Psychophysiological Effects of Respiratory Challenges before and after Breathing Training in Panic Disorder and Patients suffering from Episodic Anxiety Attacks

Panic Disorder (PD) has been associated with abnormalities in the respiratory system for a long time, and treatment programs aimed at reversing these abnormalities have been developed. Panicogenic effects of biological challenges have been shown to be altered after successful treatment. Furthermore, there is evidence that anxious non-PD patients show similar responses to these challenges and hence may benefit from some kind of breathing training (BT). To test these assumptions, we recruited 45 PD patients, 39 Episodic Anxiety (EA) patients who suffered from subclinical panic attacks, and 20 non-anxious controls (NAC). Patients were randomized to one of two versions of a 4-week therapy with BT, either lower or raise end-tidal pCO2, or a waiting list (WL). Before and after treatment, participants underwent in randomized order a Voluntary Hypoventilation (VHO) test and a Voluntary Hyperventilation (VHT) test in which they were asked to either lower or raise their pCO2 while psychophysiological measures were recorded. Each test consisted of 3 segments: 1 min baseline, 3 min paced breathing, and 8 min recovery. Before treatment, PD and EA patients were more anxious, distressed, tense, and worried than NAC, and felt more dizziness, chest pain, and nausea during the laboratory assessment. However, increases in psychological symptoms or physiological sensations from baseline to the paced breathing segments were not different between groups. The two tests produced similar changes except that anxiety and dizziness increased more during the VHT than VHO. We replicated baseline breathing abnormalities previously reported for PD patients, namely greater respiration rate, tidal volume instability, and number of sighs. However, analyses did not find that patients recovered slower to either challenge. After treatment, both therapies improved on the main outcome measure. Furthermore, BT affected baseline pCO2, resulting in lower levels in the hypocapnic groups and higher levels in the hypercapnic groups without affecting any other measures. We conclude that baseline respiratory abnormalities are specific to PD. However, data suggest that the manipulations might have been too weak to elicit other previously reported group differences. Breathing training was equally effective for the lower and raise BT. Hence, factors unrelated to modifying one’s pCO2 must have accounted for the symptomatic improvement. Breathing training should not be restricted to PD but be applied to all patients suffering from anxiety attacks

Crop yields fail to rise in smallholder farming systems in sub-Saharan Africa

Drawing on a harmonized longitudinal dataset covering more than 55,000 smallholder farms in six African countries, we analyze changes in crop productivity from 2008 to 2019. Because smallholder farmers represent a significant fraction of the world’s poorest people, agricultural productivity in this context matters for poverty reduction and for the broader achievement of the UN Sustainable Development Goals. Our analysis measures productivity trends for nationally representative samples of smallholder crop farmers, using detailed data on agricultural inputs and outputs which we integrate with detailed data on local weather and environmental conditions. In spite of government commitments and international efforts to strengthen African agriculture, we find no evidence that smallholder crop productivity improved over this 12-y period. Our preferred statistical specification of total factor productivity (TFP) suggests an overall decline in productivity of −3.5% per year. Various other models we test also find declining productivity in the overall sample, and none of them finds productivity growth. However, the different countries in our sample experienced varying trends, with some instances of growth in some regions. The results suggest that major challenges remain for agricultural development in sub-Saharan Africa. They complement previous analyses that relied primarily on aggregate national statistics to measure agricultural productivity, rather than detailed microdata

