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Background: Diagnosis of monogenic diabetes has important clinical implications for treatment and health expenditure. However, its prevalence remains to be specified in many countries, particularly from South Europe, North Africa and Middle-East, where non-autoimmune diabetes in young adults is increasing dramatically. Aims: To identify cases of monogenic diabetes in young adults from Mediterranean countries and assess the specificities between countries. Methods: We conducted a transnational multicenter study based on exome sequencing in 204 unrelated patients with diabetes (age-at-diagnosis: 26.1 ± 9.1 years). Rare coding variants in 35 targeted genes were evaluated for pathogenicity. Data were analyzed using one-way ANOVA, chi-squared test and factor analysis of mixed data. Results: Forty pathogenic or likely pathogenic variants, 14 of which novel, were identified in 36 patients yielding a genetic diagnosis rate of 17.6%. The majority of cases were due to GCK, HNF1A, ABCC8 and HNF4A variants. We observed highly variable diagnosis rates according to countries, with association to genetic ancestry. Lower body mass index and HbA1c at study inclusion, and less frequent insulin treatment were hallmarks of pathogenic variant carriers. Treatment changes following genetic diagnosis have been made in several patients. Conclusions: Our data from patients in several Mediterranean countries highlight a broad clinical and genetic spectrum of diabetes, showing the relevance of wide genetic testing for personalized care of early-onset diabetes. © 2020 Elsevier B.V.

The phase noise of surface acoustic wave resonators is explored by a passive measurement system based on the carrier suppression technique. The measurements are focused on 2.44-GHz quartz crystal resonators. These resonators are characterized in terms of motional parameters. The power dissipated through the resonators is around $500~\mu \text{W}$ . The second-order frequency-temperature coefficient of the resonators has been measured to be around −0.038 ppm/°C2 that corresponds to a classical ST cut. The resonator conditioning is presented. The measured noise exhibits a 1/ $f$ frequency fluctuation behavior. The short-term stability (flicker floor) is given in terms of Allan standard deviation. The order of magnitude is around $2\times 10^{\mathbf {-10}}$ . Additional measurements are given for resonators at 433 and 915 MHz in order to compare them. The results are presented according to the intrinsic quality factor of the resonators and compared to the previous works done in the past by T. Parker. These additional data provide valuable information on the dependence of the flicker noise levels on resonator frequency.

International audience; A carrier suppression system is implemented in order to measure the phase noise of acoustic resonators that have a low motional resistance. A special adapters’ system using transformers is proposed to improve the loaded quality factor of the resonators. With this developed device and described protocol, the inherent noise of resonators can be obtained without the usual electronical oscillator conditioning that could take part in the results. The loaded quality factor is improved from about 10% to 60% of the intrinsic quality factor. As an example, the system is used to study Langatate crystal resonators vibrating at 10 MHz. Langatate crystals can be an alternative to substitute for the quartz crystal resonators for frequency and time applications. Their coupling coefficient and the product quality factor-frequency are normally higher than those in quartz crystal resonators. For ultrastable resonators, the motional resistance obtained with Langatate crystals is about five times lower than that for the quartz crystal; it can reach typically few ohms. These resonators have been characterized in terms of impedance, Q-factors, turnover temperature, amplitude–frequency effect, and phase noise. The short-term stability of these resonators is given in terms of Allan standard deviation. The influence of the driving power is presented

Erikson's (1950) model of adult psychosocial development outlines the significance of successful involvement within one's relationships, work, and community for healthy aging. He theorized that the consequences of not meeting developmental challenges included stagnation and emotional despair. Drawing on this model, the present study uses prospective longitudinal data to examine how the quality of assessed Eriksonian psychosocial development in midlife relates to late-life cognitive and emotional functioning. In particular we were interested to see whether late-life depression mediated the relationship between Eriksonian development and specific domains of cognitive functioning (i.e., executive functioning and memory). Participants were 159 men from the over-75 year longitudinal Study of Adult Development. The sample was comprised of men from both higher and lower socioeconomic strata. Eriksonian psychosocial development was coded from men's narrative responses to interviews between the ages of 30-47 (Vaillant & Milofsky, 1980). In late life (ages 75-85) men completed a performance-based neuropsychological assessment measuring global cognitive status, executive functioning, and memory. In addition depressive symptomatology was assessed using the Geriatric Depression Scale. Our results indicated that higher midlife Eriksonian psychosocial development was associated with stronger global cognitive functioning and executive functioning, and lower levels of depression 3 to 4 decades later. There was no significant association between Eriksonian development and late-life memory. Late-life depression mediated the relationship between Eriksonian development and both global cognition and executive functioning. All of these results controlled for highest level of education and adolescent intelligence. Findings have important implications for understanding the lasting benefits of psychosocial engagement in mid-adulthood for late-life cognitive and emotional health. In addition, it may be that less successful psychosocial development increases levels of depression making individuals more vulnerable to specific areas of cognitive decline.

