661089

research-article2016
PED0010.1177/1757975916661089CommentaryE. F. Ruiz et al.

Commentary

The Latin America and the Caribbean search strategy proposal

Eloy F. Ruiz1,2, Alvaro Proaño1, Diego Proaño3, Junior Smith Torres-Román4
and J. Jaime Miranda1,5

Abstract: Latin America and the Caribbean’s public health literature is not widely recognized. Science
in this region has even been compared to a night sky with just a few specks of light. To make those lights
as reachable as possible, we developed the Latin America and the Caribbean Search Strategy (LACSS).
This is a new method to utilize our region’s health promotion results within MEDLINE/PubMed. In
contrast to a typical MeSH query, LACSS retrieves up to six times more publication results regarding
non-communicable diseases, neglected tropical diseases, injuries and other important public health
relevant topics in the region. We believe that global health promotion will be improved in this region
by improving its visibility, and this search strategy will contribute to this.

Keywords: Latin America, Caribbean Region, Public Health, Medical Subject Headings, PubMed

Introduction
It is important to understand health promotion in
a developing region such as Latin America and the
Caribbean (LAC) because the medical literature
therein is under-recognized by scientists around the
world (1), who tend to conduct searches only in
English and in English databases (2,3). Overall, Latin
America contributes only 2% of global scientific
production, mostly due to the contributions of
Argentina, Brazil, Chile and Mexico (4). As a result,
South American countries’ science has been compared
to a night sky with just a few specks of light (5). We
believe it is important to make those brightening
stars as reachable as possible to acknowledge the
importance of current health promotion innovations
in LAC; we will accomplish this by improving the
way we search for best practices and evidence.
Even though LAC remains as one of the most
imbalanced regions in socio-economic, demographic
and health characteristics (6), the development of its
research has been growing, most of it through several
country-based initiatives and ‘North-to-South’
collaborations (7,8). For example, Peruvian articles
are usually co-authored with scientists outside LAC
that allow a greater visibility (9). The diffusion of the
research conducted in these countries is not only
essential to promote consciousness about a striking
region with remarkable investigations, but also to
encourage partnerships in public health between the
LAC countries and the international community (1,7).
We want to provide readers with a new method to
exhaust the possibilities of their search results about
LAC within MEDLINE/PubMed, an idea similar to
that recommended by the Cochrane Highly Sensitive
Search Strategy for maximizing sensitivity in
systematic reviews (10) and an easier approach than
that proposed by Perel et al. (11). With the intention

1. Escuela Profesional de Medicina, Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia.
Lima, Perú.
2. CONEVID, Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia. Lima, Perú.
3. Facultad de Estomatología, Universidad Peruana Cayetano Heredia. Lima, Perú.
4. Facultad de Medicina, Universidad Nacional San Luis Gonzaga. Ica, Perú.
5. CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia. Lima, Perú.
Correspondence to: Eloy F. Ruiz, Av. Honorio Delgado 430, Urb. Ingeniería, Lima 31, Perú. Email: ruizeloyf@gmail.com

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2 E. F. Ruiz et al.

Table 1.  Classic query and the LACSS.

Classic query (“Latin America”[Mesh] OR “South America”[Mesh] OR “Central America”[Mesh] OR

“Caribbean Region”[Mesh] OR “Mexico”[Mesh]) AND Keyword

LACSS (“Anguilla” OR “Antigua and Barbuda” OR “Argentina” OR “Aruba” OR “Bahamas” OR

“Barbados” OR “Bolivia” OR “Belice” OR “Belize” OR “Brasil” OR “Brazil” OR “British Virgin
Islands” OR “Cayman Islands” OR “Chile” OR “Colombia” OR “Costa Rica” OR “Cuba” OR
“Dominica” OR “Dominican Republic” OR “Republica Dominicana” OR “Ecuador” OR “El
Salvador” OR “French Guiana” OR “Grenada” OR “Guadalupe” OR “Guatemala” OR “Guiana”
OR “Guyana” OR “Haiti” OR “Honduras” OR “Leeward Islands” OR “Jamaica” OR
“Martinique” OR “Mexico” OR “Montserrat” OR “Netherlands Antilles” OR “Nicaragua” OR
“Panama” OR “Paraguay” OR “Peru” OR “Puerto Rico” OR “Saint Kitts and Nevis” OR “Saint
Lucia” OR “Saint Vincent and the Grenadines” OR “Suriname” OR “Surinam” OR “Trinidad
and Tobago” OR “Turks and Caicos Islands” OR “Uruguay” OR “Venezuela” OR “Virgin
Islands of the United States” OR “Windward Islands” OR “Caribbean” OR “Central America”
OR “Latin America” OR “South America” OR “West Indies”) AND Keyword

