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Introdução. Embora existam diferentes estratégias para a prestação de cuidados paliativos ao paciente com câncer, pouco se conhece sobre a efetividade desses modelos. Objetivos. Comparar os efeitos da equipe de cuidado paliativo integrada ao cuidado tradicional com o cuidado tradicional sozinho no controle de sintomas em paciente com câncer avançado hospitalizado. Método. Estudo longitudinal composto por dois grupos não randomizados. 73 pacientes foram admitidos para a equipe de cuidado paliativo integrada ao cuidado tradicional (Grupo ECP) e comparados a 75 atendidos no modelo de cuidado tradicional (Grupo CT). Os sintomas foram avaliados pela Escala de Avaliação de Sintomas de Edmonton (ESAS), a satisfação por escala numérica verbal (0-10), a funcionalidade pela Escala de Desempenho Funcional Físico Karnofsky (KPS) e a adequação analgésica pelo Índice de Manejo da Dor (IMD). Os pacientes foram avaliados na admissão, após 24 e 48 horas. O desfecho primário foi a melhora clinica significativa de 2 pontos na intensidade da dor e da náusea em 48 horas, comparados com a admissão. Os dados demográficos, os sintomas e sua redução foram comparados entre os Grupos pelo Teste Exato de Fisher ou Mann Whitney. O Teste de Wilcoxon analisou alterações dos sintomas intragrupos. A regressão múltipla de Poisson controlou fatores de confusão para a melhora do sintoma. O nível de significância adotado foi de 5%. Resultados. A prevalência de sintomas foi alta em ambos os grupos: no Grupo ECP a variação foi de 43.8% (depressão) a 87.7% (sensação de bem estar), e no Grupo CT, de 24% (dispneia) a 85.5% (dor). A magnitude dos sintomas, pelo escore da mediana, foi importante em ambos os Grupos: na admissão, no Grupo ECP, variou entre 5.5 (sensação de bem estar) a 8.0 (ansiedade, apetite, constipação e tristeza), e no Grupo CT, variou de 6.0 (sensação de bem estar e dispneia) a 9.0 (perda do apetite). A mediana de sobrecarga de sintomas, avaliada pelo ESAS, foi de 50.0 em ambos os grupos. Na análise de 24 horas (intragrupo), no Grupo ECP cinco sintomas (dor, náusea, perda do apetite, dispneia, prejuízo do sono) e sobrecarga de sintomas foram reduzidos (p<0.05), enquanto no Grupo Grupo CT três sintomas (dor, náusea e prejuízo do sono) foram reduzidos (p<0.05). Na análise de 48 horas (intragrupo), dez sintomas e sobrecarga de sintomas no Grupo ECP foram reduzidos (p<0.05), enquanto quatro sintomas melhoraram no Grupo CT (p<0.05). A regressão múltipla mostrou que a dor (RR= 2.2 [IC95%1.27-3.81]) e bem estar (RR=4.6 [IC95% 1.34-15.88]) reduziram 2 pontos e foi favorável somente no Grupo ECP. Verificou-se melhor adequação da analgesia no Grupo ECP comparado ao CT (p<0.05). A satisfação do doente foi elevada e similar em ambos os grupos. Conclusão. Os doentes de ambos os grupos mostraram grande sobrecarga de sintomas e somente o sintoma dor foi adequadamente controlado pelo Grupo ECP. Os resultados encontrados demandam análise de fatores da estratégia de tratamento que possam melhorar a efetividade das ações, como avaliação sistematizada dos sintomas em curtos períodos e estratégias que permitam ajuste rápido da terapêutica quando necessário. / Introduction. Although there are many different strategies for provision of palliative care to patients with cancer, little is known about the effectiveness of these modalities. Objective.To compare the effects of a palliative care team integrated with traditional care to traditional care alone on symptom control in inpatients with advanced cancer. Method. Longitudinal study composed of two non-randomized groups. Seventy-three patients were admitted to the palliative care team integrated to traditional care (PCT Group) and compared to 75 patients treated in the traditional care model (TC Group). Symptoms were assessed by the Edmonton Symptom Assessment Scale (ESAS), satisfaction with treatment by the verbal numeric scale (0-10), performance status by the Karnofsky Performance Status Scale (KPS) and analgesic adequacy by the Pain Management Index (PMI). Patients were assessed upon admission, and after 24 and 48 hours. The primary outcomes were significant clinical improvements of 2 points in pain intensity and nausea in 48 hours, compared to admission. The demographic data, symptoms, and reduction in symptoms were compared between the groups by using Fisher\'s or Mann Whitneys Exact Tests. The Wilcoxon test examined the intragroup alteration of symptoms. The Poisson multiple regression controlled for confounding factors of improvement in symptoms. A p-value of 0.05 indicated statistical significance for all analyses. Results. The prevalence of symptoms at admission was high in both groups. In the PCT Group, it ranged from 43.8% (depression) to 87.7% (loss of well-being) and, in the TC Group, it ranged from 24% (dyspnoea) to 85.5% (pain). The magnitude of median score of symptoms was substantial in both groups: at admission for the PCT group, it ranged from 5.5 (sense of well-being) to 8.0 (anxiety, appetite, constipation, sadness), while for the TC Group, it ranged from 6.0 (sense of well-being and dyspnoea) to 9.0 (loss of appetite). The median score of the symptom burden assessed by ESAS was 50.0 in both groups. In 24 hours (intragroup), the PCT Group had significant reductions in intensity of five symptoms (pain, nausea, loss of appetite, dyspnoea, and sleep disturbance) and symptom burden, while the TC Group had significant reductions in intensity of three symptoms (pain, nausea, and sleep disturbance). In 48 hours (intragroup), the PCT Group had significant reductions in intensity of ten symptoms and symptom burden and while the TC Group had significant improve in intensity of four symptoms. Multiple regression analysis showed that pain (RR = 2.2 [95% CI 1.27-3.81]) and loss of well-being (RR = 4.6 [95% CI 1.34-15.88]) were reduced by two points and it was significantly more favourable only in the PCT Group. The PMI revealed better adequacy of analgesia in the PCT Group. Satisfaction was high and similar in both groups. Conclusion. Patients with advanced cancer in both groups showed a pronounced burden of symptoms and only pain was properly controlled in the PCT Group. The results indicate that factors that can improve treatment strategy should be implemented to improve the effectiveness of clinical assistance. Examples of factors that can improve treatment are frequent and systematic assessment of symptoms in short periods, and strategies that allow for timely adjustment of therapy when necessary.

