Approved for public release; distribution is unlimited / The 1992 European Union (EU) Common Foreign and Security Policy (CFSP, Maastricht Treaty) marked a turning point in the trans-Atlantic relationship. The Balkan conflicts and broader political changes in the 1990s compelled the EU to assume more responsibility in peace operations. The EU's 60,000 strong Rapid Reaction Force (RRF) is planned to be operational in 2003. Will the EU be able to conduct Petersberg-type peace operations? This thesis analyzes policy and military shortfalls of the Balkan peacekeeping effort. Questions about the legitimacy of armed humanitarian interventions, about difficulties in common policy formulation and translation to sound military objectives are the core problems of civil-military relations in European peace operations. The case studies focus on the EU failure to resolve the Bosnian crises between 1992-95, and on the gaps between NATO policies and military objectives in the operations of 'Implementation Force' in Bosnia and 'Allied Force' in Kosovo. The thesis considers developments in EU CFSP institutions and EU-NATO relationship as well as the EU's response to terrorist attacks on September 11 2001. The thesis argues that the difficulty in EU CFSP formulation limits the effective use of RRF in military operations. / Major, Hungarian Army

Approved for public release; distribution is unlimited / In response to the 9/11 attacks and continuing threats of mass-casualty terrorism, the United States has adopted a new security strategy that emphasizes anticipatory actions including preventive war. Prevention, undertaken in the absence of an act of aggression or an imminent threat, is prohibited by modern conceptions of just war and international law. Many critics of the strategy fear that any legitimization of preventive war would endanger international stability. But an examination of the relevant ethical issues from the perspective of just war doctrine reveals contradictions within a blanket prohibition of preventive war. Preventive "strategic interventions" against illiberal regimes-states that correlate with the threats of terrorism and weapons of mass destruction-parallel humanitarian interventions in that they have an ethical basis in the relationship between human rights and the right of state sovereignty. A widely-accepted minimum standard of human rights, incorporated into new international institutions and/or an explicit revision of the definition of just war, could serve as an ethical boundary for both preventive wars and humanitarian interventions. The formal qualification of prevention and its merger with humanitarian goals could bring enhanced international legitimacy and support to preventive actions by the United States and its allies. / Lieutenant Commander, United States Navy

Title: Patients’ views of lifestyle changes Introduction: An unhealthy lifestyle includes e.g. tobacco use, physical inactivity, unhealthy diet, and a harmful use of alcohol. These are preventable risk factors which contribute to most non-communicable diseases (NCDs). In 2015, 32 million people died in NCDs. With all the facts, knowledge awareness of an unhealthy lifestyle, some people still live an unhealthy lifestyle and are recommended by health personnel to live a healthier life. Aim: The aim of this study is to describe patients views of striving to make recommended lifestyle changes. Method: A literature study was conducted. Database search was performed in Cinahl, Psycinfo and a manual search in Pubmed. The results of eight qualitative studies were reviewed, analyzed and compiled. Result: The results were compiled into four categories; reasons to make lifestyle change; good, supportive interventions can make lifestyle change easier; shortcomings of the interventions; the part played by the nearest and dearest towards lifestyle change. All main categories each have two or three subcategories. Conclusion: Patients experiences of different interventions can be positive towards making lifestyle changes. Health personnel plays an important role to investigate patients’ needs and expectations of support in order to change their lifestyles, which is complex and requires time. / Titel: Patienters upplevelser av livsstilsförändringar Bakgrund: En ohälsosam livsstils inkluderar t.ex. tobaksanvändning, fysisk inaktivitet, ohälsosamma matvanor, och skadligt intag av alkohol. Dessa är preventiva riskfaktorer som bidrar till de flesta icke-smittsamma sjukdomarna. År 2015 dog 32 miljoner människor i icke-smittsamma sjukdomar. Med all fakta, kunskap och medvetenhet om ohälsosamma livsstilar lever fortfarande vissa människor en ohälsosam livsstil och är rekommenderade av hälsopersonal att leva hälsosammare. Syfte: Syftet med den här studien är att beskriva patienters strävan att genomföra rekommenderade livsstilsförändringar. Metod: En litteraturstudie är genomförd. Databassökning genomfördes i Cinahl, Psycinfo, samt en manuell sökning i Pubmed. Resultaten från åtta kvalitativa studier granskades, analyserades och sammanställdes. Resultat: Resultaten sammanställdes i fyra kategorier; anledningar att genomföra livsstilsförändringar; bra och stödjande insatser kan göra livsstilsförändringar lättare; tillkortakommanden i interventioner; nära och käras roll att motivera till livsstilsförändringar. Varje kategori har två eller tre underkategorier. Konklusion: Patienters erfarenheter av olika interventioner kan positivt påverka livsstilsförändringar. Hälso- och sjukvårdpersonal spelar en viktig roll att undersöka patienters behov och förväntningar av stöd för att kunna ändra deras livsstil, något som är komplext och är tidskrävande.

