No abstract

Functional Analytic Therapy (FAP) therapist training protocol was effective in improving empathy and FAP skills among Singaporean therapist trainees. These improvements were maintained at 2-month follow-up. The training was found to be acceptable in the Singaporean context, although several adaptations were suggested to increase the compatibility between FAP principles and local cultural norms.

This research explores when and how tailoring messages to attitudinal bases backfires. Study 1 demonstrated that for attitudes (toward education subsidies) that were based more on beliefs than emotions, recipients whose initial attitudes were incongruent with the message position (i.e., message opponents) showed mismatching effects, such that the affective message was more persuasive than the cognitive message. Study 2 replicated these mismatching effects among message opponents for attitudes (toward a rival university) that were primarily affective. Study 3 controlled for effects of initial attitude certainty and replicated the mismatching effects of Study 2 for affective attitudes toward an increase in tuition. Finally, Study 4 suggested a potential mechanism for mismatching effects, revealing that for attitudes (toward an online course management system) that were based more on beliefs than emotions, message opponents counter‐argued with the cognitive appeal more intensely than the affective appeal. Contrary to the notion in the extant literature that mismatching effects are relatively rare compared with matching effects, the current research suggests that mismatching effects occur for both primarily affective and cognitive attitudes when the recipient is highly opposed to the message position. The present findings also demonstrate the utility of examining attitudinal bases at the object level in the context of message tailoring. Implications for message tailoring and for affective versus cognitive attitudes are discussed. Copyright © 2013 John Wiley & Sons, Ltd.

BackgroundPeanut allergy is an increasing problem in Singapore and strict avoidance is difficult as peanut is ubiquitous in Asian cuisine.ObjectiveWe aimed to assess the efficacy and safety of peanut oral immunotherapy (OIT) in children with obvious peanut allergy in Singapore.MethodsThis was an open-label study of peanut OIT in children living in Singapore, with 2 weekly dose escalation until final maintenance dose of 3,000 mg of peanut protein and a maintenance phase of 12 months. An oral food challenge was performed at 6 months to assess for desensitisation and at 4 weeks after discontinuation of OIT having completed 12 months of maintenance therapy to assess for possible sustained unresponsiveness. The adverse events were monitored using the symptom diaries.ResultsNine subjects were started on OIT, with 7 managing to complete maintenance phase of therapy. Of these 7, all were able to tolerate at least 3,000 mg of peanut protein by 6 months of maintenance therapy, showing that the OIT was effective. Of these 7, 3 patients complied with the 4-week abstinence period after completion of OIT before another peanut challenge; 2 of the 3 subjects showed a significant decrease from the initial ability to tolerate 3,000 mg of peanut protein. Side effects were mainly gastrointestinal in nature and were more common during the updosing phase than the maintenance phase. No episodes of anaphylaxis were observed in this study.ConclusionPeanut OIT seemed to be effective and safe in our cohort of Singaporean children.

INTRODUCTIONThe prevalence of perceived food allergies exceeds that of true food allergies, especially if the estimates are based on selfreported surveys.(1) A substantial number of parents perceive food allergies in their children based on subjective reactions or allergy tests alone.(2) Others readily draw a connection between certain foods and chronic illnesses such as eczema.(2) In addition, cross-reactive foods are avoided in children with certain food allergies, as parents fear that their children will react even if they have not been tested for or eaten these foods. This is seen in many peanut-allergic children who avoid tree nuts but have not been tested for clinical reactivity to tree nuts. Similarly, demonstrating sensitisation alone, via positive skin prick tests (SPTs) or raised serum immunoglobulin E (IgE) levels, does not necessarily equate to having an allergy; (3) and eczema flare-ups are also not always related to foods.(4) Thus, it is not uncommon for children seen at allergy clinics to be on strict elimination diets based on incomplete information regarding potential food allergies. While the vast majority of these children are not allergic to the omitted foods, they are made to adhere to diets that are similar to those of patients with life-threatening reactions to these foods; this results in unnecessary food avoidance, an impaired quality of life, potentially poor weight gain and malnutrition. (5) An oral food challenge (OFC) can be used to provide parents with an objective measure of their child's true food allergies. As no local data is available on the use of OFCs to measure the presence or absence of food allergies, a retrospective chart review was carried out to describe the indications that prompted OFCs and the outcomes of the OFCs conducted. METHODSThis study was a retrospective review conducted on patients aged ≤ 18 years who underwent OFCs at the Paediatric Allergy Clinic of the National University Hospital, Singapore, from 2008 to 2010. Most of the patients were self-referred, followed by those referred from private clinics and polyclinics. The diagnostic workup of suspected food-related reactions is shown in Fig. 1. Our centre uses published diagnostic decision thresholds for serum IgE tests and SPTs that can help predict the likelihood of an allergic reaction if a particular food is ingested. (6,7) The decision to perform the challenge was based on these thresholds and the patient's clinical history. Patients generally did not proceed with an OFC if the treating physician felt that there was a high likelihood of a positive challenge, such as in the context of a recent life-threatening reaction to that food. Some patients underwent challenges for more than one food and a few patients were challenged repeatedly for the same food if their reactions were deemed to be subjective.