The sequential FOLFOX7–FOLFIRI combination is not superior to FOLFOX4 in colorectal cancer patients with resectable metastases. Patients with synchronous metastases preferably received perioperative chemotherapy, while patients with metachronous metastases were given postoperative chemotherapy in preference. We observed the highest long-term survival rates ever reported in this setting. Background Perioperative FOLFOX4 (oxaliplatin plus 5-fluorouracil/leucovorin) chemotherapy is the current standard in patients with resectable metastases from colorectal cancer (CRC). We aimed to determine whether a sequential chemotherapy with dose-dense oxaliplatin (FOLFOX7) and irinotecan (FOLFIRI; irinotecan plus 5-fluorouracil/leucovorin) is superior to FOLFOX4. The chemotherapy timing was not imposed, and was perioperative or postoperative. Patients and methods In this open-label, phase III trial, patients with resectable or resected metastases were randomly assigned either to 12 cycles of FOLFOX4 (oxaliplatin 85 mg/m2) or 6 cycles of FOLFOX7 (oxaliplatin 130 mg/m2) followed by 6 cycles of FOLFIRI (irinotecan 180 mg/m2). Randomization was done centrally, with stratification by chemotherapy timing, type of local treatment (surgery versus radiofrequency ablation with/without surgery), and Fong's prognostic score. The primary end point was 2-year disease-free survival (DFS). Results A total of 284 patients were randomized, 142 in each treatment group. Chemotherapy was perioperative in 168 (59.2%) patients and postoperative in 116 (40.8%) patients. Perioperative chemotherapy was preferentially proposed for synchronous metastases, whereas postoperative chemotherapy was more frequently used for metachronous metastases. Two-year DFS was 48.5% in the FOLFOX4 group and 50.0% in the FOLFOX7–FOLFIRI group. In the multivariable analysis, more than one metastasis [hazard ratio (HR) = 2.15] and synchronous metastases (HR = 1.63) were independent prognostic factors for shorter DFS. Five-year overall survival (OS) rate was 69.5% with FOLFOX4 versus 66.6% with FOLFOX7–FOLFIRI. Conclusions FOLFOX7–FOLFIRI is not superior to FOLFOX4 in patients with resectable metastatic CRC. Five-year OS rates observed in both groups are the highest ever reported in this setting, possibly reflecting the pragmatic approach to chemotherapy timing. Clinical trials number NCT00268398.

1. Abstract 1.1. Objective : To examine the relation of age to sustained cognitive competence in late life among men who underwent a prospective, multidisciplinary assessment from age 19 to 95, with little attrition except death and dementia. 1.2. Method: A prospective 75-year study of 268 Harvard College sophomores was begun in 1939 with data points every 2-5 years and with multiple blinded raters. Measurements included assessment of childhood environment, objective mental and physical health over time, vascular risk factors andexercise. At age 80 the surviving 142 men, wereassessedusing the Telephone Interview for Cognitive Status (TICS). Cognitive status was reassessed at ages 85, 90 and 95. 1.3. Results: The observed incidence of dementia (14 per 1,000-person years) (age 76-85) was about half that expected. Between age 80 and 90 the mean TICS score the 40 still surviving, cognitively competent men had declined only 0.65 of a point. Between ages 80 and 95 the mean TICS score of the 11 surviving cognitively competent men had declined only 0.55 of a point over 15 years. In both groups almost, half of the men’s TICS scores had not declined at all-or even increased. 1.4 . Conclusions : Excluding those men developing dementia or MCI,age per se from 80 to 95 did not appear to play a very significant role in cognitive decline among unusually long-lived, highly educated men. 2. Keywords: Cognitive Decline; Dementia; Longitudinal; MCI; Prospective; Risk Factors; TICS