The purpose of this study was to examine the effects of a school-wide attendance and truancy intervention and universal procedures (ATI-UP) on student attendance. Student attendance was measured through average daily attendance and the percentage of students who would be considered chronically absent, i.e., missing 10% or more of school. The sample included 27 elementary schools in Oregon implementing school-wide positive behavior intervention and supports (SWPBIS) with varying levels of fidelity. Results indicate that schools can have a moderate effect on increasing average daily attendance (ADA) and a small effect on decreasing chronic absenteeism, although these results were not statistically significant. SWPBIS implementation did not act as a statistically significant moderator on the ATI-UP effects, although the treatment effect on ADA decreased with higher SWPBIS implementation.

ABSTRACT Background: The population of elderly people is an expanding group with an average life expectancy far exceeding that of only several decades ago. This increased number of older adults is a direct result of improved medical improvements, but it has also created a group vulnerable to the decline of bodily functions, diminished physical strength and poor quality of life. They are susceptible to poor nutrition and frailty that can lead to ill health and poor quality of life that ultimately imposes a strain on the health care system and its resources. It is key that effective intervention be established to reverse the negative impacts on the elderly and reduce the growing expenses related to frailty and malnutrition in these older individuals. Purpose: The purpose of this literature study was to demonstrate the value of nutrition for older adults with specific focus on preventing or reducing the incidence of frailty. Method: The method used to write this paper was a literature study based on quantitative original articles. Results: It is important that the elderly maintain good nutrition including; an appropriate amount of protein, an adequate amount of total caloric intake and a diet that will prevent the onset of malnutrition that could otherwise lead to frailty. Diets with an increased amount of protein can help reduce the incidence of frailty or prevent further decline in the state of existing frailty. The prevention of malnutrition through good nutrition including a sufficient amount of daily caloric intake it integral in preventing frailty. Conclusion: This research demonstrates that good nutrition is integral for mature adults over the age of 60 years of age. It is vital that this group of individuals have a sufficient amount of protein in their daily diet, that their overall caloric intake is at an appropriate level and that good nutrition is maintained in order to avoid malnutrition that could further decline to a state of frailty. It is important to prevent malnutrition that can lead to frailty and promote good nutrition that can lead to a good quality of life for older adults. Key Words: frailty, prevention, nutrition, protein, intervention, nutritional status / SAMMANFATTNING Bakgrund: Den äldre populationen är en expanderande grupp med en livslängd som överträffar den förväntade livslängden som man hade för bara ett par år sedan. Det ökade antalet äldre individer är ett direkt resultat av de medicinska framstegen men detta har också skapat en grupp som är sårbar för kroppsliga funktionsnedgångar, försämrad fysisk styrka och dålig livskvalité. Dessa individer är mottagliga för skörhet och malnutrition vilket kan leda till dålig hälsa och dålig livskvalité och blir slutligen en belastningen för hälso- och sjukvården och dess resurser. Det är viktigt att det utförs interventioner för att reversera de negativa effekterna på de äldre individerna och minska de ökande kostnaderna relaterat till skörhet och malnutrition hos dessa äldre