Functional near-infrared spectroscopy of medical students answering various item types.

Background: Traditionally, the effect of assessment item types including true/false questions (TFQs), multiple-choice questions (MCQs), short answer questions (SAQs), and case scenario questions (CSQs) is examined through psychometric qualities or student interviews. However, brain activity while answering such questions or items remains unknown. Functional near-infrared spectroscopy (fNIRS) can be used to safely measure cerebral cortex hemodynamic response during various tasks. Hence, this fNIRS study aimed to determine differences in frontotemporal cortex activity as medical students answered TFQs, MCQs, SAQs, and CSQs. Methods: In total, 24 medical students (13 males and 11 females) were recruited in this study during their mid-psychiatry posting. Oxy-hemoglobin and deoxy-hemoglobin levels in the frontal and temporal regions were measured with a 52-channel fNIRS system. Participants answered 9-18 trials under each of the four types of tasks that were based on their psychiatry curriculum during fNIRS measurements. The area under the oxy-hemoglobin curve (AUC) for each participant and each item type was derived. Repeated measures ANOVA with post-hoc Bonferroni-corrected pairwise comparisons were used to determine differences in oxy-hemoglobin AUC between TFQs, MCQs, SAQs, and CSQs. Results: Oxy-hemoglobin AUC was highest during the CSQs, followed by SAQs, MCQs, and TFQs in both the frontal and temporal regions. Statistically significant differences between different types of items were observed in oxy-hemoglobin AUC of the frontal region (p ≤ 0.001). Oxy-hemoglobin AUC in the frontal region was significantly higher during the CSQs than TFQ (p = 0.005) and during the SAQ than TFQ (p = 0.025). Although the percentage of correct responses was significantly lower in MCQ than in the other item types, there was no correlation between the percentage of correct response and oxy-hemoglobin AUC in both regions for all four item types (p > 0.05). Conclusion: CSQs and SAQs elicited greater hemodynamic response than MCQs and TFQs in the prefrontal cortex of medical students. This suggests that more cognitive skills may be required to answer CSQs and SAQs.

Functional Near-Infrared Spectroscopy of English-Speaking Adults With Attention-Deficit/Hyperactivity Disorder During a Verbal Fluency Task.

OBJECTIVE: Functional near-infrared spectroscopy (fNIRS) provides direct and quantitative assessment of cortical hemodynamic response. It has been used to identify neurophysiological alterations in medication-naïve adults with attention-deficit/hyperactivity disorder (ADHD). Hence, this study aimed to distinguish both medication-naïve and medicated adults with ADHD from healthy controls (HC). METHOD: 75 HCs, 75 medication-naïve, and 45 medicated patients took part in this study. fNIRS signals during a verbal fluency task (VFT) were acquired using a 52-channel system and relative oxy-hemoglobin changes in the prefrontal cortex were quantified. RESULTS: Prefrontal cortex hemodynamic response was lower in patients than HCs (p ≤ ≤.001). Medication-naïve and medicated patients did not differ in hemodynamic response or symptom severity (p > .05). fNIRS measurements were not associated with any clinical variables (p > .05). 75.8% patients and 76% HCs were correctly classified using hemodynamic response. CONCLUSION: fNIRS may be a potential diagnostic tool for adult ADHD. These findings need to be replicated in larger validation studies.

Identifying neuroimaging biomarkers of major depressive disorder from cortical hemodynamic responses using machine learning approaches.

BACKGROUND: Early diagnosis of major depressive disorder (MDD) could enable timely interventions and effective management which subsequently improve clinical outcomes. However, quantitative and objective assessment tools for the suspected cases who present with depressive symptoms have not been fully established. METHODS: Based on a large-scale dataset (n = 363 subjects) collected with functional near-infrared spectroscopy (fNIRS) measurements during the verbal fluency task (VFT), this study proposed a data representation method for extracting spatiotemporal characteristics of NIRS signals, which emerged as candidate predictors in a two-phase machine learning framework to detect distinctive biomarkers for MDD. Supervised classifiers (e.g., support vector machine (SVM), k-nearest neighbors (KNN)) cooperated with cross-validation were implemented to evaluate the predictive capability of selected features in a training set. Another test set that was not involved in developing the algorithms enabled the independent assessment of the model's generalization. FINDINGS: For the classification with the optimal fusion features, the SVM classifier achieved the highest accuracy of 75.6% ± 4.7% in the nested cross-validation, and the correct prediction rate of 78.0% with a sensitivity of 75.0% and a specificity of 81.4% in the test set. Moreover, the multiway ANOVA test on clinical and demographic factors confirmed that twenty out of 39 optimal features were significantly correlated with the MDD-distinctive consequence. INTERPRETATION: The abnormal prefrontal activity of MDD may be quantified as diminished relative intensity and inappropriate activation timing of hemodynamic response, resulting in an objectively measurable biomarker for assessing cognitive deficits and screening MDD at the early stage. FUNDING: This study was funded by NUS iHeathtech Other Operating Expenses (R-722-000-004-731).

