible. The meaning of being needed is also expressed in a desire to ease the parent’s pain and an understanding that the parent needs help to recover, revealed in actions of wanting to help and naturally care for the parent. While visiting, the child has a desire to be recognized that manifests itself most strongly in the meeting with the nurse. The meaning of being recognized involves being seen, that someone initiated the visit, and being recognized through the nurse’s talks and questioning and through receiving information, but as this occurred only at a superficial, non-individual level the feeling of inclusion was not achieved. The children felt that the nurse cared for them, but not in a compassionate, caring way. The visit also revealed that the children had become aware of their sick parent’s situation by seeing the parent in the unfamiliar environment with all the equipment and medicines, and through drawings, books, and diaries. The children became aware of the shift in their parent’s condition, of the seriousness of the situation, and of how much they loved and longed for their parent.
[...]. The children also described closeness to their parent as meaningful, as they believed their presence could help the parent recover and return to them in their daily life. Being close to the parent created feelings of being significant and calmness in the child. The children described a desire to be close to their sick parent. They sat near their bed and looked at them; they did not always talk, but they were there. Sometimes they held their sick parent’s hand, and sometimes they talked a great deal with them as they felt that this helped their parent: I held his hand (Girl, 12 years).
[...]. “Time” is also described as meaningful when it comes to the children’s feelings of being needed, and is seen in the dimensions of wanting to be with the parent as quickly as possible and wanting to stay there for a longer while. If “time” was extended, this caused worries and longing. The children could sit by their parent’s bed for hours, and often stayed almost a whole day. They felt good when they stayed with their parent. They also described that it had seemed like an eternity before they could see their parent because it took so long to drive there, and that the question about the children visiting had been brought up late: Mother: We had waited several days before we brought the children to visit ... ... Child: Eight thousand years ... Mother: Three days ... Child: Eight million years... ... (Boy, 6 years).
[...]. The children described that when they had seen their sick parent in reality they saw how many needles, machines, and medicines were needed for them to get better. The equipment, bed, machines, medicines, tube in the throat, needles, blood hose, and urine catheter caught their attention. The fact that their parent could not urinate by themselves affected the children deeply in both an emotional and a humorous way. They also blamed their sick parent’s confusion on the medicines. Further, the children described that sometimes their parent was awake, while other times they slept through the whole visit. When seeing their sick parent, the child became aware that they were in pain and in a fragile position. They described this as tough, and said that seeing all this made them afraid. But at the same time, they described that it was good to see their sick parent and did not want to miss it. The child realized how sick their parent was upon seeing everything. The children also described that when they visited, they could see changes in their sick parent and in their room. They described that they noticed when there were more or fewer machines, hoses, and medicines. The parent’s situation and condition also made the children wonder about the future: Will Mom be able to walk? To eat by herself? To be home with us? (Girl, 15 years).
In this study, closeness to the parent, by sitting next to their bed, was interpreted as not only helping the child’s emotional state but also helping the parent to recover.... However, if the visit is not facilitated, children may be afraid to touch their family member or fear that they will harm them and thus stand at a distance, uncertain as to what to do.
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Some great tips for researching the documents to get the better search results with Pubmed
PubMed is free resource and is maintained by NCBI. It in fact consists of nearly 24 million citations in lieu of literature from different related scenarios including MEDLINE, online books and life science journals. Here are some great tips for researching the documents to get better results with PubMed.
My response to "Something’s Rotten in Bethesda — The Troubling Tale of PubMed Central, PubMed, and eLife"
Text is from http://scholarlykitchen.sspnet.org/2012/10/22/somethings-rotten-in-bethesda-the-troubling-tale-of-pubmed-central-pubmed-and-elife/ by Kent Anderson, Oct 22, 2012. My comments are capitalized and in bold (I'm not yelling, just trying to distinguish between the original text and my response).
PubMed Central (PMC) says it's not a publisher. PubMed claims to have a fair process that it applies uniformly to include journals in its index. [NO, THAT'S MEDLINE. MEDLINE IS A SUBSET OF THE PUBMED DATABASE] And as a government agency, PMC is generally prohibited from competing with one or more thriving private industries.