The factors leading to the development of clinical dementia remain puzzling. Of seven major factors commonly associated with Alzheimer’s disease (AD): diabetes, midlife hypertension, smoking, depression, low educational attainment, cognitive inactivity, and physical inactivity (Barnes and Yaffe 2011), none have been consistently identified by prospective studies to play a causal role in AD. One reason for debate is the lack of multi-decade studies. Shorter, decade-long prospective studies (Bennett et al 2005, Albert et al 1995, Kawas et al 2000) can produce unreliable solutions, which may confuse association with cause. For example, are depression and diminished physical and intellectual activity causes of dementia or are they premonitory symptoms? A second reason for debate is the absence of autopsy examination. Most of these seven risk factors for AD, compellingly documented in the review by Barnes and Yaffe, have a known causal effect on small vessel disease. To claim causal attribution of these risk factors to AD arises from the fact that clinical dementia correlates only modestly with autopsy evidence of either AD or small vessel pathology alone (MRC CFAS 2001, Schneider et al 2007, Riley et al 2002). Rather, dementia is much more likely to occur when small vessel disease and amyloid plaques and tau tangles occur together making an either/or diagnosis uncertain. This suggests that the alleged predictors of AD may actually be predicting dementia partially due to small vessel disease (de la Torre, 2013). In addition, longitudinal studies like the Nun Study (Snowdon 1997) and the Rush Memory and Aging Project (Bennett et al 2005) have provided dramatic case studies reflecting discrepancies between Braak Staging of AD neuropathology and severity of dementia. Our study uses 70 years of prospectively collected longitudinal data to examine the environmental predictors of sustained intact cognition and of dementia by age 90. The value of our study lies in the fact that due to high education (76% attended graduate school) and social class, our sample is unusually long-lived and had less than the expected number of risk factors for early vascular disease. (U.S. Census data reveals that the 30% survival at 90 of the original 268 men in our Study was roughly 10 times the expected proportion for white men born in 1920. (National Vital Statistics Reports 2007). When the Study members were contrasted to an Inner City comparison group (Vaillant 2002), both vascular risk factors and mortality (10 years difference) differed significantly. The Inner City men manifested diabetes, a BMI > 29, and heavy smoking (40+ pack-years) three times more frequently than our Study sample and a diastolic blood pressure at age 50 >89 mm hg twice as often. The present report is of the 196 College men (out of an original cohort of 268) who survived until age 70—when the first Study members developed dementia—and who have been followed prospectively every two years from adolescence until death or age 90 (Vaillant 2002, Vaillant 2012). First, the Study provides a means of addressing many of the cart/horse temporality directionality questions related to the environmental contributions to dementia. Second, because of the cohort’s relatively low prevalence of vascular risk factors, it is possible to question whether these are not risk factors for vascular dementia rather than AD. Third, the long follow-up permits examination of childhood risk factors for dementia. Admittedly, due to its small numbers and selected cohort, our study will only be hypothesis generating.

OBJECTIVES. Prior studies confirm that after experiencing childhood adversity, resilient adults can recover and engage in generative growth. This study explored the long-term effects of childhood adversity (assessed as harsh parenting and/or childhood poverty) on successful aging for individuals who either achieved or failed to achieve Erikson’s psychosocial developmental stage of generativity in midlife. METHOD. The study utilized a sample of 636 men from the Harvard Sample and Inner City Cohort of the 73-year longitudinal Study of Adult Development. Nested ordinary least squares regression models were used to test the mediating and moderating effects of midlife generativity on later life health and adjustment to aging. RESULTS. Men who experienced childhood adversity were less likely than men with no childhood adversity to achieve generativity in midlife. Although achievement of generativity was associated with better later life health and adjustment to aging, it neither mediated nor moderated the negative relation between childhood poverty and later life health outcomes. However, for men who experienced an adversarial childhood, achievement of generativity mediated and moderated adjustment to aging. DISCUSSION. Results suggest that psychosocial growth in adulthood can compensate for the long-term negative effects of an adversarial childhood on adjustment to aging, but not for later life health.

International audience; In this paper, a passive measurement system is used to explore the phase noise of high overtone bulk acoustic wave resonators. The chosen overtone is around 373 MHz and the temperature coefficient of frequency at room temperature is 4 ppm/K. The 1/f noise is clearly shown and a flicker floor of about σy_floor = 1.5×10-11 is demonstrated.

International audience; In this paper, passive measurement system is used to explore the phase noise of aluminum nitride contour mode resonators. Their resonant frequencies are around 220 MHz. The carrier suppression technique is used. The noise floor of the measurement system is around -135 dBc/Hz @ 1 Hz offset from the carrier. Then, measurements of several resonators are presented and discussed.

International audience; In this paper we present several configurations enabling to obtain a low-noise 5 MHz signal from the 100 MHz delivered by the frequency synthesis of a Cryogenic Sapphire Oscillator. The residual single-sideband phase noise of several dividers is reported. Especially the noise of a custom built regenerative divider has been measured to be around ℒ5MHz(1 Hz) = -145 dBc/Hz. This performance is sufficient to measure the residual phase noise of an ultra-stable quartz crystal resonator using a carrier suppression system

Coping responses to stress can be divided into three broad categories. The first coping category involves voluntarily mobilizing social supports. The second category involves voluntary coping strategies like rehearsing responses to danger. The third coping category, like fever and leukocytosis, is involuntary. It entails deploying unconscious homeostatic mechanisms that reduce the disorganizing effects of sudden stress, DSM-5 offers a tentative hierarchy of defenses, from psychotic to immature to mature. The 70-year prospective Study of Development at Harvard provides a clinical validation of this hierarchy Maturity of coping predicted psychosocial adjustment to aging 25 years later, and was associated with not developing symptoms of post-traumatic stress disorder after very severe WWII combat.