Premenopausal Singaporean Women Suffering from Major Depressive Disorder Treated with Selective Serotonin Reuptake Inhibitors Had Similar Bone Mineral Density as Compared with Healthy Controls.

The association between selective serotonin reuptake inhibitor (SSRI) treatment and lower bone mineral density (BMD) remains controversial, and further research is required. This study aimed to compare the BMD, levels of bone formation and bone metabolism markers in medicated premenopausal Singaporean women with major depressive disorder (MDD) and matched healthy controls. We examined 45 women with MDD who received SSRI treatment (mean age: 37.64 ± 7) and 45 healthy controls (mean age: 38.1 ± 9.2). BMD at the lumbar spine, total hip and femoral neck were measured using dual-energy X-ray absorptiometry. We also measured bone formation markers, procollagen type 1 N-terminal propeptide (P1NP) and bone metabolism markers, osteoprotegerin (OPG) and receptor activator of nuclear factor-kappa-Β ligand (RANKL). There were no significant differences in the mean BMD in the lumbar spine (healthy controls: 1.04 ± 0.173 vs. MDD patients: 1.024 ± 0.145, p = 0.617, left hip (healthy controls: 0.823 ± 0.117 vs. MDD patients: 0.861 ± 0.146, p = 0.181) and right hip (healthy controls: 0.843 ± 0.117 vs. MDD patients: 0.85 ± 0.135, p = 0.784) between healthy controls and medicated patients with MDD. There were no significant differences in median P1NP (healthy controls: 35.9 vs. MDD patients: 37.3, p = 0.635), OPG (healthy controls: 2.6 vs. MDD patients: 2.7, p = 0.545), RANKL (healthy controls: 23.4 vs. MDD patients: 2178.93, p = 0.279) and RANKL/OPG ratio (healthy controls: 4.1 vs. MDD patients: 741.4, p = 0.279) between healthy controls and medicated patients with MDD. Chronic SSRI treatment might not be associated with low BMD in premenopausal Singaporean women who suffered from MDD. This finding may help female patients with MDD make an informed decision when considering the risks and benefits of SSRI treatment.

Repetitive Transcranial Magnetic Stimulation for Fibromyalgia: An Updated Systematic Review and Meta-Analysis.

OBJECTIVE: Meta-analysis was performed to evaluate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in fibromyalgia on the domains of pain, depression, anxiety and quality of life. METHOD: Publications were searched with the keywords "repetitive transcranial magnetic stimulation" and "fibromyalgia" for randomized controlled trials that compare rTMS with sham stimulation for treating pain, depression, anxiety, and quality of life. Trials available until April 2021 were searched through PubMed, Scopus, Web of Science, and Cochrane Controlled Trials Register. The postintervention scores after 4 weeks for pain, depression, anxiety, and quality of life were extracted to compare the effects of rTMS and sham. Subgroup analysis was conducted based on the stimulation site. RESULTS: From 265 screened articles, 11 eligible randomized controlled trials involving 303 patients were included. The results show that rTMS is more effective than sham stimulation in improving pain (standardized mean difference [SMD] = -0.35; 95% confidence interval [CI] = -0.62 to -0.08; p = .01) and quality of life (SMD = -0.51; 95% CI = -0.78 to -0.23; p = .0003). It is not more effective than sham stimulation for depression, and anxiety. After sensitivity analysis, subgroup analysis revealed that primary motor cortex stimulation was more effective than sham for improving pain (SMD = -0.57; 95% CI = -0.91 to -0.23; p = <0.01). Neither dorsolateral prefrontal cortex nor primary motor cortex stimulation was more effective than sham in improving depression and anxiety. CONCLUSIONS: rTMS is more effective than sham in improving pain and quality of life, but it does not demonstrate reduction in depression or anxiety.