Yet, last week, with a set of actions around the fledgling funder-backed journal eLife, it became clear that PMC is a publisher, that PubMed's process for indexing journals [AGAIN, YOU'RE CONFUSING PUBMED WITH MEDLINE] is not uniformly or fairly applied and can be exploited, and that PMC competes with both publishers and publishing technology companies, leveraging PubMed itself in these competitions.
Let's break this down claim by claim.
PubMed Central As Publisher
PMC states definitively on its site that it is not a publisher:
PMC, itself, is not a publisher.
What is a publisher? An entity which engages in:
. . . the activity of making information available to general public. [SELECTIVELY QUOTING WIKIPEDIA AS YOUR SOURCE FOR A DEFINITION IS VERY SUSPECT. HERE'S THE FULL QUOTE: "Publishing is the process of production and dissemination of literature, music, or information"]
PubMed has long been a publisher of abstracts. [PUBMED DOESN'T CREATE THE ABSTRACTS] PMC is clearly a publisher of full-text content. [PMC DOESN'T CREATE THE CONTENT] Therefore, their contention that PMC is not a publisher is simply wrong.
However, there are degrees of publishing — secondary, embargoed publication is qualitatively different than primary, immediate publication. A downstream publisher is different from a primary publisher. PMC is widely understood to be a secondary, embargoed publisher. [PMC IS A DATABASE, JUST LIKE OVID HAS A DATABASE OF FULL-TEXT ARTICLES, AS DOES EBSCO, AS DO OTHERS. JOURNALS SIGN AGREEMENTS TO ALLOW THEIR CONTENT TO BE USED BY THESE DATABASES]
But what if it's becoming a primary publisher?
PMC and PubMed [MEDLINE, NOT PUBMED] require publishers to establish independent editorial and publishing practices and have these reviewed and evaluated after they've been in effect for some time. This is how it's described in PubMed and PMC documentation, and this what the community generally believes to be true and adheres to. For instance, getting content into PMC requires publishers to meet both technical and scientific standards, including:
The journal must have a reasonable number of published articles in order for NLM to make a decision about its scientific quality. [ACCORDING TO www.ncbi.nlm.nih.gov/pmc/pub/pubinfo/ "Smaller samples may be evaluated at PMC's discretion."]
A journal will be deemed to be eligible for inclusion in PMC if the NLM Selection and Acquisition Section determines that it conforms to the scientific quality criteria specified in the Collection Development Manual of the National Library of Medicine. [I REFER YOU TO http://www.nlm.nih.gov/tsd/acquisitions/cdm/formats29.html#1027134 "The Library's first priority is collecting scientific or scholarly journals containing signed papers that report original research. The intent is to assemble a comprehensive collection of the world's most significant research journals in all subjects collected at NLM, from all countries and in any language." AND TO: http://www.nlm.nih.gov/tsd/acquisitions/cdm/policy.html " Coverage of the scholarly biomedical literature shall be comprehensive; coverage of other biomedical literature may be more selective. The intent is to ensure that the collection represents the intellectual content and diversity of the world's biomedical literature."]
In standard communications with publishers about these protocols, the NLM and PubMed state:
A journal needs to be included in the NLM Collection to meet PMC's scientific quality standard. This review can take place once [the title] has published 15 articles.
[DO YOU HAVE A SOURCE FOR THIS? I HAVEN'T SEEN THIS NUMBER]
So, a journal has to publish 15 articles before any review can take place.
But what would it mean if a journal's first articles were published on PMC, and only on PMC? No review process could have occurred. There would have been no independent publication practices established, and therefore nothing to review. [REVIEW PROCESS FOR ELIFE http://www.elifesciences.org/the-journal/review-process/ BOARD OF REVIEWING EDITORS http://www.elifesciences.org/about/elife-community/reviewing-editors/ ] Allowing articles into PMC otherwise would be an abrogation of standards, or something equally questionable. It would be even more of a violation of stated policy if fewer than 15 articles were involved. [AGAIN, WHERE'S THIS POLICY?]