Exposure to adverse childhood experiences including maltreatment, family instability, and economic hardship are well-documented risk factors for psychopathology (Gilman et al. 2003; Green et al. 2010; Kessler et al. 1997). The finding that such adversities are associated with elevated risk for disorder onset not only in childhood, but also in adulthood (Green et al. 2010; Kessler et al. 1997), suggests that exposure to childhood adversity creates a generalized diathesis to psychopathology that persists across the life-course. One possible explanation for this increased liability to psychopathology is that exposure to stressors early in life impacts the development of the physiological stress response system (Heim and Nemeroff 2001; Heim et al. 2008; Loman and Gunnar 2010). Indeed, dysregulation in physiological systems has been documented among both children (Chen and Matthews 2001; Ellis et al. 2005; Essex et al. 2002) and adults (Carpenter et al. 2007; Heim et al. 2000; van der Vegt et al. 2009) exposed to psychosocial adversity in childhood. Childhood adversity is also associated with heightened emotional reactivity to stress. Elevated emotional reactivity to daily events has been documented among individuals exposed to maltreatment and other trauma (Glaser et al. 2006; Wichers et al. 2009). Although elevated physiological and emotional reactivity also have been found among children and adults with mood and anxiety disorders (Boyce et al. 2001; Goldin et al. 2009; Heim and Nemeroff 2001; Yehuda 2000), the extent to which such reactivity mediates the association between childhood adversity and adult psychopathology has, to our knowledge, not been examined directly. Importantly, the particular aspects of childhood environments that lead to maladaptive stress reactivity are poorly characterized. The term childhood adversity is used to describe a wide variety of adverse childhood experiences ranging from poverty to parental instability to maltreatment (Green et al. 2010). It may be that only severe adverse events, like abuse, lead to alterations in stress reactivity. Indeed, the preponderance of studies on childhood contributors to stress reactivity have focused on these relatively severe experiences (Carpenter et al. 2007; Glaser et al. 2006; Harkness et al. 2006; Heim and Nemeroff 2001; Kendler et al. 2004; Wichers et al. 2009). On the other hand, some evidence suggests that environments characterized by chronic adversity, such as low socio-economic status (SES) and high family conflict, are associated with elevated physiological reactivity (Chen and Matthews 2001; Ellis et al. 2005; Essex et al. 2002; Kapaku et al. 2002). The strength of the association between such environments and maladaptive patterns of stress reactivity may not be as strong as the associations with more severe experiences like abuse. However, the ubiquity of such exposures suggests their role in determining the population-level distribution of psychiatric disorders could be substantial. Extant evidence on the links between childhood adversity, stress reactivity, and psychiatric disorders has come primarily from cross-sectional studies that examine emotional and physiological responses to laboratory-based stressors (Boyce et al. 2001; Heim et al. 2000; Steptoe and Marmot 2006). Thus, it remains unclear whether emotional reactivity to stress represents a risk factor for psychopathology or simply a concomitant of current distress. Recent work has attempted to overcome this problem by demonstrating longitudinally that liability to mood and anxiety disorders following stressful life events in adulthood is heightened among individuals who have experienced childhood adversities (Hammen et al. 2000; Harkness et al. 2006; Kendler et al. 2004). These studies have assumed that a stronger association between adult stress and psychopathology is indicative of greater emotional and physiological reactivity, though reactivity was not measured directly. We are unaware of prospective research directly examining the association between emotional reactivity and the later onset of psychopathology. The current study examines the associations between the childhood social environment, adolescent emotional reactivity to stress, and the subsequent onset of mood and anxiety disorders in adulthood using prospective data from a cohort of healthy young men followed into late life. We first examine the associations between aspects of the childhood environment and emotional reactivity in late adolescence. Second, we examine the association between emotional reactivity and the onset of mood and anxiety disorders in adulthood. Finally, we evaluate whether emotional reactivity is a mechanism underlying the association between adverse childhood environments and the onset of adult psychiatric disorders. Because the sample includes men from relatively privileged backgrounds, we provide a stringent test of the relationship between the childhood social environment and emotional reactivity. If variation in the childhood environment is associated with reactivity in this sample, then the effect of the childhood environment on stress reactivity would be expected to be much greater in the general population.