In the 1970s the Canadian government took a strong stand against apartheid sport policies. Despite Canada’s limited sporting links with South Africa, Prime Minister Pierre Elliott Trudeau and his Liberal government took on a leading Commonwealth position in promoting the isolation of South African sport. The catalyst for this leadership was Canada as host of two ‘mega’ sporting events during the 1970s - the 1976 Montréal Olympics and the 1978 Edmonton Commonwealth Games. This thesis focuses on the progression and adoption of new policies and initiatives which looked to strengthen Canada’s foreign policies dealing with apartheid sport while promoting these initiatives within the Commonwealth. Canada, a senior member of the association, had proved itself to be a key ally of newly independent Commonwealth nations throughout the 1960s and into the 1970s. These nations looked to Canada for guidance. Along with taking on a stronger Commonwealth position during the Trudeau era, Canada also looked to increase its international presence by focusing less on its traditional ties with the United States and more on forging relationships with a variety of newer nations. As Canada looked outside its borders to assert itself, within the country regionalism was on the rise with the advent of Québec separatism. All these factors played a major role in the development of Canadian foreign policy during the 1970s. This thesis focuses on the balance between internal and external pressures for change and how changes unfolded in light of Canada holding two mega sporting events in quick progression. From 1968 to 1980, Trudeau dominated Canadian politics. An engaging figure, he came to power promoting his notion of a ‘Just Society’ and looking to expand Canada’s international prestige. Newly opened archives of the External Affairs Department at the Library and Archives Canada show that Trudeau played a key role in the development of Canada’s new policies, especially during the period of 1975 to 1978. The wide range of primary sources consulted, many recently opened through Access to Information and Privacy requests, alongside a variety of sources from voluntary associations, analysed in this thesis provide a fulsome, chronological narrative of how Canada moved to the forefront of the Commonwealth and the association’s movement to isolate South African apartheid sport.