individer. Syfte: Syftet med denna litteraturstudie var att demonstrera värdet av nutrition hos äldre med ett specifikt fokus på att förebygga eller reducera förekommandet av skörhet. Metod: Metoden för denna studie har varit litteraturstudie baserad på kvantitativa originalartiklar. Resultat: Det är av stor vikt att den äldre generationen uppehåller en god nutrition vilket innebär; en tillräcklig mängd protein, ett tillräckligt stort kaloriintag samt en diet som minskar risken för malnutrition som annars kan leda till skörhet. Dieter med en ökad mängd protein kan hjälpa att reducera prevalensen av skörhet eller minska vidare utveckling av redan existerande skörhet. Preventionen av malnutrition genom god nutrition med ett tillräckligt intag av kalorier är en väsentlig del för att kunna förebygga skörhet. Slutsats: Forskning visar att god nutrition är väsentligt för äldre vuxna över 60 år. Det är viktigt att denna grupp av individer har en tillräcklig mängd protein in deras diet, att deras totala kaloriintag är tillräckligt och att en god nutrition uppehålls för att kunna undvika malnutrition som senare kan leda till en fortsatt försämring av den redan existerande skörheten. Det är viktigt att förebygga malnutrition som kan leda till skörhet samt främja god nutrition som kan leda till en god livskvalité för äldre Nyckelord: Skörhet, prevention, nutrition, protein, intervention, nutritionsstatus

Thesis advisor: Barabara Hazard / This randomized controlled trial (RCT) examined a discharge nursing intervention (DNI) aimed at promoting self-regulation of care for early discharge interventional cardiology patients. The purpose of this study was to compare medication adherence, patient satisfaction, use of urgent care, and illness perception in patients with cardiovascular disease (CVD) undergoing interventional revascularization procedures who receive usual care and those who receive a DNI. The Common Sense Model (CSM) of illness representation provided the theoretical foundation for this study. The CSM is a cognitive parallel processing model that draws relationships between illness representation, coping methods, and illness outcomes to help explain the process by which people make sense of their illness. Intervention research aimed at life style changes to reduce secondary events after treatment for CVD is needed to guide evidence based care. Treatment for CVD has shifted from surgical repair with prolonged hospitalizations to interventional procedures requiring shorter hospital stays. This trend reduces nursing time to monitor complications and provide education about medication management and lifestyle changes. Patients recover in short stay areas and return home within hours or one to two days of the procedure. Cardiac disease is then managed as a chronic, but often stable condition. With this change in the delivery of care, several trends have emerged that have implications for quality nursing care and patient outcomes: a) the burden of care shifts from the hospital setting to home, b) patients are discharged without extensive education about complications and disease management, c) the occurrence of secondary events and disease progression remain a valid threat, and d) nurses with expert practice are in a unique position to assist patients and families with CVD management. This study addressed the following questions. 1. Do patients receiving the nursing intervention differ significantly from those receiving usual care on medication adherence? 2. Do patients receiving the nursing intervention differ significantly from those receiving usual care on patient satisfaction? 