Del DSM-IV-TR al DSM-5: análisis de algunos cambios

La publicación de la quinta edición del DSM ha avivado un debate iniciado tiempo atrás, desde el anuncio de los cambios en los criterios de diagnóstico propuestos por la APA. En este artículo se analizan algunas de estas modificaciones. Se plantean aspectos interesantes y acertados, como la inclusión de la dimensionalidad tanto en las clases diagnósticas como en algunos trastornos, la incorporación de un espectro obsesivo-compulsivo o la desaparición de los subtipos de esquizofrenia. También se analizan otros aspectos más controvertidos como la consideración del síndrome de psicosis atenuada, la descripción de un trastorno depresivo persistente, la reordenación en trastornos de síntomas somáticos los clásicos trastornos somatoformes, o el mantenimiento de los tres grandes grupos de trastornos de la personalidad,siempre insatisfactorios, junto con un planteamiento anunciado, pero marginal, de la perspec-tiva dimensional de las alteraciones de la personalidad. La nueva clasificación del DSM-5 abrenumerosos interrogantes acerca de la validez que se pretende mejorar en el diagnóstico, enesta ocasión, asumiendo un planteamiento más cercano a la neurología y la genética que a lapsicopatología clínica.The publication of the fifth edition of the DSM has intensified a debate begun some time agowith the announcement of the changes in diagnostic criteria proposed by the APA. This article analyzes some of these modifications. Some interesting points where it is right, such as the inclusion of dimensionality in both diagnostic classes and in some disorders, the inclusion of an obsessive-compulsive spectrum, and the disappearance of subtypes of schizophrenia. It also analyzes other more controversial points, such as the consideration of the attenuated psychosis syndrome, the description of a persistent depressive disorder, reorganization of the classic somatoform disorders as somatic symptom disorders, or maintenance of three large clusters of personality disorders, always unsatisfactory, along with an announced, but marginal, suggestion of the dimensional perspective of personality impairments. The new DSM-5 classification opens many questions about the diagnostic validity which it attempts to improve, this time taking an approach nearer to neurology and genetics than to clinical psychology

Fostering self-endorsed motivation to change in patients with an eating disorder: The role of perceived autonomy support and psychological need satisfaction

Objective: Although several studies have established the beneficial effects of self-endorsed forms of motivation for lasting therapeutic change, the way patients with an eating disorder can be encouraged to volitionally pursue change has received less attention. On the basis of Self-Determination Theory, this longitudinal study addressed the role of an autonomy-supportive environment and psychological need satisfaction in fostering self-endorsed motivation for change and subsequent weight gain. Method: Female inpatients (n = 84) with mainly anorexia nervosa and bulimia nervosa filled out questionnaires at the onset of, during, and at the end of treatment regarding their perceived autonomy support from parents, staff members, and fellow patients, their psychological need satisfaction, and their reasons for undertaking change. Furthermore, the Body Mass Index (BMI) of the patients at the onset and end of treatment was assessed by the staff. Path analyses were used to investigate the relations between these constructs. Results: At the start of treatment, perceived parental autonomy support related positively to self-endorsed motivation through psychological need satisfaction. Perceived staff and fellow patients autonomy support related to changes in self-endorsed motivation over the course of treatment through fostering change in psychological need satisfaction. Finally, relative increases in self-endorsed motivation related to relative increases in BMI throughout treatment in a subgroup of patients with anorexia nervosa. Discussion: These results point to the importance of an autonomy-supportive context for facilitating self-endorsed motivation

Psychophysiological Effects of Respiratory Challenges before and after Breathing Training in Panic Disorder and Patients suffering from Episodic Anxiety Attacks

Panic Disorder (PD) has been associated with abnormalities in the respiratory system for a long time, and treatment programs aimed at reversing these abnormalities have been developed. Panicogenic effects of biological challenges have been shown to be altered after successful treatment. Furthermore, there is evidence that anxious non-PD patients show similar responses to these challenges and hence may benefit from some kind of breathing training (BT). To test these assumptions, we recruited 45 PD patients, 39 Episodic Anxiety (EA) patients who suffered from subclinical panic attacks, and 20 non-anxious controls (NAC). Patients were randomized to one of two versions of a 4-week therapy with BT, either lower or raise end-tidal pCO2, or a waiting list (WL). Before and after treatment, participants underwent in randomized order a Voluntary Hypoventilation (VHO) test and a Voluntary Hyperventilation (VHT) test in which they were asked to either lower or raise their pCO2 while psychophysiological measures were recorded. Each test consisted of 3 segments: 1 min baseline, 3 min paced breathing, and 8 min recovery. Before treatment, PD and EA patients were more anxious, distressed, tense, and worried than NAC, and felt more dizziness, chest pain, and nausea during the laboratory assessment. However, increases in psychological symptoms or physiological sensations from baseline to the paced breathing segments were not different between groups. The two tests produced similar changes except that anxiety and dizziness increased more during the VHT than VHO. We replicated baseline breathing abnormalities previously reported for PD patients, namely greater respiration rate, tidal volume instability, and number of sighs. However, analyses did not find that patients recovered slower to either challenge. After treatment, both therapies improved on the main outcome measure. Furthermore, BT affected baseline pCO2, resulting in lower levels in the hypocapnic groups and higher levels in the hypercapnic groups without affecting any other measures. We conclude that baseline respiratory abnormalities are specific to PD. However, data suggest that the manipulations might have been too weak to elicit other previously reported group differences. Breathing training was equally effective for the lower and raise BT. Hence, factors unrelated to modifying one’s pCO2 must have accounted for the symptomatic improvement. Breathing training should not be restricted to PD but be applied to all patients suffering from anxiety attacks