A model of social stressor variables, social integration variables and demographic control variables was tested to assess their impact on alcohol use among the elderly. A secondary analysis of a survey on alcohol use among the elderly in Edmonton, Alberta, Canada, was conducted to test the major hypotheses of the study. Contingency table analysis, using gamma and partial gamma as correlation coefficients, was utilized in the data analysis. The first hypothesis, in regard to the positive relationship of social stressors with alcohol use, was confirmed. The best predictors of alcohol use among the social stressor variables were usual occupation, length of retirement, annual income, and subjective health status. The second hypothesis, that the social integration variables would be negatively related to alcohol use, received only moderate support. The results of the analysis indicated that six of the ten social integration variables were negatively related to alcohol use. Only three of these variables, retirement status, religious participation, and marital status, were statistically significant. Hypothesis three also was not confirmed. The introduction of the social integration variables did not substantially decrease the strength of the relationship between social stressors and alcohol use. Gender and age were also introduced as control variables for the relationship between social stressors and alcohol use. Age had only a limited impact on the zero-order relationships. Gender demonstrated a strong relationship with alcohol use. Statistical analyses indicated that gender was the strongest predictor of alcohol use of all the variables in the analysis. The nature of the zero-order relationships of four of the six stressor variables changed when gender was controlled, and the partial relationships decreased in strength. It was suggested that future research on alcohol use among the elderly should focus on gender differences.

Numerous studies have shown that children identified with Language Impairment (LI) have marked difficulty with producing story narratives compared to their typically developing peers. One particular area of weakness seen in the narratives of children with LI is their ability to incorporate internal states, specifically internal response, internal plan, and emotion words. The current study examines five children with LI and their descriptions of mental and emotional states of characters in story narratives under spontaneous and prompted conditions. Participants produced story retells based on a series of wordless picture books taken from the Edmonton Narrative Norms Instrument. Story retells were elicited twice for each story, once with and once without verbal prompts. As expected, children produced more internal state story elements in response to prompts. As children produced more of these elements, however, their accuracy decreased, and the states they reported did not always reflect the story content. The children with LI showed limited understanding and ability to interpret the reactions, motivations, and emotions that characters experienced. However, verbal prompts did reveal children's current abilities and understanding of internal states.

Narrative production and comprehension is a difficult task for children with language impairment (LI). Their stories are typically shorter and contain more grammatical errors than the stories of typically developing age-matched peers. This pilot study describes the abilities of six children with LI to produce stories from pictured stimuli. Stories were elicited from each child during a 10-week period. Stimulus pictures and coding procedures from the Edmonton Narrative Norms Instrument were employed to analyze the participants' story grammar (SG). Eight SG elements were assessed including character introduction, setting, initiating event (IE), internal response (IR), internal plan (IP), attempt, and outcome. The children varied highly in their production of SG elements. The SG elements that described the internal states, emotions, and motivations of the characters were the most difficult for all participants.

Many children identified with Language Impairment (LI) demonstrate difficulty comprehending and producing narratives. Their narratives are often structurally less complex and of overall poorer quality than those produced by their typically developing peers. These difficulties may negatively impact the academic and social success of children with LI. This thesis evaluates the performance of five school-aged children with LI on a story retell probe embedded within an intervention designed to address their social and emotional language abilities. During the 10-week intervention, participants completed a series of story retell probes using wordless picture books. The story stimuli were taken from the Edmonton Narrative Norms Instrument, which included six stories (divided into two story sets), elicited twice (12 total story retells). The production of story grammar (SG) categories was analyzed for each story retell. The results for each participant and SG category varied greatly, but all participants had difficulty producing the more complex SG elements. Although each participant demonstrated some improvement from the first retell to the second on at least one story, overall performance remained fairly stable over the 10-week period. Future research is needed to determine effective ways to support more complex story narratives in children with LI.

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