RESUMO
This qualitative study identified the parent health beliefs and normative beliefs related to child behavioral and mental health problems and examined the benefits and barriers of enrolling in an evidence-based parenting intervention among Filipino parents of school-aged children. A secondary aim was to also use the results to inform the development of a theory-based video intervention to increase enrollment in parenting interventions. Semi-structured interviews were conducted with fifteen parents who had or had not participated in the Incredible Years® parenting program, an evidence-based parenting intervention. Interviews were recorded and transcribed verbatim. Using a "Coding Consensus, Co-occurrence, and Comparison" methodology, emergent themes were mapped into a matrix against a priori-coded health belief model (HBM) and Theory of Planned Behavior (TPB) constructs. Parents believed that perceived susceptibility could be influenced by including knowledge of health disparities affecting Filipino youth in the U.S. Perceived severity was related to behavioral and mental health concerns about school, family dynamics, bullying and parent coping strategies. Perceived benefits included strengthening parent-child relationships, creating support systems, and learning positive parenting skills. Perceived barriers included logistics, stigma, and the perception of the relevance of the program, cultural factors such as generational differences about parenting, and family issues. Social norms and subjective norms related to parent participation were also discussed. Applying the HBM and TPB to enrollment in parenting interventions may explain low enrollment rates. Future interventions need to target perceived susceptibility to future behavioral health problems, barriers, and benefits to enrollment, and influence subjective and social norms.
RESUMO
Survival outcomes for relapsed/refractory pediatric acute myeloid leukemia (R/R AML) remain dismal. Epigenetic changes can result in gene expression alterations which are thought to contribute to both leukemogenesis and chemotherapy resistance. We report results from a phase I trial with a dose expansion cohort investigating decitabine and vorinostat in combination with fludarabine, cytarabine, and G-CSF (FLAG) in pediatric patients with R/R AML [NCT02412475]. Thirty-seven patients enrolled with a median age at enrollment of 8.4 (range, 1-20) years. There were no dose limiting toxicities among the enrolled patients, including two patients with Down syndrome. The recommended phase 2 dose of decitabine in combination with vorinostat and FLAG was 10 mg/m2 . The expanded cohort design allowed for an efficacy evaluation and the overall response rate among 35 evaluable patients was 54% (16 complete response (CR) and 3 complete response with incomplete hematologic recovery (CRi)). Ninety percent of responders achieved minimal residual disease (MRD) negativity (<0.1%) by centralized flow cytometry and 84% (n = 16) successfully proceeded to hematopoietic stem cell transplant. Two-year overall survival was 75.6% [95%CI: 47.3%, 90.1%] for MRD-negative patients vs. 17.9% [95%CI: 4.4%, 38.8%] for those with residual disease (p < .001). Twelve subjects (34%) had known epigenetic alterations with 8 (67%) achieving a CR, 7 (88%) of whom were MRD negative. Correlative pharmacodynamics demonstrated the biologic activity of decitabine and vorinostat and identified specific gene enrichment signatures in nonresponding patients. Overall, this therapy was well-tolerated, biologically active, and effective in pediatric patients with R/R AML, particularly those with epigenetic alterations.