Recognizing religiosity and spirituality as related yet distinct phenomena, and conceptualizing psychological well-being as a multidimensional construct, this study examines whether individuals' frequency of formal religious participation and spiritual perceptions are independently associated with diverse dimensions of psychological well-being (negative affect, positive affect, purpose in life, positive relations with others, personal growth, self-acceptance, environmental mastery, and autonomy). Data came from 1,564 respondents in the 2005 National Survey of Midlife in the United States (MIDUS). Higher levels of spiritual perceptions were independently associated with better psychological well-being across all dimensions, and three of these salutary associations were stronger among women than men. Greater formal religious participation was independently associated only with more purpose in life and (among older adults) personal growth; greater formal religious participation was also associated with less autonomy. Overall, results suggest a different pattern of independent linkages between formal religious participation and spiritual perceptions across diverse dimensions of psychological well-being.

Objectives We explored whether wisdom and well-being in old age are the result of early personality traits related to personality growth or personality adjustment, respectively, or successful human development as outlined by Erikson's stage theory and the life course paradigm. Method Structural equation models were applied to analyze 60-year longitudinal data of 98 white male Harvard graduates born between 1915 and 1924. Different sets of judges rated the men's childhood and adolescence, early adult personality, and midlife generativity. Items measuring wisdom and well-being in old age were self-assessed. Results Although wisdom and subjective well-being at age 80 were positively correlated, early life predictors differed. Openness to experiences in early adulthood predicted wisdom 60 years later, whereas greater emotional stability and extraversion predicted subjective well-being. Additionally, old age wisdom could be traced back to psychosocial growth throughout life, facilitated by a supportive childhood, adolescent competence, emotional stability in early adulthood, and generativity at midlife. Discussion Personality traits indicative of personality adjustment or growth differentially predict late-life well-being and wisdom. Yet a balance between personality adjustment and growth, aided by social support and competence during the formative years, might be required to promote wisdom development throughout life.

Prior studies have shown that perceived health status is a consistent and reliable predictor of morbidity and mortality. Because perceived health status and objective health are not highly correlated, we sought to identify additional factors that shape self-perceptions of health. Research suggests that childhood experience is an important predictor of health in adulthood, but most studies are retrospective. Using data from a 70-year prospective study of psychosocial development, we examined the quality of childhood environment as a predictor of perceived health in late life. This study utilizes questionnaire data from a longitudinal study of adult development to examine predictors of perceived health across seven decades. Participants were members of the Study of Adult Development, a longitudinal study of men followed for seven decades beginning in late adolescence. Childhood environment characteristics were assessed during home visits and interviews with respondents’ parents at entry into the study. At ages 63, 73, and 78, current health status was measured by an internist not affiliated with the Study, and perceived health was assessed via self-report questionnaires. Linear regression analyses were conducted to examine childhood environment as a predictor of perceived health status at these 3 time points while controlling for concurrent objective health and young adult neuroticism. Childhood environment predicted perceived health at all 3 time points. This study supports the hypothesis that the quality of childhood environment makes a unique contribution above and beyond personality traits and objective health status to perceptions of health in late life.

This study aimed to examine the possible antecedents of both dementia and sustained intact cognition at age 90 years among men who underwent a prospective, multidisciplinary assessment from ages 19 to 90 years, with little attrition.We conducted a prospective 20-year reassessment of 196 (out of 268) former Harvard college sophomores who survived until age 70 years. Since 1939, the study gathered measurements of childhood environment, dominant personality traits, objective mental and physical health over time, smoking in pack-years, alcohol abuse, and depression. Questionnaires were obtained every 2 years and physical exams every 5 years. Cognitive status was assessed at ages 80, 85, and 90 years.Despite addressing a wide variety of health, behavioral, and social factors over the lifespan, we observed few predictors with strong association with either intact cognition at age 90 years (n = 40) or dementia (n = 44). Univariate analysis revealed seven suggestive predictors of intact cognition at age 90 years or of dementia: warm childhood relationship with mother, exercise at age 60 years, high maternal education, young age of mother at subject's birth, low body mass index, good physical health at 60 years, and late retirement. Only the first three variables, warm childhood relationship with mother, exercise at age 60 years, and high maternal education, remained significant with logistic regression.In this prospective study of long-lived, highly educated men, several well-known putative predictors of Alzheimer's disease did not distinguish those who over the next 20 years developed dementia from those with unimpaired cognition until age 90 years.