Functional near-infrared spectroscopy during the verbal fluency task of English-Speaking adults with mood disorders: A preliminary study.

Functional near-infrared spectroscopy (fNIRS) provides a direct and objective assessment of cerebral cortex function. It may be used to determine neurophysiological differences between psychiatric disorders with overlapping symptoms, such as major depressive disorder (MDD) and bipolar disorder (BD). Therefore, this preliminary study aimed to compare fNIRS signals during the verbal fluency task (VFT) of English-speaking healthy controls (HC), patients with MDD and patients with BD. Fifteen HCs, 15 patients with MDD and 15 patients with BD were recruited. Groups were matched for age, gender, ethnicity and education. Relative oxy-haemoglobin and deoxy-haemoglobin changes in the frontotemporal cortex was monitored with a 52-channel fNIRS system. Integral values of the frontal and temporal regions were derived as a measure cortical haemodynamic response magnitude. Both patient groups had lower frontal and temporal region integral values than HCs, and patients with MDD had lower frontal region integral value than patients with BD. Moreover, patients could be differentiated from HCs using the frontal and temporal integral values, and patient groups could be differentiated using the frontal region integral values. VFT performance, clinical history and symptom severity were not associated with integral values. These results suggest that prefrontal cortex haemodynamic dysfunction occurs in mood disorders, and it is more extensive in MDD than BD. The fNIRS-VFT paradigm may be a potential tool for differentiating MDD from BD in clinical settings, and these findings need to be verified in a larger sample of English-speaking patients with mood disorders.

Comparison of Brain Activation Patterns during Olfactory Stimuli between Recovered COVID-19 Patients and Healthy Controls: A Functional Near-Infrared Spectroscopy (fNIRS) Study.

Impaired sense of smell occurs in a fraction of patients with COVID-19 infection, but its effect on cerebral activity is unknown. Thus, this case report investigated the effect of COVID-19 infection on frontotemporal cortex activity during olfactory stimuli. In this preliminary study, patients who recovered from COVID-19 infection (n = 6) and healthy controls who never contracted COVID-19 (n = 6) were recruited. Relative changes in frontotemporal cortex oxy-hemoglobin during olfactory stimuli was acquired using functional near-infrared spectroscopy (fNIRS). The area under curve (AUC) of oxy-hemoglobin for the time interval 5 s before and 15 s after olfactory stimuli was derived. In addition, olfactory function was assessed using the Sniffin' Sticks 12-identification test (SIT-12). Patients had lower SIT-12 scores than healthy controls (p = 0.026), but there were no differences in oxy-hemoglobin AUC between healthy controls and patients (p > 0.05). This suggests that past COVID-19 infection may not affect frontotemporal cortex function, and these preliminary results need to be verified in larger samples.

Cortical haemodynamic response during the verbal fluency task in patients with bipolar disorder and borderline personality disorder: a preliminary functional near-infrared spectroscopy study.

BACKGROUND: Functional near-infrared spectroscopy (fNIRS) is an emerging neuroimaging modality that provides a direct and quantitative assessment of cortical haemodynamic response during a cognitive task. It may be used to identify neurophysiological differences between psychiatric disorders with overlapping symptoms, such as bipolar disorder (BD) and borderline personality disorder (BPD). Hence, this preliminary study aimed to compare the cerebral haemodynamic function of healthy controls (HC), patients with BD and patients with BPD. METHODS: Twenty-seven participants (9 HCs, 9 patients with BD and 9 patients with BPD) matched for age, gender, ethnicity and education were recruited. Relative oxy-haemoglobin and deoxy-haemoglobin changes in the frontotemporal cortex was monitored with a 52-channel fNIRS system during a verbal fluency task (VFT). VFT performance, clinical history and symptom severity were also noted. RESULTS: Compared to HCs, both patient groups had lower mean oxy-haemoglobin in the frontotemporal cortex during the VFT. Moreover, mean oxy-haemoglobin in the left inferior frontal region is markedly lower in patients with BPD compared to patients with BD. Task performance, clinical history and symptom severity were not associated with mean oxy-haemoglobin levels. CONCLUSIONS: Prefrontal cortex activity is disrupted in patients with BD and BPD, but it is more extensive in BPD. These results provide further neurophysiological evidence for the separation of BPD from the bipolar spectrum. fNIRS could be a potential tool for assessing the frontal lobe function of patients who present with symptoms that are common to BD and BPD.

