Quality of Life and Its Association with Effort-Reward Imbalance among Medical Officers Working in Government Hospitals in Kuching, Sarawak, Malaysia.

Background: Medical officers (MOs) face multiple sources of work-related stress, including work system transition, job insecurity, dissatisfaction with income and intense working environments. This study aimed to examine the quality of life (QOL), effort-reward imbalance (ERI) and their association among MOs working in government hospitals in Kuching, Sarawak, Malaysia. Methods: This cross-sectional study was conducted among MOs from Sarawak General Hospital and Hospital Sentosa from May 2018 to March 2020. A total of 614 participants were selected through convenient sampling. An email with a link to three sets of questionnaires via Google forms including a questionnaire on sociodemographic data and job characteristics, the World Health Organization Quality of Life-Brief version (WHOQOL-BREF) (Malay version) and the effort-reward imbalance (ERI-Q) (long version) was sent to potential participants. A total of 276 MOs completed and returned the questionnaires. Data were analysed using descriptive, simple and multiple logistic regression analysis. A P-value of less than 0.05 was taken as a statistically significant result. Results: Most MOs reported no adversity in the workplace (i.e. 29% low effort/high reward, 5.1% high effort/high reward, 6.2% low effort/low reward and 23.6% high effort/low reward). More than half of MOs (54%) reported poor general QOL and were associated with a combination of active and passive on-calls (adjusted odds ratio [AOR] = 5.36, 95% confidence interval [CI]: 1.21, 23.79). Poor QOL in the physical domain was associated with the presence of chronic illness (AOR = 23.35; 95% CI: 4.25, 128.45), active on-calls (AOR = 14.75; 95% CI: 1.16, 188.35) and a combination of active and passive on-calls (AOR = 18.25; 95% CI: 1.39, 238.98). Men had a higher risk of poor QOL in the environmental domain (AOR = 2.03; 95% CI: 1.04, 3.98). Only 23.6% of MOs reported psychosocial adversity at work (high effort/low reward). High effort/low reward was associated with poor QOL in general (AOR = 4.71; 95% CI: 1.71, 13.01), physical (AOR = 4.53; 95% CI: 2.02, 10.17), psychological (AOR = 5.95; 95% CI: 2.82, 12.58) and environmental domains (AOR = 4.21; 95% CI: 1.95, 9.08). Low effort/high reward was found to have a lower likelihood of poor QOL in the social domain (AOR = 0.13; 95% CI: 0.04, 0.44). Conclusion: Higher ERI was found to be associated with poor QOL among MOs in government hospitals. Future research should focus on interventions to improve working conditions.

A Case Report on Charles Bonnet Syndrome.

Objective: Charles Bonnet Syndrome (CBS) consists of visual hallucinations occurring in patients with visual impairment. CBS is commonly overlooked by medical professionals and underreported by patients due to the underlying stigma attached to the presence of hallucinations. Lack of awareness regarding CBS among medical professionals may lead to failures in providing forewarning and education to patients with visual impairment. In patients who are not familiar with CBS, this might lead to a higher risk of distress, misattribution to cultural belief or mental illness, and the potential of developing psychosis, especially in elderly patients with other modalities of sensory deprivation. This case report aims to increase awareness and knowledge about CBS among clinicians for the proper management of patients. Method : This case illustrated a patient with worsening visual impairment who presented with typical CBS and later progressed to visual hallucination and persecutory delusion Results: Providing information on CBS and antipsychotics resulted in less distress and improved the patient's visual hallucination and delusion Conclusion: Education and reassurance play a role in the management of CBS. It is important for medical professionals to be aware of CBS and provide clear information for patients who are at risk to lower their distress.