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A set of national diagnostic reference levels (DRLs) was established in Malaysia for a range of breast thicknesses in 2013, but no updates for full-field digital mammography (FFDM) and digital breast tomosynthesis (DBT). Due to the increasing number of DBTs used and concern over radiation exposure, this study aimed to explore and establish local diagnostic reference levels for FFDM and DBT in Malaysia health facilities at different compressed breast thickness (CBT) ranges. The CBT, kilovoltage peak (kVp), Entrance surface dose (ESD), and average glandular dose (AGD) were retrospectively extracted from the mammography Digital Imaging and Communications in Medicine (DICOM) header. The 75th and 95th percentile values were obtained for the AGD distribution of each mammography projection for three sets of CBT range. The difference in AGD values between FFDM and DBT at three CBT ranges was determined. The DRLs for FFDM were 1.13 mGy, 1.52 mGy, and 2.87 mGy, while DBT were 1.18 mGy, 1.88 mGy, and 2.78 mGy at CBT ranges of 20–39 mm, 40–59 mm, and 60–99 mm, respectively. The AGD of DBT was significantly higher than FFDM for both mammographic views (p < 0.005). All three CBT groups showed a significant difference in AGD values for FFDM and DBT (p < 0.005). The local DRLs from this study were lower than the national DRLs, with the AGD of FFDM significantly lower than DBT.

PurposeThe purpose of this paper is to study the perception of health-care students on the recent COVID-19 pandemic in Malaysia. There was one study by Caliskhan et al. (2020) conducted among Turkish final-year medical students showed that the students were knowledgeable about and aware of the COVID-19 pandemic. To the authors’ knowledge, there are limited number of studies conducted among health-care students in Malaysia.Design/methodology/approachThe online questionnaire was randomly distributed to the health-care students in Malaysia. The questionnaire consists of socio-demographic data and perceptions on COVID-19. Descriptive analysis was used to analyse the perceptions of the health-care students on COVID-19.FindingsHealth-care students in Malaysia have positive perceptions on COVID-19, and it did not give huge impact of their interest in this health-care field. Thus, it is important that this issue is investigated, and the perceptions of health-care students on COVID-19 can be highlighted.Research limitations/implicationsThe strength of this study was the participation from the health-care students from various institutions, which have different experience and backgrounds. The study was limited on the items of question utilised. Due to the limited time and urgency of the survey, the authors were unable to study their knowledge, attitudes and way they are going to cope with this kind of pandemic as the students and as future health-care workers.Originality/valueThe paper points out the effect on the recent COVID-19 pandemic on health-care students in Malaysia. It also points out the perceptions of health-care students in Malaysia on the current pandemic. It is expected that the results of this research would serve as baseline data for health-care institutions in Malaysia to continue equip the future front liners that can adapt future challenges.

COVID-19 pandemic has driven the education system to shift from face-to-face learning to a home learning system through online learning. This sudden change has worried teachers, parents and students all over the world. Various studies have been done to study the implementation of online learning, however, there are a little number of studies among school teachers, especially in Malaysia. Thus, this study aimed to explore teachers’ perspectives on the challenges of home learning and their commendations. A qualitative study was conducted through online interview sessions among 20 teachers in Seremban District, Negeri Sembilan from October 2020 until February 2021. Researchers verified the data by repeatedly listening to the audio recording, and transcriptions, reading and re-reading the transcripts. It will be coded into themes and subthemes based on the similarities of the content to assess the challenges and recommendations of online learning. Most of the respondents agreed that the adaptability to change to online learning, infrastructural such as the internet and corporation from students and parents is the challenges faced during learning from home. More interactive methods were suggested in ensuring effective online learning which will further motivate students to be engaged in learning from home. These strategies can be adopted for future sessions to ensure every student is able to gain equal education in any situation. Article visualizations

The decision on school reopening has evoked mixed reactions from parents as they become nervous regarding this action and are uncertain to send their children to school. Therefore, this study was conducted to assess the teachers’ perspectives on the readiness and challenges of school reopening in Malaysia. A study was conducted through online interview sessions amongst 20 teachers for primary and secondary schools at Seremban district, Negeri Sembilan, Malaysia from October 2020 until February 2021. Data were coded into themes and sub-themes based on the similarities of the data. The respondents in this study agreed that they are ready for school reopening and fully follow the guidelines prepared by the Ministry of Education Malaysia such as checking body temperature, physical distancing inside and outside the classroom, enforcement of wearing mask and sanitize the area regularly. Undeniably, the teachers faced some challenges regarding new norms during school sessions. Therefore, to ensure that the students receive proper education, at the same time the measures to contain the transmission of COVID-19 are followed properly, a few suggestions have been made. The cooperation from the teachers, parents and students are also needed to ensure and achieve the smoothness of school sessions.

