Adopted children who kill their adoptive parents: An examination through the lens of attachment theory.

Adoptive parricide, the killing of adoptive parents by their adoptive children, is a phenomenon that garners much media attention but remains elusive in the extant literature. Previous studies on adoptive parricide have largely consisted of clinical case studies with limited theoretical explanations. The current study uses Bowlby's attachment theory as a theoretical framework to explore adoptive parricide. A content analysis was conducted of news sources to obtain data on adoptive parricide cases. Hypotheses were generated per attachment theory in the context of Heide's (2013b) parricide offender typology. Early adoptees (n = 27) were compared to late adoptees (n = 29) using Fisher's exact tests. Early adoptees were more likely to kill multiple victims, kill for selfish motives, be overindulged by adoptive parents, and not have limits set and enforced by adoptive parents. Late adoptees were more likely to report having been abused by their adoptive parents. The results were not consistent with attachment theory. Implications for the adoption process and adoptive parenting practices are presented.

Adopted children who kill their adoptive parents.

The killing of parents, frequently referred to as parricide, is a disturbing phenomenon that often generates widespread media coverage. Most of the scholarly literature on this topic has focused on biological offspring who kill mothers and fathers. Some analyses have examined juveniles and adults who kill their stepparents. To date, virtually no research exists on children who kill their adoptive parents because this type of victim-offender relationship has been absent from available homicide databases, thereby preventing such analyses. The present study is a content analysis of news reports of 46 cases of adopted children who killed their adoptive parents in several different countries. Data pertaining to offender and victim demographics, incident characteristics, and the processing of offenders from the initial charge through conviction and sentencing are examined. To the extent possible, media accounts are used to classify cases according to motives or circumstances leading to the killings. The article concludes with a comparison of profiles of children who kill adoptive parents in relation to those who kill biological parents, important observations that emerged from these news accounts, and discussion of possible explanations of parricide by adopted children, including adopted children syndrome, reactive attachment disorder, and biological risk factors. Limitations of this study and directions for future research are addressed.

Elucidating Intimate Partner Violence Rate Disparities Between Same- and Opposite-Sex Couples: A Demographic Approach.

Studies on intimate partner violence (IPV) rates typically find higher rates for same-sex couples than opposite-sex couples. Regardless of sexual orientation, the risk for IPV perpetration is concentrated among young adults. Given that the HIV/AIDS epidemic significantly lowered the life expectancy of sexual minority men and that recent social movements have encouraged more youths to "come out," population age differences may contribute to the observed differences in IPV rates between same- and opposite-sex couples. The present study applies direct age standardization and decomposition techniques to data from the National Incident-Based Reporting System and the American Community Survey to examine this possibility across 2,584 same-sex male, 4,029 same-sex female, and 284,614 opposite-sex physical IPV incidents. The results of the direct standardization procedures indicate physical IPV rates for same-sex male and same-sex female households would be 11.8% and 27.3% lower, respectively, if they had the same population age structure as opposite-sex households. The results of the decompositions indicate that differences in population age structure contribute 48% and 44% of the elevation in IPV rates in same-sex male and same-sex female households, respectively, compared to opposite-sex households. These findings demonstrate the promise of demographic methods to explain differences in offending rates between groups. These results suggest the need for prevention and intervention strategies aimed at youths. Future studies should be conducted with data on sexual orientation and gender identity to better elucidate the contribution of population age structure among various sexual and gender minority groups. Research comparing trends among sexual minority populations to the heterosexual population in particular should account for age where possible.

Risk Assessment and Post-Release Recidivism in a Sample of Juvenile Homicide Offenders.

Given recent U.S. Supreme Court rulings regarding the constitutionality of juveniles who received mandated life sentences, questions have arisen in the field of criminology regarding how these offenders will adjust if someday released. Risk scores were calculated for 59 male juvenile homicide offenders (JHOs) based upon the eight domains in the Youth Level of Supervision/Case Management Inventory (YLS/CMI) and used to examine recidivism among the 48 JHOs who were released. Sample subjects were charged as adults for murder and attempted murder in the 1980s, convicted, and sentenced to adult prison. Chi-square analyses were used to assess the relationship between risk score category and two measures of recidivism, which were general arrests and violent offenses. Results indicated risk scores failed to predict both general and violent recidivism. Implications of the findings and directions for future research are discussed.

Mometasone furoate nasal spray: a review of safety and systemic effects.