3. Is there a significant difference in the utilization of urgent care between those patients receiving the nursing intervention when compared to those patients receiving usual care? 4. Does a difference exist between the patients receiving the nursing intervention and those patients receiving usual care on illness perception, as measured by seven components of the IPQ-R: time line (acute and chronic), consequence, personal control, treatment (cure) control, illness coherence, timeline (cyclical), and emotional representations? Purposive sampling was used to select a sample of patients admitted for interventional procedures at an academic teaching hospital. One hundred and fifty four patients were and randomized into control and experimental groups. Final analyses included data from 129 patients. Sixty-four participants in the experimental group received the DNI which included: 1) additional written information about taking medications, 2) a medication pocket card, 3) a list of 3 cardiac internet sites,and 4) a phone call, 24 hours post procedure, from an expert cardiac nurse to review discharge instructions. Sixty-five participants in the control group received usual care. Analyses on four outcome measures, medication adherence, use of urgent care, patient satisfaction, and illness perception, revealed one statistically significant result. Participants in the experimental group, receiving the DNI, scored significantly higher than the control group on one measure, the timeline (acute/chronic) component of illness perception (p = .006) indicating a greater appreciation of the chronicity of their disease. Otherwise, there were no significant group differences found. This study provides support for nursing intervention research guided by self-regulation theory that examines the patient's perception of illness. Patients with cardiac disease who received the DNI were statistically more likely to acknowledge that their illness would last a long time. This awareness, may improve adherence to a prescribed regimen of medication and lifestyle modification. Nursing interventions guided by an understanding of patients' belief that their cardiovascular disease is chronic will add to the body of knowledge that informs providers about decisions patients make concerning medication adherence and lifestyle modifications. However, the results underscore the limitations of adding additional discharge care to this population of patients to improve medication adherence, use of urgent care, and patient satisfaction. Future research should include a longitudinal study to examine how patients who perceive their disease to be chronic in nature managed their medications and care decisions at home. / Thesis (PhD) — Boston College, 2009. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Bakgrund: Sömnen är ett av människans viktigaste basala behov och är en förutsättning för kroppens återhämtning. Hos personer med demenssjukdom råder hög förekomst av sömnstörningar, vilket kan leda till negativa konsekvenser. Det är sjuksköterskors ansvara att bedöma och identifiera eventuella sömnstörningar för att sedan kunna planera och utföra eller initiera lämpliga metoder som kan främja sömn. Syfte: Syftet var att beskriva hur sjuksköterskor kan främja sömn hos personer med demenssjukdom. Metod: Metodvalet kom att bli en litteraturstudie som följer Polit och Becks (2016) niostegsstruktur. Databaserna CINAHL och PubMed användes vid sökning efter relevanta artiklar. Databassökningen genererade tio vetenskapliga artiklar varav åtta kvantitativa, en kvalitativ samt en mixed-method. Resultat: Databearbetningen och analysen gav ett resultat med följande tre huvudteman: stimulering av kroppsliga funktioner, utbildning riktad till vårdgivare och parallell genomföring av flera sömnfrämjande metoder samt två subteman. Slutsats: Sjuksköterskor kan främja sömn hos personer med demenssjukdom genom att utföra eller initiera olika sömnfrämjande metoder: fysisk aktivitet, massageterapi, akupressur, ökad ljusexponering, aromaterapi, olika utbildningsprogram för vårdgivare eller genom att parallellt genomföra flera sömnfrämjande metoder.

