Bridging Exhibitionism and Internet Pornography: Is There A Link?

Exhibitionism is a distressing condition which may have a link with the increasing availability and usage of online sexual activities (OSA). We highlight a 42-year-old man who presented with a constant craving for OSA to achieve his sexual satisfaction which included exposing his genitalia to virtual partners, unsuspected strangers, and colleagues in public areas. His sexual behaviours were further reinforced by an online video chatting with genitalia exposure, which ended commonly with an exchange of masturbatory acts. He denied any problem with his erection and able to achieve orgasm via common sexual acts. There was no past psychiatric history nor family history of mental disorder. He volunteered to seek psychiatric help and subsequently given a psycho education on his illness and how to cope with the distress associated with his sexual acts. He was scheduled for an intensive psychotherapy to instil insight and hope to deal with his sexual difficulties

Peer-Led Group Tele-Supervision of Clinical Psychologists: Optimization of Resources – A Malaysian Case Study

Inaccessibility to clinical supervision is an issue faced by solo clinical psychologist practitioners. Combination use of web-based instant messaging and video call application were tried by 28 clinical psychologists in conducting a peer-led group tele-supervision to address ethical dilemmas, discuss case management, provide technical instruction, explore resistance and analyse countertransference, provide emotional support, and share knowledge and updated guidelines. Despite facing challenges including difficulty in face-to-face session scheduling, limited time for in-depth discussion, internet connection issues, and documentation dilemma, we believe it has potential to influence supervision practice for clinicians working in isolation in rural or remote location

Assessment of practical science communication skills as a core competency of admission to undergraduate medical programmes: nationwide outcomes and associated factors

Interprofessional scientific communication skills are an essential part of the medical profession. Multiple research suggests poor interprofessional communication has direct correlations with poor patient outcomes. As part of the inaugural Multiple Mini Interview (MMI) at Universiti Malaysia Sabah, a 5-minute station on science communication was introduced, assessed on three domains – logical thinking, communication skills, and general impression. This station featured a panicky nurse calling a doctor to get them to calculate doses of a medication, using only upper primary school-level arithmetic and knowledge of ratios. Methods: 255 candidates, grouped into 3 separate geographical groups – Klang Valley, non-Klang Valley, and Borneo – participated in the MMI featuring a science communication station. Candidates were graded in the abovementioned three domains, and correlations were calculated between scores and various sociodemographic factors, with an objective written basic science test, and with overall scores. Also, quantitative analysis was done of the “red flag” comments for candidates deemed unsuitable for the practise of medicine. Results: The average scores for West Malaysia for logical thinking scores were higher than Borneo, with non-Klang Valley scores (4.1) significantly higher than Klang Valley (3.6). Communication scores were also significantly lower in Borneo compared to West Malaysia. General impression scores hence also showed a discrepancy between West Malaysian and Bornean scores. There were a total of 8 red flags, with reasons ranging from gross miscalculation with misplaced confidence, to nervous breakdowns while performing calculations. Conclusion: The present study showed that there is a distinct separation of science communication scores between geographic regions. Also it illustrates the yawning gap between academic knowledge and “translational” scientific knowledge. The results illustrate the need for medical curricula to boost resilience and translational computational skills in medical graduates who will be working in environments that demand usual abilities under unusual and trying circumstances

Ultra brief psychological interventions for covid-19 pandemic: Introduction of a locally-adapted brief intervention for mental health and psychosocial support service

The ultra-brief psychological interventions (UBPI) was created in 2018 to empower healthcare providers with psychological skills that can be delivered within a short period. Techniques used within UBPI were adopted from a variety of well established psychotherapies and distilled into its core essentials. This enabled practitioners of UBPI to deliver specific psychological skills in the appropriate context to the client within a period of 15–20 min. UBPI was also manualised to standardised training of practitioners. During the novel coronavirus disease of 2019 (COVID-19) pandemic, UBPI was modified to suit the unique psychological demands of the pandemic. This article presents how UBPI was adapted and used with healthcare providers dealing with COVID-19 and also with the public who required psychological first aid (PFA)

The behaviour changes in response to COVID-19 pandemic within Malaysia

The novel coronavirus infection, COVID-19, is a pandemic that currently affects the whole world. During this period, Malaysians displayed a variety of behaviour changes as a response to COVID-19, including panic buying, mass travelling during movement restriction and even absconding from treatment facilities. This article attempts to explore some of these behaviour changes from a behaviourist perspective in order to get a better understanding of the rationale behind the changes

