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Fulltext Asian consensus on assessment and management of mild to moderate plaque psoriasis with topical therapy

Imafuku S, Zheng M, Tada Y, Zhang X, Theng C, Thevarajah S, et al.

J Dermatol, 2018 Jul;45(7):805-811.
PMID: 29740870 DOI: 10.1111/1346-8138.14338

A working group of dermatologists in Asian countries assessed the current status of psoriatic management in the region to prepare a consensus report on topical treatment in mild to moderate plaque psoriasis. Even though the association of psoriasis with systemic comorbidities is increasingly acknowledged, psoriasis is still lower in health-care priority lists in the region. The psychosocial impact of psoriasis may be greater in Asian countries due to cultural norms and social discrimination. Non-adherence to treatment is also common among Asians. The current care given to patients with mild to moderate psoriasis needs to be streamlined, enhanced and organized with a patient-centered care approach to achieve better outcomes. A comprehensive assessment of the disease severity and its impact on a patient's life is required before initiating treatment. Education and active involvement of the patient in the treatment plan is an important part of psoriatic management. It is recommended to personalize topical treatment to meet the needs of the patient, depending on disease severity, psychosocial impact, the patient's expectations and, more importantly, the patient's willingness and ability to actively follow the treatment procedure. Fixed-dose combination of corticosteroid and vitamin D analogs is the preferred topical medication for both initial and maintenance phases of treatment. The fast containment of the disease is the goal of the initial phase of 4-8 weeks and it demands a potent fast-acting topical therapy. Satisfactory control of the disease and prevention of relapses should be achieved during the maintenance phase with twice a week or weekend applications.

Matched MeSH terms: Social Discrimination
Fulltext Lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI+) healthcare in Singapore: perspectives of non-governmental organisations and clinical year medical students

O'Hara CA, Foon XL, Ng JC, Wong CS, Wang FY, Tan CY, et al.

Med Educ Online, 2023 Dec;28(1):2172744.
PMID: 36744296 DOI: 10.1080/10872981.2023.2172744

PURPOSE: International studies document that lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI+) patients face significant health disparities. Studies exploring the attitudes, knowledge, preparedness and comfort levels of healthcare students towards LGBTQI+ health have been conducted in the United States, United Kingdom and Malaysia. This study aims to investigate stigma in healthcare for LGBTQI+ patients in Singapore, and possible upstream factors within medical education.
METHODS: This mixed-methods study adopts a convergent parallel design. The Health Stigma and Discrimination Framework was referenced to devise in-depth interviews with representatives from 13 LGBTQI-affirming non-governmental organisations, analysed through thematic analysis. 320 clinical medical students were surveyed about attitudes, knowledge, comfort, preparedness, and perceived importance of/towards LGBTQI+ health, analysed via descriptive statistics and multivariate regression.
RESULTS: Prevailing stigma in Singaporean society against LGBTQI+ individuals is exacerbated in healthcare settings. Doctors were cited as unfamiliar or uncomfortable with LGBTQI+ health, possibly from lack of training. Among medical students surveyed, the median composite attitudes, comfort and preparedness index was 3.30 (Interquartile Range (IQR) = 0.50), 3.17 (IQR = 0.83), 2.50 (IQR = 1.00) respectively. Only 12.19% of students answered all 11 true-false questions about LGBTQI+ health correctly.
CONCLUSION: Medical students in Singapore have scored sub-optimally in their knowledge and preparedness towards LGBTQI+ health, while interpersonal and structural stigma in healthcare towards LGBTQI+ people in Singapore negatively affects health and wellbeing. These findings are an impetus to improve medical training in this area. High scores among medical students in attitudes, comfort and perceived importance of LGBTQI+ topics demonstrate that there is space for LGBTQI+ health in the local medical education curriculum. Curricular interventions can prioritise content knowledge, communication skills and sensitivity.