A motivação para o presente trabalho nasceu de um estudo sobre o art. 55 do Código de Processo Civil. Foi possível verificar, a partir daí, que o confuso e divergente tratamento que a doutrina dá a esse dispositivo legal decorre, em grande parte, da ausência de enquadramento sistemático adequado da própria assistência. Como saber quais os possíveis efeitos decorrentes da intervenção do terceiro no processo se não se sabe exatamente o motivo pelo qual ele pode intervir e nem mesmo os poderes que pode exercer durante o desenrolar da marcha processual? O direito brasileiro herdou do direito alemão a disciplina que pretendeu dar à assistência, mas sem anterior preocupação com a verificação de sua adequação, quer no próprio ordenamento germânico, quer no brasileiro. Acabou, assim, criando um labirinto do qual a doutrina ainda não conseguiu sair. Algumas tentativas doutrinárias de estudar o instituto com coerência apontam para a falta de lógica da disciplina legal da assistência, mas ainda não se pode dizer que exista no direito brasileiro um estudo sistemático da assistência. Foi o que se pretendeu fazer nesse trabalho ao demonstrar a necessidade de eliminação do art. 54 do CPC do ordenamento e a consequente reconfiguração da assim chamada assistência simples, disciplinada no art. 50 do CPC. A assistência, há tempos, está a demandar um estudo aprofundado que possa até mesmo potencializar sua utilização, já que não se pode dizer que seja algo comum nos processos embora sejam comuns as hipóteses que autorizariam sua ocorrência. / This work starts from a study about the article 55 of Civil Procedure Code. From that, it was possible to verify that the confusing and diverging treatment that the doctrine gives to this text comes mainly from the lack of a suitable systematic framing of the assistance itself. How to know which are the possible effects of third part intervention if one does not know exactly the reasons why the third part may intervene or even its powers in the procedure? Brazilian law have inherited from German law the discipline that it intended to give to assistance, but without thinking previously about its suitability, whether in the own German law, whether in the Brazilian law. This way, a maze was created from which the doctrine was not able to exit yet. Some coherent tries of studying the institute of assistance point to the lack of logic in its legal discipline, but there is not a systematic study of the assistance yet. That was the goal of this work, demonstrating the need of elimination of article 54 of Civil Procedure Code, with the reshaping of so called \"simple assistance\", ruled by article 50 of Civil Procedure Code. Assistance, for long time, needs a profound study that may improve its use, since it is uncommon in suits although the hypotheses that grant its use are very common.

Bakgrund: Kardiovaskulär sjukdom är vida spridd över världen. Många riskfaktorer för sjukdomen bör kontrolleras med hjälp av hälsopreventiva insatser och kompletteras med läkemedelsbehandling. Syfte: Syftet var att undersöka vilka preventiva insatser som studerats för patienter med vaskulära sjukdomar, och effekterna av dessa. Metod: Designen var en litteraturstudie. Tillvägagångssättet var att söka artiklar med randomiserad kontrollstudie (RCT) design. 20 artiklar inkluderades och kvalitetsgranskades enligt checklista för RCT, och kvalitetsbedömning av RCT. Artikelsökningen gjordes i universitetets databaser: Pubmed/Medline, SKOPUS och CINAHL. En artikelsyntes skapades med utgångspunkt från PICO-modellen, (Population, Intervention, Comparison, Outcome), där fokus blev att jämföra interventioner och dess eventuella effekter. Som teoretiskt ramverk används Antonovsky’s känsla av sammanhang (KASAM). Begreppen begriplighet, hanterbarhet och meningsfullhet diskuteras. Resultat: De vanligaste sätten att bedriva prevention var via utbildningsinsatser och/eller rådgivande insatser. Dessa kan vara i möte eller via distans. De vanligaste effektmåtten kunde delas in i kategorierna: laboratorieprover, antropometriska mått, levnadsvanor, blodtryckskontroll, förändringar i riskprofil och följsamhet, upplevd livskvalitet, med flera. Bäst effekt enligt denna studie hade prevention inriktad mot utfallsmåtten blodtryck, blodfetter, blodglukos, samt följsamhet rörande vård och läkemedel.  Slutsats: Utbildning och rådgivning var bra preventiva metoder i samband med intervention mot kardiovaskulär sjukdom eller risk för sådan sjukdom. Det gällde oavsett om det gällde primär- eller sekundärprevention. Interventionerna var oftast inriktade mot livsstil. Effekterna var heterogena och varierande. Resultatet visar att blodtrycksreglering och reglering av blodfetter och blodsocker nivåer är möjliga, framförallt om följsamheten ökar. / Background: Cardiovascular disease is widely spread throughout the world. Many risk factors for the disease should be controlled by means of health preventive measures and supplemented with drug treatment. Purpose: The purpose was to investigate which preventive measures were studied for patients with vascular diseases, and the effects of these. Methods: The design was a literature study. The approach was to search for articles with randomized control trial (RCT) design. 