A growing body of research suggests that personality characteristics relate to physical health; however, this relation ship has primarily been tested in cross-sectional studies that have not followed the participants into old age. The present study utilizes data from a 70-year longitudinal study to prospectively examine the relationship between the adaptive defense mechanisms in midlife and objectively assessed physical health in late life. In addition to examining the direct effect, we test whether social support mediates this relation ship. The sample consisted of 90 men who were followed for over seven decades beginning in late adolescence. Health ratings from medical records were made at three time points (ages 70, 75, and 80). Defense mechanisms were coded from narratives by trained independent raters (Vaillant, Bond, & Vaillant, 1986). Independent raters assessed social supports between ages 50 and 70. More adaptive defenses in midlife were associated with better physical health at all three time points in late life. These relationships were partially mediated by social support. Findings are consistent with the theory that defense maturity is important for building social relationships, which in turn contribute to better late-life physical health. Psychological interventions aimed at improving these domains may be beneficial for physical health.

Recent research suggests that affective disorder is associated with increased mortality and physical morbidity, but the reasons for this association remain uncertain. This report describes a 50-year prospective study of 240 men evaluated from the time they were university students in 1940–1942. A family history of mental illness was obtained and the men's habits, psychological adjustment, and marital and occupational satisfaction were followed every 2 years and their objective physical health was tracked every 5 years until age 70. Twenty-five men were identified as having affective spectrum disorder prior to age 53. Of the variables studied, the presence of affective spectrum disorder was the most powerful predictor of poor psychosocial outcome at age 65 and one of the most powerful predictors of poor physical health. Alcohol abuse and cigarette abuse accounted for the observed increased rates of heart disease and cancer. When alcohol abuse, smoking, and suicide were controlled for, affective disorder made a significant contribution to physical morbidity by age 70, but not to mortality from natural causes. Affective spectrum disorder, even in an educated population without antisocial trends, carries a profound negative risk to late-life physical and social adjustment.

Over the past 55 years, two longitudinal studies have been monitoring the drinking behaviors and their consequences of several hundred men from adolescence and early adulthood to old age. The studies identified co-occurring sociopathy, cultural factors (e.g., ethnicity), and genetic factors (i.e., a family history of alcoholism) as risk factors for alcoholism. n most alcoholics, the disease had a progressive course, resulting in increasing alcohol abuse or stable abstinence. However, some alcoholics exhibited a nonprogressive disease course and either maintained a stable level of alcohol abuse or returned to asymptomatic drinking. Long-term return to controlled drinking, however, was a rare and unstable outcome. Formal treatment, with the exception of attending Alcoholics Anonymous, did not appear to affect the men's long-term outcomes, whereas several non-treatment-related factors were important for achieving stable recovery.

SEVEN MODELS FOR CONCEPTUALIZING POSITIVE MENTAL HEALTH ARE REVIEWED: mental health as above normal, epitomized by a DSM-IV's Global Assessment of Functioning (GAF) score of over 80; mental health as the presence of multiple human strengths rather than the absence of weaknesses; mental health conceptualized as maturity; mental health as the dominance of positive emotions; mental health as high socio-emotional intelligence; mental health as subjective well-being; mental health as resilience. Safeguards for the study of mental health are suggested, including the need to define mental health in terms that are culturally sensitive and inclusive, and the need to empirically and longitudinally validate criteria for mental health.

Purpose: Wisdom has received increasing attention in empirical research in recent years, especially in gerontology and psychology, but consistent defini tions of wisdom remain elusive. We sought to better characterize this concept via an expert consensus panel using a 2-phase Delphi method. Design and Methods: A survey questionnaire comprised 53 Likert scale statements related to the concepts of wisdom, intelligence, and spirituality was developed to determine if and how wisdom was viewed as being distinct from the latter 2 concepts. Of the 57 international wisdom experts contacted by e-mail, 30 completed the Phase 1 survey and 27 also completed the Phase 2 survey. Results: In Phase 1, there were significant group differences among the con cepts of wisdom, intelligence, and spirituality on 49 of the 53 items rated by the experts. Wisdom differed from intelligence on 46 of these 49 items, whereas wisdom differed from spirituality on 31 items. In Phase 2, we sought to define wisdom further by selecting 12 items based on Phase 1 results. Most experts agreed on many of the suggested characteristics of wisdom—that is, it is uniquely human; a form of advanced cognitive and emotional development that is experience driven; and a personal quality, albeit a rare one, which can be learned, increases with age, can be measured, and is not likely to be enhanced by taking medication. Implications: There was considerable agreement among the expert participants on wisdom being a distinct entity and a number of its characteristic qualities. These data should help in designing additional empirical research on wisdom.