Last week, eLife published its first papers — four research articles, four commentaries, and an editorial. That's a total of nine articles, short of the 15 required, and the minority are scientific reports. Yet, where did eLife publish them? On eLifesciences.org, their domain? On HighWire Press, where its publisher site is being built? No. It published them on PubMed Central. All URLs listed on the eLife site point to this US government Web site (http://www.ncbi.nlm.nih.gov/pmc). In a comment on this blog last week, Robert Kiley of Wellcome Trust pointed to the only published version of eLife's introductory editorial — which resides on PMC. The US government is acting as the online publisher of eLife.
eLife branding is prominently displayed. [EVERY JOURNAL IN PMC HAS A BRANDED HEADER. SEE http://www.ncbi.nlm.nih.gov/pmc/issues/206112/ http://www.ncbi.nlm.nih.gov/pmc/journals/1420/ http://www.ncbi.nlm.nih.gov/pmc/journals/990/ http://www.ncbi.nlm.nih.gov/pmc/journals/258/ ] Within the eLife logo, the four links work separately and well. This was not a sloppy job, but a careful integration.[ AS WITH EVERY SINGLE OTHER JOURNAL IN PMC] This required coordination and planning between eLife and PMC. PMC was clearly acting as an extension of eLife. [YOU'RE SAYING THAT PMC IS "ACTING AS AN EXTENSION" OF ALL JOURNALS IN PMC?]
Screen shot of how eLife looks on PMC.
eLife put a statement on its site about how PMC was publishing its articles:
To avoid unnecessary delays in making the first accepted articles available, we are listing articles that are ready for publication here and publishing the articles themselves on PubMed Central (PMC), the public archive for life and biomedical science literature at the US National Library of Medicine. Additional papers will be published this fall and, as planned, we will launch eLife's journal Web site this Winter.
"Unnecessary delays" would be those we all tolerate as independent publishers in our dealings with PubMed and PMC — waiting for our hosting platform to be ready, [NOT A REQUIREMENT] proving our independent ability to publish by abiding by the timeframe, [WHAT TIMEFRAME?] article count, [WHAT ARTICLE COUNT?] and technical requirements [IF ELIFE DIDN'T MEET THE TECHNICAL REQUIREMENTS, IT WOULD LITERALLY BE IMPOSSIBLE FOR THEIR ARTICLES TO APPEAR IN PMC] of PubMed or PMC, and so forth. eLife editors are being disingenuous by saying these things are "unnecessary." They are required, [MEDLINE HAS STRICT REQUIREMENTS BUT ELIFE IS NOT INDEXED BY MEDLINE] and they are the norm. The are only "unnecessary" if someone helps you short-circuit the process.
The agency of the statement is also interesting — "we" (meaning eLife) are publishing the articles themselves on PMC. This assignment of agency to eLife makes it seem that PMC had no choice in the matter, [HOW ARE THEY SUPPOSED TO PHRASE IT?] and that the US government, through the NLM and NCBI, is merely a publicly available and free publishing platform, ala WordPress.
Where was the review? Where were the standards? Where was the process?
I spoke with David Lipman of NCBI about this. He told me that eLife submitted a PMC application following what he termed "the regular procedure." During the application process, eLife's representatives mentioned that their site was not up. A discussion ensued, the details of which he claimed to know nothing about, and the powers that be at PMC or NLM agreed to publish the eLife articles on PMC before the normal requirements had been met, and before eLife had demonstrated any independent ability to publish. I asked him if the NLM Acquisition and Selection Section had approved the application. He said they had. I tried to contact Joyce Backus, the head of the Section, over the weekend prior to the publication of this post, but we weren't able to connect. If warranted, I'll write more about the questions I asked her later.
