Soldier and family wellness across the life course: a developmental model of successful aging, spirituality, and health promotion, Part II.

As an alternative to the current Department of Defense approach to health promotion and related research, which is critiqued in Part I of this article, the authors present a new, integrative health promotion and wellness model. This age-graded model incorporates successful aging, targeted health promotion, and spirituality in the context of the developmental perspective provided by life course constructs. By using an age-graded, multidisciplinary system of assessment, intervention, and follow-up in the context of preparing military personnel and families for the next season of life, this model advocates the prevention of disease and disability, active engagement with life, the maximization of high cognitive and physical functioning, and positive spirituality. Preliminary, selected illustrations from a variation of this model at the U.S. Army War College are provided. Progressive extrapolation of the model to other military leadership schools is proposed as a more efficacious health promotion strategy for the Department of Defense.

Soldier and family wellness across the life course: a developmental model of successful aging, spirituality, and health promotion. Part I.

The primary purposes of this article are to (1) highlight current challenges facing health promotion advocates within the military and civilian culture; (2) present the strengths and weaknesses of the current Army approach to health promotion and preventive medicine; and (3) present several unifying themes that contribute to enhanced progress within the field of health promotion. A conceptual model that links common goals across the fields of successful aging, health promotion, spirituality and health, and life course is advocated to maximize efficacious interventions and to transform the current Army approach to health promotion. A companion article will describe an integrative model of health promotion and wellness that responds to the challenges and incorporates the unifying themes described in this article.

Electron beam computed tomography screening of the coronary arteries: experience with 3,263 patients at Walter Reed Army Medical Center.

The U.S. Department of Defense desires to reduce the impact of coronary atherosclerosis on its active duty, retired, and dependent populations. Electron beam computed tomography (EBCT) is currently the best way to noninvasively image the coronary arteries directly. Between August 1997 and February 1999, a total of 3,263 patients were scanned by EBCT in the Radiology Department at Walter Reed Army Medical Center. Scans were performed on 2,415 men (74%) and 848 women (26%). The most common age group was 50 to 54 years (25%). Coronary calcification was found in approximately half of the patients (46%), and the magnitude of the score was strongly associated with age and male gender. Average scores increased exponentially with age, doubling every 7 years. In men, average scores ranged from 17 units in those aged 35 to 39 years to 842 in those older than 70 years old. In women, average scores ranged from 1 in those 35 to 39 years to 162 in those older than 70 years. Significant numbers of patients fell into the high-risk categories, with 8% of men in their 40s, 20% of men in their 50s, 33% of men in their 60s, and 49% of men in their 70s with high scores. Scores of more than 400 units were seen in 368 patients (8%) overall. There is a large amount of coronary calcium present in military personnel and their dependents, in patterns that are consistent with previous studies. Many patients had very high scores that are consistent with advanced coronary artery disease. EBCT should play a central role in the identification of occult calcific atherosclerosis of the coronary arteries in military, retired, and dependent patients.