Tetanus: A bibliographic analysis of theses from Turkey

Abstract

Objectives: The aim of this study was to conduct a bibliographic analysis of the theses on tetanus published in our country.

Materials and methods: The bibliometric analysis was carried out on tetanus-related graduate theses written in Turkey between 1971 and 2020. The theses were examined in terms of date, type, subject, institution, sample size, and index.

Results: The study included 41 theses. The sample size ranged from 13 to 1,292. Ege University, Dokuz Eylul University, Gazi University, and Mustafa Kemal University were the institutions with the most theses written from 28 different institutions. Thirty (73.1%) of the theses were medical specialty theses. They were mostly written by the branches of Infectious Diseases and Clinical Microbiology (31.7%) and Microbiology (21.9%).

Conclusion: In the content analysis of the theses, it was determined that there were studies on antibody level/immunity/vaccine and seroprevalence, but there were few studies on disease treatment. This study is limited to the theses written in our country. By expanding the scope of the study, more detailed information can be obtained.

Introduction

Tetanus is an infectious disease caused by the anaerobic bacillus Clostridium tetani (C. tetani) which can be fatal due to convulsions.[1] Although tetanus is now rare in developed countries due to vaccination, it remains a public health problem, mainly in developing countries, due to insufficient vaccination. Because C. tetani spores cannot be eliminated from the environment, this disease will continue to stay on the agenda.[1,2]

The most important function of universities with postgraduate education is to train future academicians, and evaluating theses written in many branches of the academy from an integrated perspective gives science a different point of view. For this purpose, bibliometric techniques can be used.[3-5]

There has been a significant increase in scientific content in Turkey and around the world in recent years, and it is necessary to evaluate scientific content while planning studies. The purpose of this study was to provide a perspective on the determination of deficiencies in the field, with a bibliographic analysis of postgraduate theses on “tetanus” to researchers who plan to study on this subject.

Patients and Methods

The study group consisted of 41 postgraduate theses with the keyword “tetanus” written in Turkey between 1971 and 2020 and indexed in the database of The Council of Higher Education (CoHE) National Theses Center. In this study, document analysis (bibliometric research), one of the qualitative research methods, was used.[6] Bibliometric research contributes to the development of future science policies by assessing the proficiency, number, and quality of scientific branches in their corresponding fields. In this study, the theses were examined in terms of date, type, place, subject, institution, sample size, and index. The study was conducted in accordance with the principles of the Declaration of Helsinki.

Theses, which can be accessed in the National Theses Center Database of the Council of Higher Education (CoHE), were transferred to the thesis review form created by the researchers and analyzed. While creating the thesis review form, the forms used in similar studies were examined, and a proposal form was created.[7-11]

The year the theses were published, the institution, research method, data analysis techniques, study group, and research topic were all examined in this research. The study was conducted in accordance with ethical principles.

Results

Data analysis

In the study, descriptive analysis was performed while content analysis was carried out. The frequency analysis of the sampling, data collection techniques, and data analysis methods was used to evaluate the research.

A. Descriptive analysis: A total of 41 theses were analyzed. The following are the contents of the parameters that were assessed in the analysis.

1. The year of theses: Looking at the distribution by year, it was found that most theses were written between 2001 and 2010 (Table 1).

Table 1. Evaluation of doctoral dissertations

2. Level of theses: The highest number was found at the level of specialization in medicine (n=30, 73.1%), and the second was at the level of master's degree (n=8, 19.5%) (Figure 1).

Figure 1. Distribution of graduate theses according to years and education level.

B. Sampling and thematic analysis: The sample size ranged between 13 and 1292. The institutions with the most theses written from 28 different institutions were Ege University, Dokuz Eylül University, Gazi University, and Mustafa Kemal University, each with two theses. Thirty (73.1%) of theses were Medical Specialty theses. Thirteen (31.7%) of the theses were written in Infectious Diseases and Clinical Microbiology, 10 (24.3%) in Microbiology, nine (21.9%) in Public Health, three (7.3%) in Child Health and Diseases, and one in Anesthesiology, Family Medicine, Orthopedics, Veterinary Medicine, First and Emergency Aid, Obstetrics and Gynecology (Figure 2). There was a study on a rat and a colt. Others were on human. Six were in pregnant women, and two were in newborns. There were 12 vaccines, 10 antibody levels, three tetanus treatments, immunity and seroprevalence studies.

Figure 2. Distribution of theses according to branches.