Lipman claimed that eLife "seemed like a reasonable bet" owing to the quality of its backers and its editorial staff. Yet, when asked why a publisher like AAAS or the American Chemical Society or Lippincott or a hundred others don't benefit from the same affordances [THEY ALL HAVE THE SAME OPPORTUNITY TO SUBMIT TO PMC. HERE'S AN ACS JOURNAL: http://www.ncbi.nlm.nih.gov/pmc/journals/1791/ AND LIPPINCOTT USED TO PARTICIPATE: http://www.ncbi.nlm.nih.gov/pmc/journals/230/ AND AAAS HAS JOURNALS INDEXED IN MEDLINE; IT COULD CHOOSE TO PARTICIPATE IN PMC TOO] and don't by extension seem like "a reasonable bet," he had no good answer.
Clearly, PMC is the primary publisher of eLife. [PMC DOES NOT CREATE THE ARTICLES] Articles in eLife appear nowhere else — not in print, not on a publishing platform through independent private means, nowhere. The editors of eLife are representing that it was their doing, [REASONABLE PEOPLE WOULD ASSUME THAT ELIFE CHOSE TO APPLY FOR PARTICIPATION IN PMC. OF COURSE YOU NEED PMC'S ASSISTANCE] but that’s clearly not true — they needed agreement and assistance from PMC, which is owned by an agency of the US government.
The implications of this are troubling. US taxpayers are now directly subsidizing [US TAXPAYERS ARE SUPPORTING NLM. SO WHAT? ARE YOU ARGUING THAT PMC IS DIRECTLY SUBSIDIZING EVERY PARTICIPATING JOURNAL?] a Delaware-based 501(c)3 that is also partially a UK-based charity. NLM, PMC, and NCBI have given one entity special accommodation [I REFER YOU TO THE POLICIES AT http://www.ncbi.nlm.nih.gov/pmc/pub/pubinfo/ ] and violated its own policies and practices to make this happen.
As if this weren't enough, PMC's role as a primary publisher [A PUBLISHER SELECTS, PREPARES, AND DISSEMINATES MATERIAL. PMC DOES NOT RUN AN ARTICLE SUBMISSION PROCESS, DOES NOT EDIT THE ARTICLES, AND DOES NOT PROVIDE THE XML DATA COMPRISING THE PUBLISHED ARTICLE] doesn't stop with eLife. The online version of the Journal of the Medical Library Association (JMLA) is also published primarily on PMC. [JMLA CHOSE TO MAKE ITS CONTENT FREELY AVAILABLE VIA PMC (WITH PMC'S AGREEMENT AND ASSISTANCE, OF COURSE).] PMC also publishes the Journal of Biomolecular Techniques for the Association of Biomolecular Resource Facilities (ABRF). The PMC site for this journal is framed in the ABRF site.
In much the same way that any commercial or non-profit publisher is the publisher of a society's journal, PMC is a primary publisher — for eLife, and for at least two other journals. [WHO IS THE PUBLISHER OF A JOURNAL? THE ENTITY SELECTING AND PREPARING THE MATERIAL? THE PRINTER OF THE HARD COPY? THE PROVIDER OF THE WEBSITE? THE PUBLISHER OF THE ANNALS OF FAMILY MEDICINE IS THE ANNALS OF FAMILY MEDICINE, INCORPORATED. IT IS NOT AAFP (WHICH RUNS THE PRODUCTION), NOR MODERN LITHO, NOR ALLEN PRESS. NOT EVEN HIGHWIRE PRESS IS THE PUBLISHER. HIGHWIRE PRODUCES ONLINE VERSIONS OF CONTENT AND "FACILITATE[S] THE DIGITAL DISSEMINATION" OF CONTENT. http://highwire.stanford.edu/about/]
PubMed’s Indexing Process Can Be Subverted [PUBMED DOES NOT EQUAL MEDLINE]
eLife published its first articles on October 15, 2012 — one week ago. Yet, search PubMed, and lo and behold, eLife articles are included in PubMed. The record in the NLM Catalog still states "PubMed Coverage to be announced" and "Not currently indexed for MEDLINE." This distinction is functionally meaningless [WELL, THAT'S THEIR IGNORANCE. THERE ARE LOTS OF ITEMS LISTED IN PUBMED BUT NOT IN MEDLINE] to our readers, authors, and most of our editors. PubMed is what they use [WHO RELIES ONLY ON PUBMED? AUTHORS/RESEARCHERS HAD BETTER NOT BE USING PUBMED ALONE, OR ELSE THEY'RE DOING LOUSY SEARCHES. THERE'S A GOOD REASON WHY INSTITUTIONS PAY OVID, EBSCO, DIALOG, ETC, FOR ACCESS TO MEDLINE AND OTHER DATABASES], and PubMed is where they want to be indexed. [NO, THEY WANT TO BE INDEXED IN MEDLINE. INCLUSION IN PUBMED IS SECOND-BEST] So it's no surprise that PubMed is what is being leveraged by PMC. [WHY WOULD NLM SEPARATE PMC AND PUBMED? IT MAKES NO SENSE FOR AN ENTITY TO HAVE ONE DATABASE FULL OF CONTENT AND NOT CONNECT IT TO ANOTHER ONE OF THEIR DATABASES. PUBMED ALSO LINKS USERS TO THE PUBLISHERS' WEBSITES, TO LIBRARIES, AND TO OTHER DATABASES.]
