Purpose: Transgender people are frequent targets of discrimination. Discrimination against transgender people in the context of healthcare can lead to poor health outcomes and facilitate the growth of health disparities. This study explores factors associated with medical doctors' intentions to discriminate against transgender people in Malaysia. Methods: A total of 436 physicians at two major university medical centers in Kuala Lumpur, Malaysia, completed an online survey. Sociodemographic characteristics, stigma-related constructs, and intentions to discriminate against transgender people were measured. Bivariate and multivariate linear regression were used to evaluate independent covariates of discrimination intent. Results: Medical doctors who felt more fearful of transgender people and more personal shame associated with transgender people expressed greater intention to discriminate against transgender people, whereas doctors who endorsed the belief that transgender people deserve good care reported lower discrimination intent. Stigma-related constructs accounted for 42% of the variance and 8% was accounted for by sociodemographic characteristics. Conclusions: Constructs associated with transgender stigma play an important role in medical doctors' intentions to discriminate against transgender patients. Development of interventions to improve medical doctors' knowledge about and attitudes toward transgender people are necessary to reduce discriminatory intent in healthcare settings.

Introduction: People with HIV (PWH) in Malaysia experience high levels of stigma, which may act as a barrier to accessing healthcare. Stigma against PWH in medical settings is understudied in Malaysia. In the present study, we examine factors associated with physicians' intention to discriminate against PWH in Malaysia. Methods: A cross-sectional online survey was emailed to all 1431 physicians at two major university hospitals in Malaysia; 568 (39.6%) participants completed the survey and were included in this analysis. Measures included intention to discriminate against PWH, stigma-related constructs, and socio-demographic characteristics. Multivariate linear regression was used to identify factors associated with intention to discriminate against PWH. Results: Participants were comprised of women (53.5%), Malays (43.1%), and Chinese (35.0%) with nearly 10 years of clinical experience. Most participants were from non-surgical specialties (77.6%). The final multivariate linear regression showed that physicians who expressed greater discriminatory intent against PWH also expressed more negative feelings toward PWH, more HIVrelated shame, were more fearful of HIV, and believed that PWH do not deserve good care.

Introduction: Fatigue is an important yet infrequently evaluated component in patients with rheumatoid arthritis (RA) and may have a major impact on quality of life. Objectives: To evaluate fatigue, identify factors associated with fatigue and assess the effect of fatigue on health-related quality of life (HRQoL) in a multi-ethnic cohort of RA patients. Methods: A cross-sectional study was performed in patients who fulfilled European League Against Rheumatism/ American College of Rheumatology 2010 criteria for RA. Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) questionnaire was used to assess fatigue. Potential factors for fatigue were categorized into RA-related (gender, seropositivity [rheumatoid factor and/or anti-citrullinated protein antibody], disease duration, visual analog scale pain score, Disease Activity Score of 28 joints-erythrocyte sedimentation rate [DAS28-ESR], ESR, hemoglobin level, functional disability [Health Assessment Questionnaire-Disability Index, HAQ-DI score], EQ-5D-3L, concomitant prednisolone use and number of conventional synthetic disease-modifying anti-rheumatic drugs [csDMARDs] used) and non-RA-related (age, body mass index, ethnicity and number of co-morbidities). Results: A total of 214 patients (86.9% female) were included; the median age was 62 (25-91) years and 67.3% were seropositive. Seventy-six (33.5%) patients had moderate disease activity, 12 (5.6%) had high disease activity and 152 (71%) patients had mild difficulties to moderate disability HAQ-DI scores. Median of total FACIT-F score was 113.2 (36.3-160.0). Joint factors of younger age, longer disease duration, higher HAQ score (increased functional disability), and lower EQ-5D (poorer HRQoL) were significantly associated with higher levels of fatigue (all P < .02). Conclusion: Fatigue was associated with functional disability and has a significant impact on HRQoL in RA. Fatigue assessment should be considered in routine clinical practice for RA patients.