The development of corticosteroids that are delivered directly to the nasal mucosa has alleviated much of the concern about the systemic adverse effects associated with oral corticosteroid therapy. However, given the high potency of these drugs and their widespread use in the treatment of allergic rhinitis, it is important to ensure that intranasal corticosteroids have a favourable benefit-risk ratio. One agent that typifies the systemic safety found in the majority of intranasal corticosteroids is mometasone furoate nasal spray, a potent and effective treatment for seasonal and perennial allergic rhinitis and nasal polyposis. Mometasone furoate does not reach high systemic concentrations or cause clinically significant adverse effects. Results from pharmacokinetic studies in adults and children suggest that systemic exposure to mometasone furoate after intranasal administration is negligible. This is probably because of the inherently low aqueous solubility of mometasone furoate, which allows only a small fraction of the drug to cross the nasal mucosa and enter the bloodstream, and because a large amount of the administered drug is swallowed and undergoes extensive first-pass metabolism. There is no clinical evidence that mometasone furoate nasal spray suppresses the function of the hypothalamus-pituitary-adrenal axis when the drug is administered at clinically relevant doses (100-200 microg/day); consequently, mometasone furoate nasal spray has not been associated with growth inhibition in children. The safety and tolerability of mometasone furoate nasal spray have been rigorously assessed in clinical trials involving approximately 4,500 patients, with epistaxis, headache and pharyngitis being the most common adverse effects associated with treatment in adolescents and adults. The clinical effectiveness of mometasone furoate nasal spray, coupled with its agreeable safety and tolerability profile, confirms its favourable benefit-risk ratio.

Evaluation of potential for pharmacokinetic interaction between mometasone furoate and formoterol fumarate after oral inhalation from a fixed-dose combination metered-dose inhaler device.

A fixed-dose combination (FDC) containing mometasone furoate (MF) and formoterol fumarate (F) in a pressurized metered dose inhaler (MDI) is approved for asthma and is being developed for COPD. This randomized, open-label, 4-period crossover study compared single-dose pharmacokinetics of MF 800 µg; F 20 µg; MF 800 µg + F 20 µg coadministered (MF + F); and MF 800 µg/F 20 µg (MF/F) FDC in healthy subjects. MF, F, and MF + F were administered from single-ingredient MDI devices. MF and formoterol plasma samples were obtained predose and up to 48 hours post dose for estimation of AUC0-tf (primary endpoint) and Cmax . Treatments were deemed comparable if the 90% CIs for the geometric mean ratios (GMRs) fell within 70-143%. MF AUC0-tf was comparable following treatment with MF + F versus MF (GMR 98%; 90% CI 85-113%) and MF/F versus MF + F (GMR 95%; 90% CI 82-109%). Similarly, formoterol AUC0-tf was comparable following treatment with MF + F versus F (GMR 98%; 90% CI 77-124%) and MF/F versus MF + F (GMR 108%; 90% CI 85-136%). The 90% CIs for MF and formoterol Cmax fell within the prespecified comparability bounds for all comparisons. Systemic exposures to MF and formoterol were similar following treatment with the FDC MDI device versus individual or concomitant use of single-ingredient MDI devices.

An evaluation of the systemic bioavailability of mometasone furoate (MF) after oral inhalation from a MF/formoterol fumarate metered-dose inhaler versus an MF dry-powder inhaler in healthy subjects.

PURPOSE: This randomized, open-label, multiple-dose, two-period, crossover study compared the systemic bioavailability of mometasone furoate (MF) administered from a metered-dose inhaler containing MF and formoterol fumarate (F) (MF/F-MDI) versus MF administered from a single-ingredient dry-powder inhaler (MF-DPI). METHODS: Healthy, non-smoking adults, 18-65 years with body mass index 18-29 kg/m(2) (N = 12) received MF 800 µg/F 20 µg via MF/F-MDI or MF 800 µg via MF-DPI twice daily for 5 days separated by a 7-day period. MF pharmacokinetics (AUC(0-12 hour) , Cmax , and Tmax ) were measured at Day 1 and 5 after each treatment. Safety and tolerability were assessed. RESULTS: Systemic exposure to MF based on AUC(0-12 hour) was ∼25% lower following MDI versus DPI administration. The Day 5 geometric mean ratio (MDI/DPI) estimates (90% confidence intervals [CI]) for AUC(0-12 hour) and Cmax were 0.747 (0.61, 0.91) and 0.606 (0.49, 0.75), respectively. The accumulation index (R) value for MF was higher following MDI (3.81-fold) versus DPI administration (2.34-fold) indicative of prolonged absorption. The most common adverse events were tremor, headache, and catheter site pain. CONCLUSIONS: Systemic exposure to MF was lower following multiple-dose MF/F-MDI administration versus MF-DPI administration. The magnitude of this difference is not considered to be clinically important. MF/F-MDI was safe and generally well tolerated.