The philosophy of mind is intimately connected with the philosophy of action. Therefore, concepts like free will, motivation, emotions (especially positive emotions), and also the ethical issues related to these concepts are of abiding interest. However, the concepts of consciousness and free will are usually discussed solely in linguistic, ideational and cognitive (i.e. “left brain”) terms. Admittedly, consciousness requires language and the left-brain, but the aphasic right brain is equally conscious; however, what it “hears” are more likely to be music and emotions. Joy can be as conscious as the conscious motivation produced by the left-brain reading a sign that says, “Danger mines!!” However, look in the index of a Western textbook of psychology, psychiatry or philosophy for positive emotions located in the limbic system. Notice how discussion of positive spiritual/emotional issues in consciousness and motivation are scrupulously ignored. For example, the popular notions of “love” being either Eros (raw, amoral instinct) or agape (noble, non-specific valuing of all other people) miss the motivational forest for the trees. Neither Eros (hypothalamic) nor agape (cortical) has a fraction of the power to relieve stress as attachment (limbic love), yet until the 1950s attachment was neither appreciated nor discussed by academic minds. This paper will point out that the prosocial, “spiritual” positive emotions like hope, faith, forgiveness, joy, compassion and gratitude are extremely important in the relief of stress and in regulation of the neuroendocrine system, protecting us against stress. The experimental work reviewed by Antonio Damasio and Barbara Fredrickson, and the clinical example of Alcoholics Anonymous, will be used to illustrate these points.

Objective To examine patterns of chronic opioid use in selected groups with arthritis and low back pain and compare them with patterns among persons with ischemic heart disease. Methods The study database consisted of Medicare beneficiaries who were enrolled in a drug benefit program for low-to-moderate income Pennsylvania residents. We identified selected patients who had a diagnosis of rheumatoid arthritis, osteoarthritis, chronic low back pain, or ischemic heart disease since 1995. Chronic opioid use, defined as at least six 30-day prescriptions in a year, was the endpoint of interest. We examined the proportion of patients meeting this definition during the period 1996–2001 and determined predictors based on multivariable Cox proportional hazards models. Results Four percent of subjects with rheumatoid arthritis used opioids chronically in 2001, compared with

Objective: Until now, prospective studies of aging have begun with 50- to 60-year olds, not adolescents. Premature deaths, childhood variables, and alcohol abuse have been often ignored. So has positive aging. As people live longer, gerontology needs to understand the determinants of health as well as illness in the later years. Method: The present study follows a cohort of adolescent boys (332 inner-city youths) for 60 years or until death. Complete physical exams were obtained every 5 years and psychosocial data every 2 years. Predictor variables assessed prior to age 50 include six variables reflecting uncontrollable factors—parental social class, environmental strengths, number of family problems, major depression, ancestral longevity, and premorbid physical health at age 50—and six variables reflecting (at least some) personal control: alcohol abuse, smoking, marital stability, body mass index, coping mechanisms, and education. The four outcome variables chosen to assess healthy aging at 70 reflected both “mind” and “body”. They included objectively assessed variables (death and/or disability prior to 70, and objectives mental health) and two subjectively assessed variables (perceived instrumental activities of daily living and life enjoyment). Results: Multivariate analysis suggested that positive aging at 70 could be predicted by variables assessed prior to age 50. More hopeful still, if the six variables under some personal control were controlled, depression was the only uncontrollable variable that affected the quality of subjective and objective aging. Conclusions: First, we may have greater personal control over our biopsychosocial health after retirement than previously recognized. Second, in this cohort, psychiatric rather than sociological predictors appeared more important.

Recent research suggests that affective disorder is associated with increased mortality and physical morbidity, but the reasons for this association remain uncertain. This report describes a 50-year prospective study of 240 men evaluated from the time they were university students in 1940-1942. A family history of mental illness was obtained and the men's habits, psychological adjustment, and marital and occupational satisfaction were followed every 2 years and their objective physical health was tracked every 5 years until age 70. Twenty-five men were identified as having affective spectrum disorder prior to age 53. Of the variables studied, the presence of affective spectrum disorder was the most powerful predictor of poor psychosocial outcome at age 65 and one of the most powerful predictors of poor physical health. Alcohol abuse and cigarette abuse accounted for the observed increased rates of heart disease and cancer. When alcohol abuse, smoking, and suicide were controlled for, affective disorder made a significant contribution to physical morbidity by age 70, but not to mortality from natural causes. Affective spectrum disorder, even in an educated population without antisocial trends, carries a profound negative risk to late-life physical and social adjustment.