When the doctoral theses were analyzed, it was found that they were all prospective, with sample sizes ranging from 90 to 431 (Table 1). Looking at the master's theses, it was found out that the majority of them (87.5%) were prospective, and the sample group consisted of people except for one study. The sample size ranged from 13 to 365, and they were performed in a variety of fields ranging from veterinary to nursing (Table 2).

Table 2. Evaluation of master’s theses

Most theses (n=31) were written in the field of specialization in medicine, and a detailed analysis was performed in this field (Table 3).

Table 3. The bibliometric analysis of specialization theses in medicine

Discussion

According to World Health Organization (WHO) data for 2019, there are 14,751 new cases of tetanus worldwide, and tetanus is still one of the diseases that remains important. Therefore, studies are needed to prevent and manage this disease. Vaccination policies have reduced neonatal tetanus cases worldwide over the years. However, sporadic cases of tetanus continue to occur in adults whose antibody levels have declined over time, who have previously been vaccinated but have not received booster doses, or who have never been vaccinated.[12,13]

Tetanus immunization is also considered important by the Ministry of Health of the Republic of Turkey, and there is an “Expanded Program on Immunization” circular on the subject.[14] Adult tetanus cases, however, are still being reported in our country.[15-19]

Apart from the theses conducted in our country, other tetanus studies were examined, and it was found that seroprevalence and immunity studies were found in the local literature.[20-23] There are also studies that evaluate knowledgeopinion-attitude about tetanus vaccination.[24] The majority of the theses examined in our study were antibody level/immunity/seroprevalence/ vaccine studies, with a small number of theses on treatment.

There was no bibliographical review of this topic in either local or foreign literature. In the literature review, there were only a few foreign reviews and meta-analyses.[25-30]

The limitations of the study were the scope and source of the researched theses. The data were obtained by evaluating only theses written in our country, rather than the international literature.

In conclusion, according to the content analysis of tetanus theses, there were antibody level/immunity/vaccine and seroprevalence studies, but there were few studies on disease treatment. By expanding the scope of the research, more detailed information can be obtained. In this way, a comparative study can provide researchers working in this field with a new perspective on developments.

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

The authors received no financial support for the research and/or authorship of this article.