Comparison of the systemic bioavailability of mometasone furoate after oral inhalation from a mometasone furoate/formoterol fumarate metered-dose inhaler versus a mometasone furoate dry-powder inhaler in patients with chronic obstructive pulmonary disease.

BACKGROUND: Coadministration of mometasone furoate (MF) and formoterol fumarate (F) produces additive effects for improving symptoms and lung function and reduces exacerbations in patients with asthma and chronic obstructive pulmonary disease (COPD). The present study assessed the relative systemic exposure to MF and characterized the pharmacokinetics of MF and formoterol in patients with COPD. METHODS: This was a single-center, randomized, open-label, multiple-dose, three-period, three-treatment crossover study. The following three treatments were self-administered by patients (n = 14) with moderate-to-severe COPD: MF 400 µg/F 10 µg via a metered-dose inhaler (MF/F MDI; DULERA(®)/ZENHALE(®)) without a spacer device, MF/F MDI with a spacer, or MF 400 µg via a dry-powder inhaler (DPI; ASMANEX(®) TWISTHALER(®)) twice daily for 5 days. Plasma samples for MF and formoterol assay were obtained predose and at prespecified time points after the last (morning) dose on day 5 of each period of the crossover. The geometric mean ratio (GMR) as a percent and the corresponding 90% confidence intervals (CI) were calculated for treatment comparisons. RESULTS: Systemic MF exposure was lower (GMR 77%; 90% CI 58, 102) following administration by MF/F MDI compared to MF DPI. Additionally, least squares geometric mean systemic exposures of MF and formoterol were lower (GMR 72%; 90% CI 61, 84) and (GMR 62%; 90% CI 52, 74), respectively, following administration by MF/F MDI in conjunction with a spacer compared to MF/F MDI without a spacer. MF/F MDI had a similar adverse experience profile as that seen with MF DPI. All adverse experiences were either mild or moderate in severity; no serious adverse experience was reported. CONCLUSION: Systemic MF exposures were lower following administration by MF/F MDI compared with MF DPI. Additionally, systemic MF and formoterol exposures were lower following administration by MF/F MDI with a spacer versus without a spacer. The magnitude of these differences with respect to systemic exposure was not clinically relevant.

Hypothalamic-pituitary-adrenal axis effects of mometasone furoate/formoterol fumarate vs fluticasone propionate/salmeterol administered through metered-dose inhaler.

BACKGROUND: The effects of mometasone furoate and fluticasone propionate on the hypothalamic-pituitary-adrenal axis were compared when administered from combination metered-dose inhaler (MDI) products. METHODS: In a randomized, open-label, placebo-controlled, parallel group study, 66 patients with mild to moderate asthma received one of the following four treatments bid through an MDI for 42 days: mometasone furoate/formoterol (MF/F) 200 µg/10 µg, MF/F 400 µg/10 µg, fluticasone propionate/salmeterol (FP/S) 460 µg/42 µg, or placebo. Plasma cortisol concentrations were measured over 24 h on days -1 (baseline) and 42. Geometric mean ratio (GMR) and 90% CI for mean change from baseline to day 42 in 24-h plasma cortisol area under the curve (AUC) were calculated for each treatment. If the 90% CI for the GMRs fell within 70% to 143%, treatments were deemed comparable. RESULTS: Mean baseline cortisol AUCs were similar across groups. Mean cortisol effects (change from baseline) were similar for MF/F 400 µg/10 µg and FP/S 460 µg/42 µg (GMR, 119%; 90% CI, 101%-140%). Effects of MF/F 200 µg/10 µg on cortisol AUC were similar to placebo (GMR, 92%; 90% CI, 78%-110%), whereas MF/F 400 µg/10 µg and FP/S 460 µg/42 µg lowered cortisol AUC vs placebo (GMR, 78% [90% CI, 66%-92%] and 66% [90% CI 56%-78%], respectively). All treatments were generally well tolerated. CONCLUSIONS: MF/F 400 µg/10 µg or FP/S 460 µg/42 µg bid through an MDI led to similar reductions from baseline in mean cortisol AUC (22% and 34% lower than placebo, respectively), whereas the effect of MF/F 200 µg/10 µg was similar to placebo.