20 articles were included and quality checked according to checklist for RCT, and quality assessment of RCT. The article search was done in the university's databases: Pubmed/Medline, SKOPUS and CINAHL. An article synthesis was created from the PICO model, (Population, Intervention, Comparison, Outcome). There, focus was on comparing interventions and its possible effects. As theoretical framework, Antonovsky’s Sense of Coherence (SOC) was used. The concepts of comprehensibility, manageability and meaningfulness are discussed. Results: The most common ways of conducting prevention were through training initiatives and/or advisory initiatives. These can be in personal meetings or remotely. The most common measures of effectiveness could be divided into categories: laboratory samples, anthropometric measures, lifestyle habits, blood pressure control, changes in risk profile and compliance, perceived quality of life, and more. The best effect according to this study was prevention aimed at the outcome measures blood pressure, blood lipids, blood glucose, and adherence to care and medication. Conclusion: Education and counseling were good preventative methods in connection with intervention against cardiovascular disease or the risk of such disease. It applied irrespective of the use of primary or secondary prevention. The interventions were usually focused on lifestyle. The effects were heterogeneous and varied. The result shows that blood pressure regulation and regulation of blood lipids and blood sugar levels are possible, especially if compliance is increasing.

Promouvoir l'activité physique durablement à l'adolescence est un enjeu majeur de santé publique. À ce jour, les programmes susceptibles d'être efficients restent discutés. ICAPS, une étude randomisée de quatre ans, a montré l'intérêt d'une approche socioécologique pour promouvoir l'activité physique, limiter la sédentarité et prévenir le surpoids chez l'adolescent. Cependant, le maintien à long terme, l'équité et les mécanismes expliquant l'efficacité de cette intervention restaient à démontrer. Dans ce travail, nous avons montré que les effets d'ICAPS se maintenaient à distance de l'intervention de manière équitable. Les effets étaient similaires quels que soient le genre et le poids initial et tendaient à être plus élevés chez les adolescents les moins socialement favorisés, les plus sédentaires et ne bénéficiant pas de support parental à la pratique d'activité physique. Grâce à l'utilisation de modèles d'équations structurelles, nous avons pu démontrer que l'efficacité de l'intervention reposait bien sur les mécanismes envisagés dans le modèle théorique initial. Les déterminants personnels (perception de l'activité, norme sociale, sentiment d'accomplissement personnel et intention de pratiquer), le support social et l'offre d'activité ont été identifiés comme des médiateurs significatifs. Nous avons de plus montré que le programme avait favorisé des interactions synergiques entre ces facteurs. Autrement dit, grâce à son action sur le support social et l'environnement, ICAPS a permis aux adolescents de mettre en pratique les compétences acquises grâce aux actions ciblant l'individu, renforçant l'efficacité de l'intervention et son maintien à long terme / Promoting long term physical activity practice during adolescence is one of the public health priorities. Nowadays, the question about the program’s efficiency aiming at reaching this objective is still on course. ICAPS, a four year randomized controlled trial, highlighted the benefits of a socioecological approach in the physical activity promotion and the sedentary behavior and overweight preventions in adolescence. However, the sustainability, the equity and the understanding efficacy mechanisms of such a program have still not been studied. In this report, long term effects of the ICAPS program have been established as its efficient equity. ICAPS effects were similar whatever the adolescent’s gender and initial weight status and were stronger among the adolescent’s from a low socioeconomic status, with a higher sedentary behavior and among those considered as having a low parental support towards physical activity practice. Using structural equation modeling, our results confirmed the efficiency mechanisms of the socioecological approach. Individual determinants (physical activity perception, social norm, self efficacy and intention to practice), adolescent’s social support and physical activity offer were identified as significant mediators. Moreover, we have highlighted that the program has promoted synergistic interactions between them. Finally, with its action over the social support and the environment, the ICAPS program allowed the adolescent’s to put into practice the competences they have acquired with the individual centered actions, reinforcing the program efficacy and its long term sustainability