References

1. Wen SC, Webb C, Miles F, Wilson E. Tetanus in New Zealand children: Intensive care management of a vaccine preventable disease. J Paediatr Child Health 2016;52:1070-4.
2. Available at: https://www.uptodate.com/contents/ tetanus [Accessed: December 5, 2020]
3. Al U, Doğan G. Hacettepe Üniversitesi Bilgi ve Belge Yönetimi Bölümü tezlerinin atıf analizi. Türk Kütüphaneciliği 2012;26:349-69.
4. Kayaoğlu HD. İstanbul Üniversitesi Bilgi ve Belge Yönetimi Bölümü’nde araştırma eğilimleri 1967- 2008: Lisansüstü tezlerinin içerik analizi. Türk Kütüphaneciliği 2009;23:535-62.
5. Bonilla-Aldana DK, Quintero-Rada K, MontoyaPosada JP, Ramírez-Ocampo S, Paniz-Mondolfi A, Rabaan AA, et al. SARS-CoV, MERS-CoV and now the 2019-novel CoV: Have we investigated enough about coronaviruses? - A bibliometric analysis. Travel Med Infect Dis 2020;33:101566.
6. Available at: https://tez.yok.gov.tr/UlusalTezMerkezi/tezSorguSonucYeni.jsp [Accessed: November 15, 2020]
7. Muslu Ü. Global literatürde antropometri ve plastik cerrahi birlikteliği: 1975 ve 2017 yılları arasındaki akademik yayınların bibliyometrik analizi. Hitit Üniversitesi Sosyal Bilimler Enstitüsü Dergisi 2018;11:1321-36.
8. Şenel E, Demir E, Alkan RM. Bibliometric analysis on global Behçet disease publications during 1980- 2014: İs there a Silk Road in the literature? J Eur Acad Dermatol Venereol 2017;31:518-22.
9. Polat E, Düzgün E, Yeşiltaş M. İklim değişikliğinin turizme etkisini belirlemeye yönelik hazırlanan lisansüstü tezlerin bibliyometrik profili. Gümüşhane Üniversitesi Sosyal Bilimler Enstitüsü Elektronik Dergisi 2019;10(EkSayı):240-9.
10. Altaş A, Acar Y. Bibliometric profile of the postgraduate dissertations written in the field of gastronomy. Aksaray Üniversitesi İktisadi ve İdari Bilimler Fakültesi Dergisi 2018;10:1-10.
11. Sönmez H, Hastürk HG. Türkiye’de fen eğitimi alanında doktora düzeyinde yapılan tez çalışmalarının bibliyografik analizi. İnsan ve Toplum Bilimleri Araştırmaları Dergisi 2020;9:3174-94.
12. Available at: https://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/passive/tetanus/en/ [Accessed: November 15, 2020]
13. Available at: https://www.cdc.gov/tetanus/ surveillance.html [Accessed: November 15, 2020]
14. T.C. Sağlık Bakanlığı. Genişletilmiş bağışıklama programı genelgesi. Available at: https://www.saglik. gov.tr/TR,11080/genisletilmis-bagisiklama-programigenelgesi.html [Accessed: November 15, 2020]
15. Koruk ST, Söğüt O, Karaağaç L, Çalişir C, Yalçın Ş. The disease that is unforgettable: A case of rapidly progressive tetanus. Journal of Academic Emergency Medicine 2013;12:174-7.
16. Ergonul O, Erbay A, Eren S, Dokuzoguz B. Analysis of the case fatality rate of tetanus among adults in a tertiary hospital in Turkey. Eur J Clin Microbiol Infect Dis 2003;22:188-90.
17. Bayram A, Esmaoğlu Çoruh A, Akın A. Yoğun bakım ünitesinde ciddi tetanoz olgu yönetimi. Erciyes Med J 2010;32:143-6.
18. Dumanlı Özcan AT, İzdeş S, Taştan S, Kanbak O. Ağır tetanoz olgusu. Anestezi Derg 2007;15:196-8.
19. Temoçin F, Köse H, Sarı S. İnkübasyon süresi kısa olan bir jeneralize tetanos olgusu. Klimik Derg 2018;31:64-6.
20. Kurçer MA, Şimşek Z, SolmazA, Dedeoğlu Y, Gülel R. Şanlıurfa Harrankapı Sağlık Ocağı Bölgesi’nde 0-2 yaş çocuk ve gebelerde aşılanma oranları ve aşılanmada sorunlar. Harran Üniversitesi Tıp Fakültesi Dergisi 2005;2:10-5.
21. Simsek Z, Koruk I, Yasar O. An intervention study: The effectiveness of sustainable mobile health care services for migratory and seasonal farmworkers. 12th World Congress on Public Health: Making a Difference in Global Public Health: Education, Research and Practice. 27 April - 1 May 2009, İstanbul: WHO; 2009.
22. Maral I, Baykan Z, Aksakal FN, Kayikcioglu F, Bumin MA. Tetanus immunization in pregnant women: Evaluation of maternal tetanus vaccination status and factors affecting rate of vaccination coverage. Public Health 2001;115:359-64.
23. Önde M, Ergin F, Atasoylu G, Çıbık A. Aydın'da 15-49 yaş arası kadınlarda tetanoz bağışıklamasında kaçırılmış fırsatlar. Adnan Menderes Üniversitesi Tıp Fakültesi Dergisi 2007;8:12-8.
24. Saoğlu İ, Özsoy SA, Öztürk Dönmez R. Kadın hastalıkları ve doğum uzmanı hekimlerin gebelikte tetanos aşısına ilişkin görüşleri. Ege Tıp Dergisi 2013;52:67-72.
25. Rodrigo C, Fernando D, Rajapakse S. Pharmacological management of tetanus: An evidence-based review. Crit Care 2014;18:217.
26. Korber A, Graue N, Rietkotter J, Kreuzfelder E, Grabbe S, Dissemond J. Insufficient tetanus vaccination status in patients with chronic leg ulcers. Results of a prospective investigation in 100 patients. Dermatology 2008;217:69-73.
27. Yen LM, Thwaites CL. Tetanus. Lancet 2019;393:1657-68.
28. Leidner AJ, Murthy N, Chesson HW, Biggerstaff M, Stoecker C, Harris AM, et al. Cost-effectiveness of adult vaccinations: A systematic review. Vaccine 2019;37:226-34.
29. Afshar M, Raju M, Ansell D, Bleck TP. Narrative review: Tetanus-a health threat after natural disasters in developing countries. Ann Intern Med 2011;154:329-35.
30. Crone VE, Uslu B, Bærentzen FØ, Holmgaard DB, Wiese L. Tetanus in Denmark - a forgotten but dangerous disease. Ugeskr Laeger 2019;181:V10180698.