Matched MeSH terms: Social Discrimination
We'll never get past the glass ceiling! Meta-stereotyping, world-views and perceived relative group-worth

Owuamalam C, Zagefka H

Br J Psychol, 2013 Nov;104(4):543-62.
PMID: 24094283 DOI: 10.1111/bjop.12006

This article examines the implications of perceived negativity from members of a dominant outgroup on the world views and perceived relative group worth of members of disadvantaged groups. We hypothesized that concerns about the negative opinions a dominant outgroup is perceived to hold of the ingroup (i.e., meta-stereotypes) would undermine group members' views about societal fairness. We expected this trend to be mediated by recall of previous personal experiences of discrimination. We further hypothesized that members' views about societal fairness would predict their perception of the ingroup's worth relative to the outgroup - such that undermined views about societal fairness would be associated with lower perceived ingroup worth relative to the outgroup. Taken jointly, results from two studies using two real intergroup contexts support these hypotheses and are discussed in terms of their implications for the social mobility of members of disadvantaged groups.

Matched MeSH terms: Social Discrimination/psychology*
Fulltext Transgender women in Malaysia, in the context of HIV and Islam: a qualitative study of stakeholders' perceptions

Barmania S, Aljunid SM

BMC Int Health Hum Rights, 2017 10 18;17(1):30.
PMID: 29047415 DOI: 10.1186/s12914-017-0138-y

BACKGROUND: Globally, one of the key groups considered to be at high risk of acquiring HIV are transgender women, often a marginalised group. In the Malaysian context there has been a scarcity of published research relating to transgender women, a sensitive issue in a Muslim majority country, where Islam plays an influential role in society. Furthermore, there has been a paucity of research relating to how such issues relate to HIV prevention in transgender women in Malaysia. Thus, the aim of this study is to explore the attitudes of stakeholders involved in HIV prevention policy in Malaysia towards transgender women, given the Islamic context.
METHODS: In-depth interviews were undertaken with stakeholders involved in HIV prevention, Ministry of Health, Religious Leaders and People Living with HIV, including transgender women. Thirty five participants were recruited using purposive sampling from June to December 2013 within Kuala Lumpur and surrounding vicinities. Interviews were in person, audiotaped, transcribed verbatim and used a framework analysis.
RESULTS: Five central themes emerged from the qualitative data; Perceptions of Transgender women and their place in Society; Reaching out to Transgender Women; Islamic doctrine; 'Cure', 'Correction' and finally, Stigma and Discrimination.
DISCUSSION: Islamic rulings about transgenderism were often the justification given by participants chastising transgender women, whilst there were also more progressive attitudes and room for debate. Pervasive negative attitudes and stigma and discrimination created a climate where transgender women often felt more comfortable with non-governmental organisations.
CONCLUSION: The situation of transgender women in Malaysia and HIV prevention is a highly sensitive and challenging environment for all stakeholders, given the Muslim context and current legal system. Despite this apparent impasse, there are practically achievable areas that can be improved upon to optimise HIV prevention services and the environment for transgender women in Malaysia.

Matched MeSH terms: Social Discrimination*
Fulltext Gender identity, healthcare access, and risk reduction among Malaysia's mak nyah community

Gibson BA, Brown SE, Rutledge R, Wickersham JA, Kamarulzaman A, Altice FL

Glob Public Health, 2016 Aug-Sep;11(7-8):1010-25.
PMID: 26824463 DOI: 10.1080/17441692.2015.1134614

Transgender women (TGW) face compounded levels of stigma and discrimination, resulting in multiple health risks and poor health outcomes. TGW identities are erased by forcing them into binary sex categories in society or treating them as men who have sex with men (MSM). In Malaysia, where both civil and religious law criminalise them for their identities, many TGW turn to sex work with inconsistent prevention methods, which increases their health risks. This qualitative study aims to understand how the identities of TGW sex workers shapes their healthcare utilisation patterns and harm reduction behaviours. In-depth, semi-structured interviews were conducted with 21 male-to-female transgender (mak nyah) sex workers in Malaysia. Interviews were transcribed, translated into English, and analysed using thematic coding. Results suggest that TGW identity is shaped at an early age followed by incorporation into the mak nyah community where TGW were assisted in gender transition and introduced to sex work. While healthcare was accessible, it failed to address the multiple healthcare needs of TGW. Pressure for gender-affirming health procedures and fear of HIV and sexually transmitted infection screening led to potentially hazardous health behaviours. These findings have implications for developing holistic, culturally sensitive prevention and healthcare services for TGW.

Matched MeSH terms: Social Discrimination*