Education systems in Malaysia, especially higher education institutions, are currently based on blended learning. The sudden outbreak of COVID-19 has disrupted many sectors and education is not an exception. To ensure the continuity of learning, the government has suggested for e-learning to be practiced in all institutions. The study aimed to assess the challenges and perceptions of e-learning among the tertiary level students. A study was conducted through an online survey in a private institution in Malaysia from March to April 2020. Descriptive analysis was used to assess the mean score of the challenges and perceptions. A total of 1,065 respondents participated in this study. Majority of the respondents (50.2%) had positive perceptions of e-learning as it was well supported. However, challenges on the Internet speed and quota affected the e-learning effectiveness. Thus, the strategies to improve instructional design on e-learning are necessary to develop more interactive activities and at the same time suits with low internet bandwidth.

Anxiety was the barrier mostly chosen by women for not performing mammography examination. Music was perceived as an effective method in reducing these barriers. Thus, this study was done to investigate how music would influence anxiety level among women undergoing mammogram screening. A cross-sectional descriptive study was conducted at randomly selected private hospitals around Klang Valley. The ’State-Trait Anxiety Inventory’ form was used to measure the level of anxiety. Respondents were categorized into two groups, which are control (no music) and experimental (with music) groups. Descriptive analysis was used to determine the anxiety level and T-test analysis were used to compare the anxiety level between both groups. A total of 60 respondents participated in this study in which 30 (50.0%) were in a control group and 30 (50.0%) were in the experimental group. Mean age of respondents were 53.5 (±12.7) years. The anxiety level is high in women who underwent mammography with no music (60.0%) as compared those with music (53.3%), although the difference is not significant (p>0.05). Music intervention has potential in reducing anxiety level during mammography examination.

Mammography is one of the screening tool that using x-ray dose to detect breast cancer at early stage for women older than 40 years old. By performing mammography screening annually, it can decrease mortality from breast cancer. Pain and anxiety often a hindrance to the rate of intake of mammography screening among the women. A systematic review was conducted to know the association of music with anxiety and pain on patients during mammography screening. Review identification was performed through a database search on MEDLINE and CINAHL, and 2 qualified studies were selected. The keyword used is “music therapy”, “anxiety”, ‘pain”, and “mammography”. A total of 2 articles showed the use of music among women who undergoing mammography screening. The previous studies showed that the use of music can decrease level of pain and anxiety among women during mammography screening. Thus, applying music during the screening should be implemented to encourage women for annual mammography screening.

Daily food intake of women may affect their bone health by altering their bone mineral density (BMD) as the lack of certain nutrients may affect bone integrity whilst, BMD also can be a predictor of breast cancer. To date, many studies have been conducted to discuss on association of BMD and mammographic breast density (MBD) and how both are related to breast cancer risks but no consideration has been made on dietary intake. Therefore, this study was designed to determine the association of dietary intake with BMD and other breast cancer risk factors. A cross-sectional study on 76 pre- and postmenopausal women above 40 years underwent mammogram screening and Dual Energy X-ray Absorptiometry (DEXA) was conducted in Hospital Kuala Lumpur (HKL) for the duration of 1 year. Purposive sampling method was used to choose the respondents. Women who are diagnosed with breast cancer and underwent cancer treatment were excluded from this study. DEXA unit (Hologic Discovery W, Hologic, Inc) were used to measure BMD at the femoral neck and lumbar spine in grams per centimetre squared (g/cm2 ) and they were classified into normal and abnormal group based on the T-scores. The subjects were asked about their daily dietary pattern for a duration of three days using Diet History Questionnaire (DHQ). The mean of selected characteristics were compared between groups. Additionally, binary logistic regression was used to determine the association between diet intake with BMD and other risk factors of breast cancer. The total number of pre- and postmenopausal women who consented to participate in this study are equal. The mean age was 47.1 years and 54.9 years for premenopausal and postmenopausal women respectively. The results indicate only menopausal age of the women was statistically significant (p < 0.05). A number of 17% premenopausal and 9% of postmenopausal women showed to have family history of breast cancer, however, it was not statistically significant (p = 0.12). There was no significant difference in daily energy intake of food in both groups (p = 0.22). None of the nutrients in daily food intake showed to be statistically significant. Menstrual status showed an association with BMD with p < 0.05 and the remaining risk factors did not show any association. Logistic regression revealed that only menstrual status had correlation with BMD in both groups. This study provided the dietary pattern and the effects on bone health. The association of other risk factors of breast cancer with BMD were also analysed and most of it showed a negative association. DOI : http://dx.doi.org./10.17576/JSKM-2017-1502-19