A chain mediation model on COVID-19 symptoms and mental health outcomes in Americans, Asians and Europeans.

The novel Coronavirus-2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO) in March 2020, impacting the lifestyles, economy, physical and mental health of individuals globally. This study aimed to test the model triggered by physical symptoms resembling COVID-19 infection, in which the need for health information and perceived impact of the pandemic mediated the path sequentially, leading to adverse mental health outcomes. A cross-sectional research design with chain mediation model involving 4612 participants from participating 8 countries selected via a respondent-driven sampling strategy was used. Participants completed online questionnaires on physical symptoms, the need for health information, the Impact of Event Scale-Revised (IES-R) questionnaire and Depression, Anxiety and Stress Scale (DASS-21). The results showed that Poland and the Philippines were the two countries with the highest levels of anxiety, depression and stress; conversely, Vietnam had the lowest mean scores in these areas. Chain mediation model showed the need for health information, and the perceived impact of the pandemic were sequential mediators between physical symptoms resembling COVID-19 infection (predictor) and consequent mental health status (outcome). Excessive and contradictory health information might increase the perceived impact of the pandemic. Rapid COVID-19 testing should be implemented to minimize the psychological burden associated with physical symptoms, whilst public mental health interventions could target adverse mental outcomes associated with the pandemic.

An Asia-Pacific study on healthcare workers' perceptions of, and willingness to receive, the COVID-19 vaccination.

OBJECTIVE: In the fight against COVID-19, vaccination is vital in achieving herd immunity. Many Asian countries are starting to vaccinate frontline workers; however, expedited vaccine development has led to hesitancy among the general population. We evaluated the willingness of healthcare workers to receive the COVID-19 vaccine. METHODS: From 12 to 21 December 2020, we recruited 1720 healthcare workers from 6 countries: China, India, Indonesia, Singapore, Vietnam and Bhutan. The self-administrated survey collected information on willingness to vaccinate, perception of COVID-19, vaccine concerns, COVID-19 risk profile, stigma, pro-socialness scale, and trust in health authorities. RESULTS: More than 95% of the healthcare workers surveyed were willing to vaccinate. These respondents were more likely to perceive the pandemic as severe, consider the vaccine safe, have less financial concerns, less stigmatization regarding the vaccine, higher pro-socialness mindset and trust in health authorities. A high perceived pandemic risk index, low vaccine harm index and high pro-socialness index were independent predictors in multivariable analysis. CONCLUSIONS: The majority of healthcare workers in Asia are willing to receive COVID-19 vaccination. Perceived COVID-19 susceptibility, low potential risk of vaccine harm and pro-socialness are the main drivers. These findings may help formulate vaccination strategies in other countries.

The impact of COVID-19 pandemic on physical and mental health of Asians: A study of seven middle-income countries in Asia.

The coronavirus disease (COVID-19) pandemic has impacted the economy, livelihood, and physical and mental well-being of people worldwide. This study aimed to compare the mental health status during the pandemic in the general population of seven middle income countries (MICs) in Asia (China, Iran, Malaysia, Pakistan, Philippines, Thailand, and Vietnam). All the countries used the Impact of Event Scale-Revised (IES-R) and Depression, Anxiety and Stress Scale (DASS-21) to measure mental health. There were 4479 Asians completed the questionnaire with demographic characteristics, physical symptoms and health service utilization, contact history, knowledge and concern, precautionary measure, and rated their mental health with the IES-R and DASS-21. Descriptive statistics, One-Way analysis of variance (ANOVA), and linear regression were used to identify protective and risk factors associated with mental health parameters. There were significant differences in IES-R and DASS-21 scores between 7 MICs (p<0.05). Thailand had all the highest scores of IES-R, DASS-21 stress, anxiety, and depression scores whereas Vietnam had all the lowest scores. The risk factors for adverse mental health during the COVID-19 pandemic include age <30 years, high education background, single and separated status, discrimination by other countries and contact with people with COVID-19 (p<0.05). The protective factors for mental health include male gender, staying with children or more than 6 people in the same household, employment, confidence in doctors, high perceived likelihood of survival, and spending less time on health information (p<0.05). This comparative study among 7 MICs enhanced the understanding of metal health in the general population during the COVID-19 pandemic.