Potvrđivanje učinkovitosti testa identifikacije poremećaja uzrokovanih alkoholom (AUDIT) – verzija na Dusun jeziku u konzumenata alkohola u Sabahu, Borneo

Introduction: The Alcohol Use Disorder Identification Test (AUDIT) developed by WHO is instrumental in identifying individuals on the alcohol misuse spectrum. However there is no culturally appropriate Dusun language version in Sabahan Borneo. This study aims to develop and validate a Dusun language version of AUDIT (AUDIT-D). Methods: AUDIT was translated to Dusun and back translated to English and Malay. The first version was pilot tested in 20 participants and harmonised. The harmonised version was administered to 50 Dusun first language speakers fluent in Malay from villages in rural Sabah. Participants filled in socio-demographic questionnaires, Dusun (AUDIT-D) and Bahasa Malaysia (AUDIT-M) versions of AUDIT, and validated Bahasa Malaysia versions of the M.I.N.I. alcohol dependence subscale and CAGE. Results: ROC curves calculated AUDIT-D dependence cut-off of 9 and more, with prevalence of dependence at 46%. Factor analysis of AUDIT-D yielded a one - or three-factor solution, distinct from the AUDIT-M factor structure. Cronbach alpha coefficients for the total AUDIT-D was 0.83. Significant Spearman’s correlations existed between AUDIT-D and AUDIT-M scores (Spearman’s rho=0.999, p<.001). AUDIT-D and AUDIT-M were both significantly correlated with M.I.N.I. alcohol dependence subscales (rho=0.624 and 0.617 respectively, with p<0.0001). Both were not significantly correlated with CAGE. Conclusion: The AUDIT-D questionnaire has acceptable psychometric properties, properties and demonstrates similar factor structures to other areas with high alcohol dependence prevalence. It is suitable for the assessment and identification of alcohol use disorders in the unique Sabahan Borneo cultural landscape.Uvod: Test identifikacije poremećaja uzrokovanih alkoholom (AUDIT eng. The Alcohol Use Disorder Identification Test) kojeg je razvila Svjetska zdravstvena organizacija (WHO), od iznimne je koristi u identifikaciji pojedinaca koji boluju od poremećaja ponašanja uzrokovanih alkoholom. Doduše, ne postoji kulturološki primjerena verzija testa na Dusun jeziku u saveznoj državi Sabah na otoku Borneu, Malezija. Cilj ovog istraživanja je razviti i potvrditi verziju AUDIT test na Dusun jeziku. Metode: AUDIT test je preveden na Dusun jezik, zatim s Dusun jezika na engleski i malezijski. Prva verzija je bila pilot test koji je uključio 20 ispitanika, te je bio usklađen. Usklađena verzija testa je provedena na 50 ispitanika čiji je prvi jezik bio Dusun, te su također bili tečni u malezijskom jeziku, a bili su žitelji ruralnih sela Sabaha. Ispitanici su ispunili socio-demografske upitnike, Dusun (AUDIT-D) i Bahasa malezijske (AUDIT-M) verzije testa, usklađene verzije M.I.N.I. testa alkoholne ovisnosti na Bahasa malezijskom jeziku, te CAGE upitnik. Rezultati: ROC krivulje izračunale su graničnu ovisnost AUDIT-D od 9 i više, s prevalencijom ovisnosti od 46%. Faktorska analiza AUDIT-D dala je jedno- ili trofaktorsko rješenje, za razliku od strukture faktora u AUDIT-M testu. Cronbach alfa koeficijenti za ukupni AUDIT-D bili su 0,83. Značajne Spearmanove korelacije postojale su između AUDIT-D i AUDIT-M rezultata (Spearmanov rho = 0,999, p <0,001). AUDIT-D i AUDIT-M bili su značajno povezani s M.I.N.I. podskupinama za ovisnosti o alkoholu (rho = 0,624 i 0,617, s p <0,0001). Oba nisu pokazala značajnu povezanost s CAGE upitnikom. Zaključak: AUDIT-D upitnik ima prihvatljiva psihometrijska svojstva i pokazuje slične faktorske strukture u odnosu na druga područja s visokom prevalencijom ovisnosti o alkoholu. Prikladan je za procjenu i utvrđivanje poremećaja ponašanja uzrokovanih konzumacijom alkohola u jedinstvenom kulturnom krajoliku Sabaha

Integrating Digital Health for Healthcare Transformation Conceptual Model of Smart Healthcare for northern Borneo