Estrogen is known to affect both mammographic breast density and bone mineral density. Breast density is a well-known risk factor of breast cancer determined by the physiological hormonal changes. Studies shown inconclusive relationship of breast density and bone mineral density as breast cancer risk factors. This study aimed to determine the relationship of bone mineral density; mammographic breast density and serum estrogen concentration level in Malaysian women. A cross sectional study on 108 women aged above 40 years who underwent bone scan and mammography screening was conducted at the General Hospital Kuala Lumpur from 2016 to 2017. Subjects were chosen using convenient sampling technique. With women commenced cancer treatment and women who had mastectomy done being excluded from the study. An independent-t and chi-square statistical test were used to analyze the continuous and categorical data whilst binary logistic regression was used to determine the mentioned relationship. A total of 75.5% of the respondents had a normal bone mineral density in the hip and 76.9% in the spine. Abnormality in bone mineral density were recorded to be higher in postmenopausal women with the bone mineral density in spine (23.2%) region were slightly higher compared to the hip (18.5%). There was no statistical significant relationship between mammographic breast density and serum concentration level with bone mineral density in hip and spine.

Background: Electrical impedance tomography (EIT) is a new non-invasive, mobile screening method which does not use ionizing radiation to the human breast; allows conducting quantitative assessment of the images besides the visual interpretation. The aim of this study was to correlate the quantitative assessment and visual interpretation of breast electrical impedance tomographs and associated factors. Materials and Methods: One hundred and fifty mammography patients above 40 years and undergoing EIT were chosen using convenient sampling. Visual interpretation of the images was carried out by a radiologist with minimum of three years experience using the breast imaging - electrical impedance (BI-EIM) classification for detection of abnormalities. A set of thirty blinded EIT images were reinterpreted to determine the intra-rater reliability using kappa. Quantitative assessment was by comparison of the breast average electric conductivity with the norm and correlations with visual interpretation of the images were determined using Chi-square. One-way ANOVA was used to compare the mean electrical conductivity between groups and t-test was used for comparisons with pre-existing Caucasians statistics. Independent t-tests were applied to compare the mean electrical conductivity of women with factors like exogenous hormone use and family history of breast cancer. Results: The mean electrical conductivity of Malaysian women was significantly lower than that of Caucasians (p

High mammographic breast density is an established risk factor for breast cancer whilst bone mineral density is a marker of estrogen cumulative exposure. This study was conducted to compare bone mineral density in Malaysian premenopausal and postmenopausal women; with and without breast cancer. Besides, it was to determine the relationship between bone mineral density and mammographic breast density in these groups. A cross-sectional study on 50 women above 40 years old who underwent mammogram and Dual Energy X-ray Absorptiometry was conducted at the General Hospital Kuala Lumpur for a year. Respondents were chosen using purposive sampling and women who had commenced cancer treatment were excluded from the study. The mean of selected characteristics were compared between groups using independent-t and Mann-Whitney U for continuous and categorical data respectively whilst Chi-square analysis was used to determine the association of bone mineral density and mammographic breast density. A total of 31 and 19 pre- and postmenopausal women respectively. Women with scattered fibroglandular breasts were the most affected by cancer, although, there was no statistical difference (p=0.298). There was no significant difference in women with contraceptive and/or hormone replacement therapy usage with breast density based on the classification of bone mineral density (p=0.214), cancer (p=0.344) and menstrual status (p=0.298). In conclusion, there was an adverse association between bone mineral density and mammographic breast density in both premenopausal and postmenopausal women; with and without breast cancer.