Psychophysiological Effects of Respiratory Challenges before and after Breathing Training in Panic Disorder and Patients suffering from Episodic Anxiety Attacks

Panic Disorder (PD) has been associated with abnormalities in the respiratory system for a long time, and treatment programs aimed at reversing these abnormalities have been developed. Panicogenic effects of biological challenges have been shown to be altered after successful treatment. Furthermore, there is evidence that anxious non-PD patients show similar responses to these challenges and hence may benefit from some kind of breathing training (BT). To test these assumptions, we recruited 45 PD patients, 39 Episodic Anxiety (EA) patients who suffered from subclinical panic attacks, and 20 non-anxious controls (NAC). Patients were randomized to one of two versions of a 4-week therapy with BT, either lower or raise end-tidal pCO2, or a waiting list (WL). Before and after treatment, participants underwent in randomized order a Voluntary Hypoventilation (VHO) test and a Voluntary Hyperventilation (VHT) test in which they were asked to either lower or raise their pCO2 while psychophysiological measures were recorded. Each test consisted of 3 segments: 1 min baseline, 3 min paced breathing, and 8 min recovery. Before treatment, PD and EA patients were more anxious, distressed, tense, and worried than NAC, and felt more dizziness, chest pain, and nausea during the laboratory assessment. However, increases in psychological symptoms or physiological sensations from baseline to the paced breathing segments were not different between groups. The two tests produced similar changes except that anxiety and dizziness increased more during the VHT than VHO. We replicated baseline breathing abnormalities previously reported for PD patients, namely greater respiration rate, tidal volume instability, and number of sighs. However, analyses did not find that patients recovered slower to either challenge. After treatment, both therapies improved on the main outcome measure. Furthermore, BT affected baseline pCO2, resulting in lower levels in the hypocapnic groups and higher levels in the hypercapnic groups without affecting any other measures. We conclude that baseline respiratory abnormalities are specific to PD. However, data suggest that the manipulations might have been too weak to elicit other previously reported group differences. Breathing training was equally effective for the lower and raise BT. Hence, factors unrelated to modifying one’s pCO2 must have accounted for the symptomatic improvement. Breathing training should not be restricted to PD but be applied to all patients suffering from anxiety attacks

Assessing COVID-19 vaccine hesitancy and barriers to uptake in Sub-Saharan Africa

Abstract Background Despite improved availability of COVID-19 vaccines in Sub-Saharan Africa, vaccination campaigns in the region have struggled to pick up pace and trail the rest of the world. Yet, a successful vaccination campaign in Sub-Saharan Africa will be critical to containing COVID-19 globally. Methods Here, we present new descriptive evidence on vaccine hesitancy, uptake, last-mile delivery barriers, and potential strategies to reach those who remain unvaccinated. Our data comes from national high frequency phone surveys in six countries in East and West Africa with a total population of 415 million people. Samples were drawn from nationally representative samples of households interviewed in recent in-person surveys. Our estimates are based on a survey module harmonized across countries and are re-weighted to mitigate potential sample selection biases. Results We show that vaccine acceptance remains generally high among respondents in Sub-Saharan Africa (between 95.1% and 63.3%) even though hesitancy is non-negligible among those pending vaccination. Many who are willing to get vaccinated are deterred by a lack of easy access to vaccines at the local level. Furthermore, social ties and perceptions as well as intra-household power relations matter for vaccine take-up. Among the unvaccinated population, radio broadcasts have widespread reach and medical professionals are highly trusted. Conclusions Our findings highlight that creating a positive social norm around COVID-19 vaccination, messaging that leverages trusted and accessible information sources and channels, and more easily accessible vaccination sites at the community level are promising policy options to boost vaccination campaigns in the region and end the pandemic everywhere