The philosophy of mind is intimately connected with the philosophy of action. Therefore, concepts like free will, motivation, emotions (especially positive emotions), and also the ethical issues related to these concepts are of abiding interest. However, the concepts of consciousness and free will are usually discussed solely in linguistic, ideational and cognitive (i.e. "left brain") terms. Admittedly, consciousness requires language and the left-brain, but the aphasic right brain is equally conscious; however, what it "hears" are more likely to be music and emotions. Joy can be as conscious as the conscious motivation produced by the left-brain reading a sign that says, "Danger mines!!" However, look in the index of a Western textbook of psychology, psychiatry or philosophy for positive emotions located in the limbic system. Notice how discussion of positive spiritual/emotional issues in consciousness and motivation are scrupulously ignored. For example, the popular notions of "love" being either Eros (raw, amoral instinct) or agape (noble, non-specific valuing of all other people) miss the motivational forest for the trees. Neither Eros (hypothalamic) nor agape (cortical) has a fraction of the power to relieve stress as attachment (limbic love), yet until the 1950s attachment was neither appreciated nor discussed by academic minds. This paper will point out that the prosocial, "spiritual" positive emotions like hope, faith, forgiveness, joy, compassion and gratitude are extremely important in the relief of stress and in regulation of the neuroendocrine system, protecting us against stress. The experimental work reviewed by Antonio Damasio and Barbara Fredrickson, and the clinical example of Alcoholics Anonymous, will be used to illustrate these points.

This paper proposes that eight positive emotions: awe, love (attachment), trust (faith), compassion, gratitude, forgiveness, joy and hope constitute what we mean by spirituality. These emotions have been grossly ignored by psychiatry. The two sciences that I shall employ to demonstrate this definition of spirituality will be ethology and neuroscience. They are both very new. I will argue that spirituality is not about ideas, sacred texts and theology; rather, spirituality is all about emotion and social connection. Specific religions, for all their limitations, are often the portal through which positive emotions are brought into conscious attention. Neither Freud nor psychiatric textbooks ever mention emotions like joy and gratitude. Hymns and psalms give these emotions pride of place. Our whole concept of psychotherapy might change if clinicians set about enhancing positive emotions rather than focusing only on negative emotions.

The AA. report on a 40-year study of 169 college men and their wives. They examined marital satisfaction prospectively and retrospectively. When examined retrospectively, marital satisfaction followed a weak curvilinear pattern with the lowest point of marriage at approximately 20 years. When studied prospectively, the U-curve disappeared and marital satisfaction remained relatively stable, particularly in the middle and later years. The difference between the spouses came only in their assesment of the difficulty of solving disagreements, which seemed for the wives to become more difficult over time. These patterns of marital satisfaction held true whether studied according to number of years married, age of each partner, or stage of the family life cycle.

Twelve highly obese patients were studied to determine if “defensive maturity” ratings might correlate with sustained weight loss (SWL). Six patients with SWL averaging 24.2% had significantly (P

Fifty-one patients who on admission in 1959-62 were diagnosed schizophrenic and yet achieved full remission were followed for 4-16 years (average 10 years). Subsequently, 20 of the remitting schizophrenics relapsed, spent an average of 25% of the followup period hospitalized, and could unambiguously be relabeled chronic schizophrenia. Except for brief relapses in a few cases, 31 patients maintained full remission throughout the followup period. What was most significant was that on first admission the 20 remitting schizophrenics who became chronic were just as reactive (i.e., manifesting acute onset, precipitants, and good premorbid adjustment) and almost as "affective" (i.e., manifesting depression and heredity positive for affective psychosis) as the 31 patients whose remissions were sustained. These findings support the hypothesis that remitting schizophrenics are not necessarily a discrete type of schizophrenic requiring fresh labels. Rather, such patients may be more simply classified as schizophrenics who get predictably better after their first admission.

Summary This article reviews the treatment history of 100 hospital-treated heroin addicts and 100 hospital-treated alcohol-dependent individuals. The two cohorts were prospectively followed for 20 and 12 years respectively and factors related to relapse and freedom from relapse were sought. Premorbid social stability, especially stable employment history, proved a more effective predictor of long-term outcome than the severity or chronicity of addiction. Inpatient treatment exerted little effect on long-term course. For both samples, encountering one or more of the following—community compulsory supervision, a substitute dependence, new relationships, and inspirational group membership—appeared associated with freedom from relapse. The challenge of preventing relapse in diabetes is offered as a useful analogy for preventing relapse in the addictions.

This is a report of social mobility in 278 inner-city men studied for 4 decades and over 3 generations. 63.3% of the men and 59.8% of their children were upwardly mobile. 8 variables captured 28% of the explained variance in upward social mobility: IQ, mother's education, mother's occupation, boyhood ego strength, and four ego defense mechanisms--intellectualization, dissociation, sublimation, and anticipation. Of the 8 variables, intellectualization--the capacity to isolate ideation from the associated affect--explained the most unique variance, especially over 3 generations. Childhood relations of subjects with parents and father's IQ exerted no discernible effect on children's upward social mobility.