Rural-urban differences in preferences for influenza vaccination among women of childbearing age: implications for local vaccination service implementation in Vietnam.

OBJECTIVES: Pregnant women and new mothers are among the most vulnerable to seasonal influenza; however, little is known about their preferences for flu vaccination. We examined the rural-urban differences in uptake, demand and willingness to pay (WTP) for influenza vaccination among women of childbearing age, to assess the feasibility of implementing locally produced vaccines in Vietnam. METHODS: A cross-sectional study was performed in both urban and rural areas of Hanoi in 2018. Socio-demographic characteristics, history of vaccination, demand and WTP for influenza vaccines were obtained. A multivariate logistic regression model was employed to identify the associated factors. RESULTS: Of 750 participants, 29.9% had had flu shots in the current or previous flu season and 64.3% indicated demand for this vaccine. The median of the maximum amount of WTP for influenza vaccination services was US$ 8.5 (IQR: 8.5-17.0). Women living in rural areas had a significantly lower uptake and higher demand, and were willing to pay less than women in urban locations (21.1% vs. 36.6%; 69% vs. 60.2%; and US $8.5 vs. US $11.7, respectively). For urban participants, factors associated with higher demand and WTP for flu shots included having ANC in health facilities and having been vaccinated against influenza in the past; for rural women, these factors were having suffered from influenza and hearing about it. CONCLUSIONS: This study informs the feasibility of implementing locally produced influenza vaccines in Vietnam. Educational programs, along with counselling services and government subsidies, should be implemented to improve the coverage, demand and WTP for the vaccine.

OBJECTIFS: Les femmes enceintes et les nouvelles mères sont parmi les plus vulnérables à la grippe saisonnière; cependant, on en sait peu sur leurs préférences pour la vaccination contre la grippe. Nous avons examiné les différences entre les zones rurales et urbaines dans l'adoption, la demande et la volonté de payer pour la vaccination antigrippale chez les femmes en âge de procréer, afin d'évaluer la faisabilité de la mise en œuvre de vaccins produits localement au Vietnam. MÉTHODES: Une étude transversale a été réalisée dans les zones urbaines et rurales de Hanoi en 2018. Les caractéristiques sociodémographiques, les antécédents de vaccination, la demande et la volonté de payer pour les vaccins antigrippaux ont été obtenus. Un modèle de régression logistique multivariée a été utilisé pour identifier les facteurs associés. RÉSULTATS: Sur 750 participantes, 29,9% s'étaient fait vacciner contre la grippe au cours de la saison grippale actuelle ou précédente, 64,3% ont indiqué une demande pour ce vaccin. La médiane du montant maximal de la volonté de payer pour les services de vaccination contre la grippe était de 8,5 USD (IQR: 8,5 à 17,0). Les femmes vivant dans les zones rurales avaient une adoption nettement plus faible, une demande plus élevée et étaient prêtes à payer moins que les femmes des zones urbaines (21,1% contre 36,6%; 69% contre 60,2%; et 8,5 USD contre 11,7 USD, respectivement). Pour les participantes urbaines, les facteurs associés à une demande plus élevée et à la volonté de payer pour les vaccins contre la grippe comprenaient le fait d'avoir des soins prénatals dans les établissements de santé et d'avoir été vaccinés contre la grippe dans le passé; pour les femmes rurales, ces facteurs comprenaient, avoir souffert de la grippe et en avoir entendu parler. CONCLUSIONS: Cette étude informe sur la faisabilité de la mise en œuvre de vaccins antigrippaux produits localement au Vietnam. Des programmes éducatifs, ainsi que des services de conseil et des subventions gouvernementales devraient être mis en œuvre pour améliorer la couverture, la demande et la volonté de payer pour le vaccin.

Fertility Desire in HIV/AIDS Research During 1992-2019: A Systematic Text Mining of Global Literature.