of validating our query, we compared it with the
Medical Subject Headings (MeSH) terms most
frequently used for searching studies regarding the
LAC region in MEDLINE/PubMed.
Methods
In order to standardize our search, we took as a
reference the way the MeSH term ‘Latin America’ is
defined (12). Usually, this MeSH term is broken
down into the following subterms: ‘Caribbean
Region’, ‘Central America’, ‘Mexico’, and ‘South
America’. With these results, we created the ‘Classic
Query’ as the comparator for our proposed system.
Our proposal takes each subterm, and does an
iterative search on each single country within the
region. We call this ‘The Latin America and the
Caribbean search strategy’ (LACSS). The first part
of the search query consists of all terms that conform
to the LAC region according to its MeSH, combined
with ‘AND’ and followed by a Keyword. Both
queries are shown in Table 1.
We conducted a search in MEDLINE/PubMed on
22 February 2016, using several keywords
categorized as non-communicable diseases (NCD),
neglected tropical diseases (NTD), injuries and other
important public health relevant topics in the region.
We chose these subjects because the LAC countries
have experienced a fast epidemiological transition
since the 1990s, where a combination of NCDs and
injuries, on top of a well-known infectious scenario,
has generated a unique setting (6). Keywords are
displayed in Table 2.
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Finally, we compared the performance of our
search strategies (number of articles retrieved) and
calculated the ratio between them by dividing the
total results in the LACSS by the total results in the
Classic Query.
Results
We found around 40,000 more results with our
proposed method than with the classic MeSH query
(Table 2). Interestingly enough, we can see up to a
6-fold increase by using LACSS. When we calculated
the ratio differences between the results, the biggest
ratios were seen for ‘Epilepsy’ and ‘Fibromyalgia’,
whilst the smaller ratio differences were observed in
‘Domestic Violence’ and ‘Accidents, Traffic’. If we
separate the keywords by groups (NCD, NTD,
Injuries) we noticed that the group with the biggest
change in results is in the NCD group (median of
3.79); followed by NTD group (median of 1.84) and
finally the Injuries group (median of 1.57).
Discussion
As we had previously described, LAC is a region
where chronic conditions overlap with infectious
diseases. Because both are so relevant in our area,
we focused on articles on those topics. When
comparing the number of items found using the
Classic Query versus the LACSS, our results
demonstrated that our structured approach allowed
us to obtain as much as six times more information
than the Classic Query. The maximization of the

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 Commentary 3

Table 2.  Keywords and results according to each query.

Classic Query LACSS Ratio

NCD ‘Alzheimer Disease’[Mesh] 259 1284 4.96

Keyword ‘Asthma’[Mesh] 1035 2385 2.30
‘Atherosclerosis’[Mesh] 121 653 5.40
‘Cataract’[Mesh] 124 313 2.52
‘Diabetes Mellitus’[Mesh] 2844 8128 2.86
‘Epilepsy’[Mesh] 509 3369 6.62
‘Fibromyalgia’[Mesh] 35 200 5.71
‘Hypertension’[Mesh] 2009 5610 2.79
‘Kidney Failure, Chronic’[Mesh] 529 1699 3.21
‘Myocardial Infarction’[Mesh] 496 1882 3.79
‘Obesity’[Mesh] 2623 5944 2.27
‘Osteoporosis’[Mesh] 224 872 3.89
‘Peripheral Arterial Disease’[Mesh] 17 68 4.00
‘Pulmonary Disease, Chronic Obstructive’[Mesh] 211 822 3.90
‘Stroke’[Mesh] 438 1573 3.59
NTD ‘Chagas Disease’[Mesh] 2723 6424 2.36
Keyword ‘Chikungunya Fever’[Mesh] 41 68 1.66
‘Cysticercosis’[Mesh] 410 1209 2.95
‘Dengue’[Mesh] 1572 2319 1.48
‘Helminthiasis’[Mesh] 5437 9638 1.77
‘Leishmaniasis’[Mesh] 2287 4356 1.90
‘Leprosy’[Mesh] 1055 1795 1.70
‘Taeniasis’[Mesh] 452 1341 2.97
Injuries ‘Accidents, Traffic’[Mesh] 465 728 1.57
Keyword ‘Domestic Violence’[Mesh] 704 1035 1.47
‘Drowning’[Mesh] 25 44 1.76
Other ‘Bartonella Infections’[Mesh] 117 200 1.71
Keywords ‘HIV’[Mesh] 1246 2564 2.06
‘Malaria’[Mesh] 2404 3635 1.51
‘Helicobacter pylori’[Mesh] 541 1270 2.35
‘Stomach Neoplasms’[Mesh] 542 1277 2.36
‘Tuberculosis’[Mesh] 2878 4840 1.68
‘Zika Virus’[Mesh] 3 5 1.67
Total 34376 77550 2.26