The transfer of education system from the traditional approach to Outcome Based Education (OBE) had given a significant change in many educational institutions worldwide. In Malaysia, most of the education institutions had implemented OBE in their system and had shown an increment in the students’ academic achievement. The reform in the health services that stresses on professionalism had brought the necessity to adopt OBE in allied health education. Thus, the Faculty of Health Sciences in KPJ Healthcare University College (KPJUC) implemented OBE on 2014 and positive result had been showed. There is a notable paucity of studies that focused on the students' perception on the educational system. This study focused on students' perception on OBE system in terms of students' understanding and their academic achievement. The student’s perception is the most crucial part as they are the medium of the system. They are the ones who undergo the system thoroughly, and they are the final product of the OBE system. This study used a descriptive method of research wherein the quantitative data were gathered using questionnaires. The participants were 19 graduating students from Bachelor of Medical Imaging (BMI) and Bachelor of Physiotherapy (BPY). The study showed that the perception of students regarding the program outcomes was good and this finding will help to improvise the lacuna in the system and can be the stepping-stone to a better education system in future.

Bone mineral density (BMD) is a lifetime marker of estrogen in a woman's body and has been associated with increased breast cancer risk. Nonetheless the actual association is still debatable. Furthermore, estrogen is very crucial in maintaining human bone density and gradually decreases over age. A systematic search was conducted to assess any association of BMD with breast cancer risk factors among premenopausal and postmenopausal women.Review identification was performed through databases searching on MEDLINE, CINAHL and SCOPUS and 19 qualified studies were elected. The keywords used were "bone mineral density", "breast cancer", and "breast density".A total of 19 articles showed variation with the majority of the studies focused on postmenopausal and a few focused on premenopausal women. Overall there was no concensus on effects.An enormous effort is being undertaken by researchers to prove that BMD might be one of the significant risk factors for breast cancer.

Asian Pacific Journal of Cancer Prevention, 17, 7

Outcome-Based Education (OBE) is now identified as essential to excellence in education. OBE can be described as the transparent application of a set of measurable criteria in setting a standard of proficiency. The students’ perception is the most crucial part as they are the medium of the system, as they are the ones who undergo the system thoroughly, and are the final product of the OBE system. Thus, their perception will directly show the effectiveness of the OBE system. This study focused on students’ perception on OBE system that had been applied in KPJ Healthcare University College (KPJUC) since 2014, in terms of students’ understanding and academic achievement. This is a mixed model study, which consisted of quantitative and qualitative study. A descriptive method of analysis was used, wherein the quantitative data were gathered using questionnaires and a survey interview was done as a qualitative supplementary data. The findings of this study discovered that the students have a positive perception toward the system.

Electrical Impedance Tomography (EIT) is a potential adjunct modality for breast cancer screening. It is mobile and does not use ionizing radiation. It is based on the theory that cancer cells display altered local dielectric properties, thus illustrate measurably higher conductivity values. EIT was validated with mammography (MMG); ultrasound (US) and biopsy. A total of 150 symptomatic mammography patients with US breast above 40 years undergone EIT. Respondents were chosen using convenience sampling. The analysis of MMG, US and EIT were done independently by four independent radiologists with minimum of five years' experience with BI-RADS classification for recognition of abnormalities. A total of 62 (41.3%) subjects had consistent interpretation of EIT, MMG and US whilst 88 (58.7%) subjects had coherent interpretation. Intra-rater agreement for EIT, MMG and US interpretation was good (κ≥0.7). EIT had 64.4% of sensitivity using diagnostic MMG, 70.1% of specificity, 67.1% of positive and 67.5% of negative predictive value. Specificity and positive predictive value increased to 76.3% and 80%, respectively when combination EIT, MMG and US were used. From 13 biopsy cases; 90% was proven as malignant lesions whilst 76.9% of 10 biopsy cases as benign lesions by EIT. Menopausal status and age (p>0.05) was not correlated significantly with EIT performance. EIT had 64.4% of sensitivity and is recommended to be a potential primary screening technique for detection of breast abnormality prior Breast Self Examination However MMG has to be done to confirm the diagnosis.