The confusion between PubMed and MEDLINE, [WHICH YOU HAVE DEMONSTRATED QUITE WELL YOURSELF] along with how PMC can be used as a backdoor into PubMed, [PMC IS NOT A "BACKDOOR" INTO PUBMED] is what eLife is exploiting, [EXPLOITING? YOU MAKE IT SOUND LIKE A BAD THING TO PROVIDE PUBLIC ACCESS TO BIOMEDICAL RESEARCH] with the help of having PMC as its primary publisher. [AGAIN, I COMPLETELY DISAGREE WITH THE WAY YOU'RE THROWING AROUND THE WORD "PUBLISHER."]
It takes more to get into MEDLINE. In the Collection Development Manual, the following statement appears:
Once an electronic journal has been accessible for at least six months, an editor or publisher may request that the journal be reviewed for possible indexing if at least 20 articles have been published and made available online.
This statement has a few aspects. The electronic journal must be accessible for at least six months — independently. Not published on PMC, but accessible through private means as evidence that it is sustainable and independent. For six months — not six hours or six minutes. By having PMC as its primary publisher, [NO AGAIN] eLife is subverting these requirements. [I REPEAT, ELIFE IS NOT INDEXED IN MEDLINE] They are not likely to launch as an independent journal — independent of US government publishing operations, [THE GPO ISN'T PUBLISHING ELIFE, IS IT?] that is — until early next year.
My organization began publishing two online-only journals more than a year ago. We followed the stated requirements, which are reiterated on the application itself. [YOU MEAN YOU APPLIED FOR INDEXING IN MEDLINE? YOU CONTINUE TO CONFLATE PUBMED, MEDLINE, AND PMC] We waited six months and 20 articles before submitting out applications, even a little longer to ensure that some technical issues could be worked out and some editorial roles assigned after the journals were launched. We are still waiting to be indexed in PubMed and MEDLINE. We followed the process. Dozens and dozens of other publishers do so, as well. [YES, AND THEY WAIT THEIR TURN FOR THE SELECTION COMMITTEE TO REVIEW THEIR JOURNALS FOR INDEXING IN MEDLINE. THE PROCESS IS COMPLETELY, UTTERLY DIFFERENT FOR PMC.]