results with this new LACSS hopefully prevents the
loss of important elements that could contribute to
the inquiry readers are seeking.
The increase in the number of items found is
because the Classic Query presents some drawbacks
and pitfalls. First, it requires the article to be indexed
by the MeSH term of the country or the region. A
second important factor to consider is that the
National Library of Medicine (NLM) indexing
process may fail when assigning the MeSH terms,
retrieving fewer results (13). The example that
Hooijmans et al. use in their paper is that the NLM
may miss MeSH terms for a specific topic, such as
only assigning the MeSH term ‘mice’ instead of
‘animals’ and ‘mice’ for mice-related experiments
(13). Furthermore, Fielding and Powell stated that
MeSH terms may be poorly indexed (14), and this
was later demonstrated by Minguet et  al. when
they proved the low quality of assignment of the
pharmacy-specific MeSH terms (15). This means
that if the MeSH term is not set as a keyword in the
article, it would not be found in the search. Third,
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4 E. F. Ruiz et al.
there is a delay when MeSH-indexing newly
submitted articles (13), which makes them
impossible to find. Finally, many scientists do not
know how to use MEDLINE/PubMed to its full
extent, especially when applying the MeSH terms
(13). Liu demonstrated that MeSH terms differ in
usefulness according to the user’s level of expertise
(16). This means that the lack of familiarity with a
specific topic and its MeSH term may lead to the
loss of crucial information, even when using separate
terms for each country, and could lead our
brightening stars of LAC to fade away in the archive.
This problem arises with new epidemics, such as
Zika Virus, in which LACSS proved to be 1.67 times
as efficient when retrieving results. Getting more
information about the virus in our region of the
world would help others know what is happening
and help innovate new public health ideas to fight it
and promote good health practices.
There are four limitations to our LACSS. A first
criticism of our proposed system is that we limited
ourselves to only creating a method to perform
literature searches in MEDLINE/PubMed and
avoided using LAC databases which perhaps could
be more representative of the quantity of articles in
the region (17). Undesirably, the LAC database
search engines are limited and do not allow complex
searches. Although some initiatives have been
developed to maximize results when using them (18),
they have not had a noteworthy impact. This is the
reason why we only chose MEDLINE/PubMed to
create our LACSS. The second limitation refers to its
cumbersome syntax which can make it harder for
researchers and scientists to replicate. The third
limitation is that our query uses MeSH keywords to
look for specific topics, which may limit the number
of results (as stated before). However, this was done
mostly in order to compare with the classical method
of searching. The fourth limitation is if, for example,
a country’s name is not listed in the publication but
only the nationality (Brazil vs. Brazilian), our query
will not find it. LACSS was created to help increase
sensitivity of the search results; however, it could be
argued that some articles that will come up are not
relevant to the researcher. This can occur in two
scenarios; the first one is when an author’s affiliation
is associated with a specific country but the research
was not done there. The second scenario where this
could occur is when a country’s name is just mentioned
in the abstract without having actual relevance.
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We acknowledge that aside from being an
innovative search strategy, our system is also a
powerful tool for authors, because if we consider
that these publications are failing to be read, they
will not be cited, and thus the dissemination of their
findings will be hindered.
Conclusion
We encourage readers and researchers interested
in obtaining the largest amount of public health
information about the LAC region in MEDLINE/
PubMed to use our LACSS. It will brighten a little
bit our dark night sky of science, and will help
others build on prior knowledge to help promote
and improve public health. If we are lucky enough
this might even help our region have a night sky as
bright as day.
Author contributions
Conceived and designed the idea: EFR, AP, JJM. Acquisition
of data: EFR, AP, DP, JST. Wrote the first draft of the
manuscript: EFR, AP, DP. Contributed to the writing of the
manuscript: EFR, AP, DP, JST, JJM. Critical revision of the
manuscript: JJM. Approval of the submitted and final
version: EFR, AP, DP, JST, JJM.
Declaration of conflicting interest
None declared.
Funding
JJM is affiliated to CRONICAS Centro de Excelencia en
Enfermedades Crónicas at Universidad Peruana Cayetano
Heredia, which is funded by the National Heart, Lung And
Blood Institute, National Institutes of Health, Department
of Health and Human Services, under contract Number
HHSN268200900033C.
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