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Background:Psoriatic arthritis (PsA) is a chronic inflammatory condition in which a delayed diagnosis will have health impacts including physical and psychological aspects. Thus, identification of risk factors and early diagnosis are crucial in clinical practice. In Malaysia, 13.7% of patients with underlying psoriasis develop PsA 1. However, there are limited data on the risk factors in developing PsA in these patients, not just in Malaysia but also in the Southeast Asia region.Objectives:To analyse sex, clinical features, comorbidities in patients with psoriasis and PsA, and the predictive factors of developing PsA in patients with underlying psoriasis.Methods:A retrospective study was carried out involving patients with a physician-verified diagnosis of psoriasis who were attending the dermatology and/or rheumatology clinics at the University of Malaya Medical Centre, Kuala Lumpur between 2015 to 2020. Data were retrieved from electronic medical records. Data collected included sex, age, body mass index (BMI), duration of psoriasis, socio-demographics, comorbidities, body area affected, severity of skin involvement, presence of nail involvement and systemic therapy used in treating psoriasis. Systemic therapy is defined as methotrexate, sulfasalazine and/or acitretin used before diagnosis of PsA. Patients with psoriasis who developed PsA had information collected on tender joint count, swollen joint count and erythrocyte sedimentation rate (ESR) at their initial visit to the rheumatologist. Logistic regression analyses were performed to identify the possible risk factors of developing PsA.Results:A total of 330 psoriasis patients which included 54.5% male and a mean age of 53 (standard deviation, SD 18.85) years were included. Eighty-three (25.0%) patients were diagnosed with PsA. Among patients with PsA, 39.8% were males with a mean age of 54 (SD 15.79) years. Majority of the PsA patients were ethnic Malay (45.8%), followed by 28.9% Chinese and 25.3% Indian. The median duration of developing PsA was at 36 (IQR 3.5 - 114) months after the diagnosis of psoriasis. 12.3% presented with active polyarthritis at the initial diagnosis of PsA. There was a significant difference in the use of systemic therapy in females, in which there was a higher rate of systemic therapy used in female PsA patients prior to developing PsA as compared to females with psoriasis who did not develop PsA (n=24, 48% vs n=16, 16%; p < 0.001). There was no significant association between ethnicity, education level, comorbidities, BMI, body area affected and family history of psoriasis with development of PsA. The predictive factors in developing PsA are females (OR = 3.14, 95% CI 1.77,5.58), presence of nail involvement (OR = 3.72, 95% CI 1.91,7.26) and the use of systemic therapy (OR = 3.04, 95% CI 1.70,5.43), (all p values <0.001).Conclusion:This study highlighted that female sex, presence of nail involvement and use of systemic therapy prior to PsA diagnosis are predictive risk factors in developing PsA among patients with underlying psoriasis. Further prospective studies with larger cohorts are needed to better delineate these risk factors.References:[1]Mohd Affandi A, Khan I, Ngah Saaya N. Epidemiology and Clinical Features of Adult Patients with Psoriasis in Malaysia: 10-Year Review from the Malaysian Psoriasis Registry (2007-2016). Dermatology research and practice. 2018;2018:4371471.Figure 1.Comorbidities among Patients with underlying Psoriasis and Psoriatic Arthritis (n=330)Chi-square test revealed that there was no significant difference between psoriasis and psoriatic arthritis (p > 0.05)Disclosure of Interests:WAI YANG LOO: None declared, FARIZ YAHYA Speakers bureau: speaker for Novartis, Gilead, AbbVie, Janssen, Eli Lilly, Zuellig-Pharma and Pfizer., Consultant of: consultancy work with Novartis, Gilead, AbbVie, Eli Lilly, Zuellig-Pharma and Pfizer., Grant/research support from: research grants from Novartis, Gilead, AbbVie, Boehringer-Ingelheim and Pfizer., WINN HUI HAN: None declared, NIK AIMEE AZIZAH FAHEM: None declared, SHIN SHEN YONG: None declared, Lydia Say Lee Pok: None declared, Zhenli Kwan Speakers bureau: Novartis, Zuellig, YING CHEW TEE: None declared.