The evolution of COVID-19 vaccine hesitancy in Sub-Saharan Africa: evidence from panel survey data

Abstract Background COVID-19 vaccination efforts are lagging in Sub-Saharan Africa, as just over 20 percent of the population has been fully vaccinated. COVID-19 vaccine hesitancy is considered important as a prerequisite for widespread vaccine take-up. Here, we study the dynamics of vaccine acceptance, its correlates, and reasons for hesitancy over time, drawing on two years of panel survey data. Methods In this observational study, we use multiple rounds of data from national High Frequency Phone Surveys (HFPS) in five countries in East and West Africa (Burkina Faso, Ethiopia, Malawi, Nigeria, and Uganda), covering a period between 2020 and 2022. The surveys are cross-country comparable and draw their samples from nationally representative sampling frames. Based on this data source, the study presents population-weighted means and performs multivariate regression analysis. Results COVID-19 vaccine acceptance was high throughout the study period (68% to 98%). However, acceptance levels were lower in 2022 than in 2020 in three countries (Burkina Faso, Malawi, Nigeria), and higher in one country (Uganda). Moreover, individuals are observed to change their stated vaccine attitudes between survey rounds, to a limited extent in some countries (Ethiopia) and more frequently in others (Burkina Faso, Malawi, Nigeria, Uganda). Vaccine hesitancy is higher in richer households, and those residing in urban areas; among women and those better educated. Hesitancy is lower in larger households and among heads of the household. The main reasons for hesitancy are concerns about side effects of the vaccine, its safety and efficacy, as well as assessments of COVID-19 risk, though these reasons fluctuate over time. Conclusions Reported COVID-19 vaccine acceptance levels remain far above vaccination rates in the study countries, suggesting that vaccine hesitancy is not the primary obstacle to reaching greater vaccine coverage, which may instead be related to access and delivery barriers as well as supply shortages. Nevertheless, vaccine attitudes appear malleable so that continued efforts are needed to retain high levels of vaccine acceptance

Do cash transfers alleviate common mental disorders in low- and middle-income countries? A systematic review and meta-analysis

A large literature has demonstrated the link between poverty and mental ill-health. Yet, the potential causal effects of poverty alleviation measures on mental disorders are not well-understood. In this systematic review, we summarize the evidence of the effects of a particular kind of poverty alleviation mechanism on mental health: the provision of cash transfers in low- and middle-income countries. We searched eleven databases and websites and assessed over 4,000 studies for eligibility. Randomized controlled trials evaluating the effects of cash transfers on depression, anxiety, and stress were included. All programs targeted adults or adolescents living in poverty. Overall, 17 studies, comprising 26,794 participants in Sub-Saharan Africa, Latin America, and South Asia, met the inclusion criteria of this review. Studies were critically appraised using Cochrane’s Risk of Bias tool and publication bias was tested using funnel plots, egger’s regression, and sensitivity analyses. The review was registered in PROSPERO (CRD42020186955). Meta-analysis showed that cash transfers significantly reduced depression and anxiety of recipients (dpooled = -0.10; 95%-CI: -0.15, -0.05; p<0.01). However, improvements may not be sustained 2–9 years after program cessation (dpooled = -0.05; 95%-CI: -0.14, 0.04; ns). Meta-regression indicates that impacts were larger for unconditional transfers (dpooled = -0.14; 95%-CI: -0.17, -0.10; p<0.01) than for conditional programs (dpooled = 0.10; 95%-CI: 0.07, 0.13; p<0.01). Effects on stress were insignificant and confidence intervals include both the possibility of meaningful reductions and small increases in stress (dpooled = -0.10; 95%-CI: -0.32, 0.12; ns). Overall, our findings suggest that cash transfers can play a role in alleviating depression and anxiety disorders. Yet, continued financial support may be necessary to enable longer-term improvements. Impacts are comparable in size to the effects of cash transfers on, e.g., children’s test scores and child labor. Our findings further raise caution about potential adverse effects of conditionality on mental health, although more evidence is needed to draw robust conclusions