Digital health has revolutionised the delivery of healthcare globally. However, integrating digital health in the system for transforming healthcare at a larger scale needs to be contextually relevant. Sabah, a state in northern Borneo, has distinctive public health concerns on thalassaemia, colorectal cancer, ischaemic heart disease, mental health, malaria, tuberculosis, and maternal and child health. Envisioning equal access to healthcare throughout the state, a conceptual model called smart healthcare is conceived for healthcare transformation through digital health integration based on the main clinical niche. The three domains of smart healthcare model is smart hospital, smart wellness and smart uber health. Smart hospital is aimed as the central core for materialising smart healthcare model as it serves as the platform to integrate digital health for diagnostic tools and treatment modalities. The purpose of smart wellness is to ensure uninterrupted healthcare and promotes preventive medicine at home and community setting through the ecosystem feeding by the smart hospital. This ecosystem is connected with smart uber health in order to bring the healthcare services to patients and succesfully overcoming the issue on inaccessibility. Each domain is highlighted with certain niche and related healthcare technology

Learning psychodynamic psychotherapy in Southeast Asia

The subjective nature of psychodynamic psychotherapy (PP) makes training and supervision more abstract compared to other forms of psychotherapy. The issues encountered in the learning and supervision process of PP of Malaysian psychiatry trainees are discussed in this article. Issues of preparation before starting PP, case selection, assessment of patients, dynamic formulations, supervision, anxieties in the therapy, countertransference, termination of therapy, the treatment alliance, transfer of care, the therapeutic setting, and bioethical considerations are explored. Everyone's experience of learning PP is unique and there is no algorithmic approach to its practice. With creative thinking, effort, and “good enough” supervision, a trainee can improve PP skills, even in underserved areas of the world

Inculcating collaborative practice among healthcare professionals: initiative from hospital Universiti Malaysia Sabah

Introduction: Collaborative working culture is an important milestone to be inculcated in a hospital setting. In the process of preparation for the upcoming teaching hospital of Universiti Malaysia Sabah (HUMS), the organisational value of innovative, collaborative, compassionate, empowering, and sustainable needs to be inculcated to the both management and clinical staffs. The objective of this study was to assess the efficacy of a collaborative practise workshop in staff. Methods: A two days experiential learning workshop was conducted to deliver and inculcate the organisational value of HUMS to 32 existing and newly recruited healthcare professionals, which include doctor, nurses, assistant medical officer, dental assistant, pharmacist, and radiographer. The topics consisted of principles of collaborative practice, skill of validation, feedback-giving method, approach for value identification and goal setting, reflective practice, public communication during crisis, shared decision making, and organisational problem solving. Different delivery methods include round table discussion, role play, and group work were used. Innovative real time practice of giving feedback to the management was performed directly to the hospital chief executive officer and chief clinical officer. Results: Immediate feedback from the participants found that the candidates found the course was enriching and it helped them to develop an alternative perspective on how to get work done. The staffs expressed their idea, concern, and expectation more openly with the method learned using what they had learnt. The limitation included the challenge of transition from previous working culture to new environment without further supervision. Conclusions: Further systematic evaluation using more detailed assessment tool is needed to understand the long term efficiency and translatability of the learning outcomes into clinical practice once the hospital is ready

Prevalence and Associated Factors of Depression, Anxiety and Stress Among Doctors in North Borneo

Introduction: Doctors are known to deal with high occupational stress, causing increased risk of depression, anxiety and stress.Nevertheless, the prevalence and associatedfactors of depression, anxiety and stress among registered doctorsworking in 24 public hospitals in Sabah, Malaysia are not known yet. Methods: This cross-sectional study was conducted using convenient sampling from September-October 2018. The data of 21-item Depression Anxiety Stress Scale (DASS-21) was collected via online link anonymously. Results: Among 314 doctors, majority of them were females (62.1%), mean age 29 (SD 2.72), non-Sabahan (82.8%), Malays (46.8%), not married (78.3%) and medical officers (93.6%). Prevalence of severe/extremely severe anxiety symptoms was 27.4%,depression (22.9%) and stress (18.5%). Doctors perceiving themselves to be depressed, anxious and/or stressed were more likely to develop the corresponding symptoms. Females and Chinese were twice more likely to report anxiety symptoms. Being married had protective effect against depressive symptoms, while working in same hospital for longer time had a significant but weak protective effect against anxiety and stress symptoms. Conclusions: Mental health issue among doctors is substantial and need to be addressed effectively for the benefit of their life, patients and country