Mindfulness-based stress reduction for people with multiple sclerosis ? a feasibility randomised controlled trial

Background: Multiple sclerosis (MS) is a stressful condition. Mental health comorbidity is common. Stress can increase the risk of depression, reduce quality of life (QOL), and possibly exacerbate disease activity in MS. Mindfulness-Based Stress Reduction (MBSR) may help, but has been little studied in MS, particularly among more disabled individuals. Methods: The objective of this study was to test the feasibility and likely effectiveness of a standard MBSR course for people with MS. Participant eligibility included: age > 18, any type of MS, an Expanded Disability Status Scale (EDSS) </= 7.0. Participants received either MBSR or wait-list control. Outcome measures were collected at baseline, post-intervention, and three-months later. Primary outcomes were perceived stress and QOL. Secondary outcomes were common MS symptoms, mindfulness, and self-compassion. Results: Fifty participants were recruited and randomised (25 per group). Trial retention and outcome measure completion rates were 90% at post-intervention, and 88% at 3 months. Sixty percent of participants completed the course. Immediately post-MBSR, perceived stress improved with a large effect size (ES 0.93; p < 0.01), compared to very small beneficial effects on QOL (ES 0.17; p = 0.48). Depression (ES 1.35; p < 0.05), positive affect (ES 0.87; p = 0.13), anxiety (ES 0.85; p = 0.05), and self-compassion (ES 0.80; p < 0.01) also improved with large effect sizes. At three-months post-MBSR (study endpoint) improvements in perceived stress were diminished to a small effect size (ES 0.26; p = 0.39), were negligible for QOL (ES 0.08; p = 0.71), but were large for mindfulness (ES 1.13; p < 0.001), positive affect (ES 0.90; p = 0.54), self-compassion (ES 0.83; p < 0.05), anxiety (ES 0.82; p = 0.15), and prospective memory (ES 0.81; p < 0.05). Conclusions: Recruitment, retention, and data collection demonstrate that a RCT of MBSR is feasible for people with MS. Trends towards improved outcomes suggest that a larger definitive RCT may be warranted. However, optimisation changes may be required to render more stable the beneficial treatment effects on stress and depression. Trial registration: ClinicalTrials.gov Identifier NCT02136485; trial registered 1st May 2014

Cognitive deficits associated with cancer: A model of subjective and objective outcomes

Cancer and its treatment can affect many different aspects of quality of life. As a construct measured subjectively, quality of life shows an inconsistent relationship with objective outcome measures. That is, sometimes subjective and objective outcomes correspond with each other and sometimes they show little or no relationship. In this article, we propose a model for the relationship between subjective and objective outcomes using the example of cognitive function in people with cancer. The model and the research findings on which it is based help demonstrate that, in some circumstances, subjective measures of cognitive function correlate more strongly with psychosocial variables such as appraisal, coping, and emotions than with objective cognitive function. The model may provide a useful framework for research and clinical practice in quality of life for people with cancer

Pax Americana ou o império da insegurança? Pax Americana or the empire of insecurity?

No artigo pretende-se mostrar a posição dos Estados Unidos em um diferente contexto conceitual e histórico, como tentativa de escapar-se do imediatismo da discussão atual do país como um poder imperial ou hegemônico, trazidos pelos debates atuais. Revela-se assim, problemas de definições dos conceitos de imperialismo e hegemonia, assim como da dominação formal/infomal distorcendo a real imagem e posição da América do Norte no campo internacional nos dias atuais.<br>The article intends to show the position of the United States in a different conceptual and historical context, as attempt to run away itself of the immediacy of the current debate of the state as one to be able imperial or hegemonic, brought for the current discussion. It discloses thus, problems of definitions of the concepts of imperialism and hegemony, as well as of the formal and informal domination, distorting the real image and position of North America in the international field in the current days

Postcolonialism and organizational knowledge in the wake of China’s presence in Africa: interrogating South-South relations

China's presence in Africa appears to be part of a new geopolitical dynamic that may be affecting the way management and organizational knowledge from the South should be conceptualized and studied. The purpose of this article is to interrogate the adequacy of emerging critical management theories premised on challenging the West’s modernization projects, particularly Postcolonial and Dependency Theories, in the light of a changing geopolitical dynamic. It discusses the need for a new theoretical lens through which to understand and research China’s presence in Africa at organizational and community levels. It points to the lack of empirical knowledge at these levels, and proposes a research agenda based on an interrogation of China’s previous anti-colonial relationship with African countries and the way its present-day motives are played out at organizational level, and with an aim to understanding the extent to which China’s engagement is given voice to African management and organizational knowledge