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Increasing diversity within the Journal

      In June this year, two meetings of the Editorial Board of JCE affirmed the importance of promoting and extending diversity in all its manifestations within the journal. In the December issue we are pleased to present the first tranche of articles that report on the growth of the evidence eco-systems in health and social care in China. These two series, addressing health and social care respectively build on earlier similar collections that promoted work undertaken in the Caribbean, India, Latin America and South Africa [
      • Tricco Andrea C.
      • et al.
      The International Clinical Epidemiology Network increases capacity for clinical epidemiology research in Jamaica.
      ,
      Introduction
      Challenges to clinical epidemiology in India.
      ,
      • Gómez Restrepo Carlos
      • et al.
      Latin American Clinical Epidemiology Network Series – Paper 1: The Latin American Clinical Epidemiology Network “LatinCLEN”.
      ,
      • Young Taryn
      • et al.
      Clinical Epidemiology in South Africa series. Paper 1: Evidence-based health care and policy in Africa: past, present, and future.
      ]. As can been in Figure 1, each of these series has accompanied a rise in the number of publications from low and middle income countries, although as the graphic comparing authorship across time also shows, the increase has not been maintained.
      Data provided by our publishers show that the number of annual submissions to JCE are continuing to rise. In 2020, contributors from Asia made up the largest segment for the first time (472/1269, 37.2%), followed by Europe (419/1269, 33%) and North and Central America (244/1269, 19.2%). However, the same data from Oceania, Africa and South America make for less promising reading; authors from these regions made up merely 130/1269 (10.2%) in total. This heterogeneous picture is compounded by the comparison for published articles, in which Europe (157/301, 52%) and North and Central America dominate (85/301, 28.2%) with Asia in third place at 33/ 301 (11%). Together, Oceania and South America contribute merely 26 published articles and no published manuscripts were led by authors from Africa.
      To address these challenges, action is clearly needed at multiple levels. The first article in the China series provides a history of the development of EBM in China using the approach of creating an oral history through interviews with some of the key actors [
      • Li Bo
      • et al.
      Clinical Epidemiology in China series. Paper 1: Evidence-based medicine in China: An oral history study.
      ]. The article shows the importance of the development of a network of influential centres and research groups, and also the role of eminent supporters from outside China. It also demonstrates clearly that many of the challenges faced in China will be recognisable to clinical epidemiologists across the world: including low awareness and understanding of EBM among health professionals and the public, and the ubiquitous scarcity of funding and learning opportunities. The authors report how concerted action to address all of these challenges can create the platform for future success.
      The second article in the series develops this further, focussing on the adoption and implementation of GRADE within the Chinese evidence eco-system [
      • Xun Yangqin
      • et al.
      Clinical Epidemiology in China series. Paper 2: Promoting GRADE at the national level: The experience from China.
      ]. Since the opening of the first GRADE centre in China in 2011, Chinese researchers have contributed to the development of the GRADE methods through the GRADE working group, and have supported their use via translation of key articles. There has also been a substantial programme of workshops and meeting across the growing network of GRADE centres. This has led to an increase in the use of GRADE by guidelines producers, albeit there remains room for further improvement. Continuing the theme of action at multiple levels, the authors report the important role of social media platforms WeChat and Weibo in expanding awareness.
      The quality of systematic reviews and guidelines is a worldwide challenge. As Editors of JCE we are aware of the many submissions from Chinese researchers highlighting the limitations of many aspects of reviews and guidelines published in China and elsewhere. Such willingness to be self-critical is an important attribute towards building improvement. In the third article in the China series Cao and colleagues present an evaluation of the methodological and reporting quality of 336 systematic reviews published by Chinese authors between 2016 and 2018 [
      • Cao Liujiao
      • et al.
      Clinical Epidemiology in China series. Paper 3: The methodological and reporting quality of systematic reviews and meta-analyses published by China' researchers in English-language is higher than those published in Chinese-language.
      ]. The findings show some characteristic challenges, with few than 50% of SRs reporting the development of a protocol or registration, or providing sufficient description of searches or funding support. Interestingly, the results also show that reviews written in English demonstrated slightly better methods and reporting compared with those written in Chinese. The 4th paper in the series presents a similar evaluation of the quality of methods and reporting of published clinical practice guidelines in China, using the RIGHT checklist and AGREE II tools [
      • Zhou Qi
      • et al.
      Clinical Epidemiology in China series. Paper 4: The reporting and methodological quality of Chinese clinical practice guidelines published between 2014 and 2018: A systematic review.
      ]. In common with similar studies elsewhere, the authors identify improvement but considerable challenges remaining across both content and reporting. This includes but is not limited to underuse of GRADE.
      Future issues of the journal will expand the China focus further, covering the development of a national branch of the Equator network, and a three paper series on the growth of evidence in the social sciences in China [
      Evidence-based social sciences in China: introduction to a special collection.
      ].
      What can we learn from the China experience? The rise in submissions shows that the development of a co-ordinated network of EBM centres has, at least in part, helped to increase awareness of JCE and perhaps also to promote it as a potential journal in which to publish. The low publication figures suggest that there is still work to do to ensure that researchers understand the mission and expectations of the journal, and perhaps also in how articles are selected for publication. Furthermore, work undertaken by experienced JCE editors, led by Tony and Inday Dans has demonstrated that mentoring of researchers can be successful at assisting researchers to achieve publication, albeit this activity is unsupported financially and requires considerable commitment. As Tony has said, accessibility of the published articles is also a critical feature, particularly in low income countries, in building awareness and visibility. Open access, which has increased substantially for JCE articles published in 2021, and should continue this trend should ameliorate this. Furthermore, the inclusion, where appropriate, of sections within manuscripts that address the applicability of content to LMIC settings (see example, Figure 2), can promote effective knowledge translation [
      Ticagrelor was cost effective versus Clopidogrel in acute coronary syndrome in Chile De la Puente C, et al.
      ].
      Broadening geographical inclusion is a key strategic priority for JCE in 2022. We aim to address this in different ways by building on the experience and expertise of our colleagues in China and elsewhere. At the end of another challenging year for the global community, we also wish to thank the many contributors and peer reviewers who have supported the journal. We are immeasurably grateful to you, and wish you and your communities all peace and good health for 2022 and beyond.

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