Being indexed in PubMed [YOU DON'T GET "INDEXED" BY PUBMED. YOU MIGHT HAVE CITATIONS LISTED IN PUBMED, YOU MIGHT HAVE SELECTED ITEMS ADDED FOR INDEXING IN MEDLINE, YOU MIGHT HAVE YOUR FULL JOURNAL SELECTED FOR INDEXING IN MEDLINE] is a big deal for fledgling journals, because editors, authors, and readers often mistake PubMed for MEDLINE. Indexing in PubMed [IF SOMEONE CLAIMS TO BE INDEXED IN PUBMED WHEN THEY'RE NOT IN MEDLINE, THAT IS MISLEADING AND PEOPLE WILL CATCH ON. ANY DECENT PUBLISHER WOULD PROCLAIM INDEXING IN MEDLINE, NOT PUBMED] makes a difference in attracting editors, it makes a difference in attracting good papers, and it makes a difference in establishing legitimacy with an audience. Allowing certain journals to shortcut their way into PubMed [NO ONE SHORTCUTS THEIR WAY INTO PUBMED. THERE ARE PRACTICES FOR ADDING CITATIONS, WHICH ARE SELECTED BY NLM. EVEN JOURNALS INDEXED IN MEDLINE DON'T AUTOMATICALLY HAVE EVERY PUBLISHED ITEM ADDED TO MEDLINE OR EVEN PUBMED] in direct violation of its own stated processes and requirements is just wrong, but to leverage this to move the needle for PMC only compounds the problem. And to allow a new publisher to leverage PMC as eLife has goes one step further.
There was no one- to two-year wait for eLife to get into PubMed through MEDLINE because they got in immediately by being in PMC. [YEP, JUST LIKE ALL THOSE OTHER JOURNALS WHO WERE WILLING TO MAKE THEIR FULL-TEXT CONTENT AVAILABLE VIA PMC]. No process akin to what other publishers have to go through. [JUST ABOUT ANY BIOMEDICAL PUBLISHER CAN MAKE THEIR CONTENT FREELY AVAILABLE VIA PMC. THEY WANT YOUR FULL-TEXT CONTENT.] Immediate acceptance into PubMed. [NOT REALLY. IF YOU'RE NOT INDEXED BY MEDLINE, YOU CAN'T SEND YOUR CITATION DATA DIRECTLY TO THEM. PMC HAS TO TAKE ELIFE'S DATA AND SEND THE CITATIONS TO PUBMED. AGAIN, NOT MEDLINE.] Magically. Inexplicably. With the US government as its primary publisher. [THE PUBLISHER OF ELIFE IS ELIFE SCIENCES PUBLICATIONS, LTD]
Before I spoke with him, I emailed Lipman, head of NCBI, last week to get his perspective on this. Here's what he said:
The NLM Selection and Acquisition Section considers a number of factors in deciding whether the scientific quality of a journal merits acceptance into PMC. The minimum number of articles required for this evaluation may vary based on the credentials of the publisher and/or sponsoring organization and of the editorial board, and on the quality of the journal's editorial policies and practices. eLife citations appear in PubMed after the articles are released in PMC, which is no different from any other non-Medline journal in PMC.
In my conversation with him a couple of days later, Lipman referred again and again back to this email, as if it explained everything. [YES, IT DOES EXPLAIN EVERYTHING] Yet, when I quoted the NLM's own stated standards [WHICH STANDARDS? YOU KEEP MIXING UP THE PMC STANDARDS WITH THOSE OF MEDLINE. HE PROBABLY COULDN'T FIGURE OUT HOW TO EXPLAIN IT MORE CLEARLY] back to him, the pregnant pause was notable. [MAYBE HE WAS TRYING TO BE POLITE AND NOT SNARKY] And, as mentioned above, he couldn't explain why the "practices" and "policies" and "credentials" of eLife might be stronger than those of a hundred other, more established publishers. [SHOW ME THE ESTABLISHED BIOMEDICAL PUBLISHER WHO HAS BEEN DENIED ACCESS TO PMC.]
A matter of minutes after I received Lipman's email quoted above, another publisher I was speaking with received a response from PMC to a general question about their policies and approach, to see if being open access (OA) made a difference to the process:
One of your new journals (it doesn't matter if it is OA or not) will need to publish at least 15 articles before it can be evaluated by the Selections Group. Once it is approved by the Selections Group, then sample articles can be sent to PMC for data evaluation. When you're ready to submit a new journal, please just send me the title, ISSN(s), and url.