There has been an increase of fertility desire among people living with HIV/AIDS (PLWH) thanks to the advancement of HIV treatment and prevention of mother-to-children transmission programs. However, the development of research focusing on this topic over the past three decades is not well documented. We aimed to explore the trend of global publications regarding fertility desires among PLWH and identify their contents through the natural language processing technique. Dataset from 1992 to 2019 was downloaded using the Web of Science Core Collection. Bibliometric indicators such as change in total publications, citations, and countries' collaboration were examined. Main topics of selected publications were determined using the latent Dirichlet allocation. There were 303 articles published during the period 1992-2019, with a rapid increase in the number of publications in the past 5 years. Common themes included determinants of fertility desire, HIV prevention for adolescents, and safer conception for couples affected with HIV. However, publications on HIV care and antenatal care for women with HIV had been still limited. Findings suggested a call for the future support and collaborations for fertility intention, as well as the promotion of HIV care and service for adolescents and pregnant women with HIV, especially in countries with poor resources and a high burden of HIV/AIDS.

Global Mapping of Interventions to Improve the Quality of Life of People Living with HIV/AIDS: Implications for Priority Settings.

Enhancing the quality of life (QOL) of people living with HIV and AIDS (PLWHA) has become a significant global health goal, as combination antiretroviral therapy has helped to transform HIV/AIDS from a fatal illness to chronic disease. In this study, we aim to comprehensively describe the growth of research publications and the development of research landscapes regarding interventions to improve QOL among PLWH, as well as to characterize interdisciplinary topics and emerging interests of the research community. English articles and reviews published from 1991 to 2018 concerning interventions to improve QOL among PLWHA were retrieved from the Web of Science. Collaboration among organizations sharing coauthorships and co-occurrence network of authors' keywords was illustrated through network graphs. Latent Dirichlet Allocation was used for classifying papers into corresponding topics. A total of 2304 publications were included in the study. The USA continues to lead in research productivity, followed by South Africa, China, and India. Emerging research themes were found to be the application of multilevel interventions and long-term care, rehabilitation, along with topics relating to mental health issues, behavioral therapy and social supports for patients receiving treatments, and application of e-health approaches in designing and implementing interventions. There has been, however, a modest appearance of topics covering local, cultural, and environmental contexts of interventions. The findings of the study suggest expanding the coverage of psychosocial, behavioral, and contextualized interventions, increasing the involvement of family and community, improving the effectiveness of technology-based and e-health interventions, and developing strategies for lifelong treatment of HIV/AIDS.

Attitudes about and practices for skin cancer prevention among patients with dermatological issues in Hanoi, Vietnam: a cross-sectional study.

BACKGROUND: Raising awareness and educating people regarding practices for skin cancer or melanoma prevention are critical in the context of the adversely increasing effects of global climate change. This study aimed to explore the knowledge, attitudes, and practices regarding skin cancer prevention and to determine the associated factors to knowledge, attitudes, and practices among dermatological patients in Vietnam. METHODS: This cross-sectional study included 590 dermatological patients between 18 and 82 years of age, who received an examination or treatment from the National Hospital of Dermatology in Hanoi, Vietnam, from September to December 2018. The respondents' attitudes on skin cancer and cancer prevention were assessed via face-to-face interviews with a structured questionnaire conducted by trained interviewers. RESULTS: Of the 590 respondents, the majority of people had correct responses to the question regarding skin cancer knowledge. Among the total participants, 39.8% thought that they were at risk of skin cancer, and 13.8% believed their occupation increased their skin cancer risk. The majority of respondents used hats (94.9%) and sunscreen skin coats (89.5%) and went into the shade (86.3%) when exposed to the sun. Women were less likely to be aware of their skin cancer risk but were more likely to practice prevention behaviors. CONCLUSION: Our results show that dermatological patients have acceptable knowledge towards skin cancer prevention, but still need to change their behavior to prevent the risk of skin cancer. This study highlights the importance of education to raise awareness regarding skin cancer in order to promote practice prevention strategies for skin cancer in Vietnam.

Pre-exposure Prophylaxis in HIV Research: A Latent Dirichlet Allocation Analysis (GAPRESEARCH).