So, again we have the 15-article requirement — for everyone, it seems, except eLife. [SEE http://www.ncbi.nlm.nih.gov/pmc/pub/pubinfo/ "The sample set must comprise approximately 50 articles and be representative of the variety of article types, styles and file formats found in the journal. Smaller samples may be evaluated at PMC's discretion." KEY WORD: DISCRETION]
Lipman's response is coded and disingenuous because he says that things like "credentials," "policies," and "practices" inform their decisions about what gets this magical treatment, [I THINK THE WELLCOME TRUST, THE MAX PLANCK INSTITUTE, AND THE HOWARD HUGHES MEDICAL INSTITUTE QUALIFY AS HAVING GOOD "CREDENTIALS."] but obviously the process as understood by people who work with the Selections Group is not the process Lipman or someone else he knows uses. [SNARK]
As I mentioned above, I asked him about this in our phone call. There was not a satisfactory answer. He said grand things like "we look at the big picture" and "we've been burned by publishers who have moved or stopped journals" [THERE ARE JOURNALS WHO AGREED TO MAKE THEIR FULL-TEXT CONTENT AVAILABLE ON PMC AND THEN BACKED OUT LATER. A DATABASE WITH RANDOM, SHORT SEQUENCES OF ARTICLES IS NOT VERY USEFUL. PMC HAS AN INTEREST IN ACCEPTING CONTENT FROM PUBLISHERS WHO ARE COMMITTED TO MAKING THEIR CONTENT AVAILABLE AND HAVE THE FUNDING TO STAY ALIVE] (how moving a journal affects PubMed is beyond me), and "it seemed like a reasonable bet" to take eLife early.
Let's take his words at face value — would any traditional publisher lack in "credentials" or "policies" or "practices" around a new journal and quality? [I REFER YOU TO ELSEVIER'S Australasian Journal of Bone & Joint Medicine AS ONE EXAMPLE] Not very likely. In fact, if quality and reliability were the criteria guiding decision-making — and you might hope they would be — you'd expect a fast lane for established publishers, many of which have been around for more than a century, attract top-tier editors, and have advanced publishing infrastructure. [THEY'RE WELCOME TO APPLY TO PMC, BUT I GUESS THEY'RE AFRAID OF LOSING MONEY] How a journal like eLife — which hasn't proven it can publish independently of US government subsidy, which hasn't published the requisite number of articles, [AGAIN, I REFER YOU TO "Smaller samples may be evaluated at PMC's discretion" http://www.ncbi.nlm.nih.gov/pmc/pub/pubinfo/ ] and which has yet to demonstrate solid editorial or business practices [THEY HAVE THEIR BOARD OF REVIEWING EDITORS http://www.elifesciences.org/about/elife-community/reviewing-editors/ , THEIR EDITORIAL LEADERSHIP http://www.elifesciences.org/about/elife-community/editorial-leadership/ , THE ARTICLES THEY SUBMITTED TO PMC, AND THEIR FUNDING FROM THREE OUTSTANDING NONPROFIT INSTITUTIONS] — gets a free pass suggests a strong ulterior motive is at work, something that may approach outright cronyism.
Lipman's criteria are at worst euphemisms for a specific set of policies and practices, perhaps OA, as some people I spoke with suspect — yet, even other OA publishers don't get this magic. [YES THEY DO. MAYBE NOT QUITE AS QUICKLY, I DON'T KNOW. BUT I SEE A LOT OF HIDAWI JOURNALS IN PMC. I HAVE RECEIVED HUNDREDS OF ANNOUNCEMENTS OF JOURNALS BEING ADDED TO PMC.] They have to wait, follow procedures, and prove they can publish independently. So this exception was even more specific — it was for eLife, and that's very troubling.
In addition to being unfair and infuriating, this event also shows how PMC is part of the competitive landscape with a definite role in determining who wins and loses. It leverages PubMed in this regard. It takes an active and biased role in who benefits and who suffers. It is competitive. And this is our next topic.
[OKAY, I'M TIRED OF ARGUING AND PROBABLY WASTING MY TIME. MAYBE SOMEONE ELSE CAN CONTINUE MY ATTEMPT TO REFUTE THE INCORRECT AND MISLEADING STATEMENTS IN THE REMAINER OF KENT'S POST.]