Pre-exposure prophylaxis (PrEP) has been shown to be an effective approach to prevent human immunodeficiency virus (HIV) infections; however, implementation of the service remains challenging. This global bibliometric analysis aims to describe the current trends in HIV research prevention through PrEP to reveal the potential gaps of knowledge and to put forward recommendations for future research. A bibliometric analysis was conducted through Web of Science from 1990 to 2017. Exploratory factor analysis was also employed to find research domains emerging from the abstracts' contents. Latent Dirichlet allocation, which is a topic modeling algorithm, was utilized to perform text mining and determine relationships among text documents. A total of 4852 papers regarding HIV PrEP research were retrieved. The number of papers and their impact has significantly increased. Preventing sexual transmissions, improving access, and quality of health-care services for current users, as well as men who have sex with men, pregnant women and children, were the research domains most related to PrEP. We found a data gap in research regarding sex workers, potential side effects of PrEP, and misjudgment toward PrEP users. Despite the growth in research about HIV PrEP, there exist barriers to scaling up the implementation of PrEP worldwide and for such intervention to reach its fWull potential. International research collaboration efforts to investigate the potential safety concerns of PrEP and develop strategies to eliminate social misjudgment against PrEP users are warranted. Addressing these knowledge gaps might facilitate the development of effective global implementation strategies for PrEP in the future.

A Global Bibliometric Analysis of Services for Children Affected by HIV/AIDS: Implications for Impact Mitigation Programs (GAPRESEARCH).

Tremendous progress has been made over the past three decades in the fight against the HIV epidemic; however, children experienced substantial physical and psychosocial effects of HIV infection. To inform services and policy development, we analyzed research growth and current trends in studies on children with HIV/AIDS. A total of 17,598 research papers and reviews in English, which were published on Web of Science, were downloaded. VOSviewer was used to generate an author keyword cooccurrence network and a network illustrating the connection among countries by shared coauthorships. Exploratory factor analysis was employed to identify research domains emerging from the abstracts' contents. The number of papers and their impacts had grown significantly in the past decade. The majority of study settings were in African countries. Research topics related to HIV in children were robust in areas of prevention of mother-to-child transmission and HIV and comorbidities treatments. Although psychosocial and behavioral disorders were recognized in previous studies, the number of interventions in these fields is still limited or not sustained. This study presents the global research trends and interests, points out research gaps of available publications and suggests several implications for services and intervention programs for children infected with HIV/AIDS. While preventions of mother-to-child transmission have been extensively studied, more efforts should be made to fulfill the lack of research on young people who are at risk of being infected or who are already infected with HIV. System thinking approach is needed in the design and implementation of future studies.

Evolution of Interdisciplinary Landscapes of HIV/AIDS Studies from 1983 to 2017: Results from the Global Analysis for Policy in Research (GAPRESEARCH).

In recent years, there have been numerous calls by researchers to adopt multi-disciplinary and international perspectives to address the HIV pandemic. Meaningful and prudent public health policy should be based on sound empirical data and research. Henceforth, our study aims to contribute to the current literature by conducting a comprehensive global mapping and determine the landscapes of HIV/AIDS research covering the years between 1983 and 2017. Bibliometric and content analysis was used to describe trends in research productivity, usages, research collaborations, and clusters of research topics. Exploratory factor analysis, Jaccard's similarity index, and Ward dendrogram were applied to abstracts' contents to determine the development of interdisciplinary research landscapes. The United States of America continues to lead in research production and be main hub for author- and country-level collaborations. Research employing an epidemiological, social, and/or behavioral perspective for studying HIV/AIDS was found to dwarf in the presence of basic and biomedical HIV research. Interdisciplinary approaches to HIV research have been increasing with the creation of various research landscapes: strong constructs of studies examining health status, clinical responses, and HIV treatment, risk behaviors have been formed, while research topics relating to psycho-behavioral and cultural aspects as well as services have emerged along. To effectively prevent and control the disease, more researches are needed to provide culturally relevant and/or contextualized evidence of effective interventions. It is also necessary to enhance the ability and partnership of local researchers as well as invest in research infrastructure at national and regional levels to implement high-quality studies since they are the "gate-keepers" who could respond to local changes in a timely manner. These types of research could be a helpful guide for international donors, governments, and academicians to set up research priorities in target groups and settings, and to develop future research agendas globally.