Attitudes to ageing mediates the relationship between perception of age-friendly city and life satisfaction among middle-aged and older people in Macao: a cross-sectional study.

BACKGROUND: Societal attitudes toward ageing play a significant role in shaping one's ageing experience, and an age-friendly environment can potentially enhance the life satisfaction of older individuals. The objective of this study is to examine the role of attitudes to ageing as mediators in the association between the perception of an age-friendly city and life satisfaction among middle-aged and older adults. METHODS: Using the tools of Age-Friendly City (AFC) criteria, Attitudes to Ageing Questionnaire (AAQ) to measure psychosocial loss, psychological growth, and physical change, and Satisfaction with Life Scale (SWLS) to assess the level of life satisfaction among community-dwelling middle-aged and older people in Macao. Multiple mediation analysis was performed to test the mediation effect. RESULTS: A total of 543 participants were included in this study. The average score of AFC was 4.25, the total scores of psychosocial loss, physical change, and psychological growth were 24.06, 29.00, and 26.94 respectively. The total score of SWLS was 24.06. There was a partial mediation of attitudes to ageing in the relationship between perception of age-friendly city and life satisfaction. The mediation effect explained 56.1% of the total effect of AFC to life satisfaction. CONCLUSION: The development of an age-friendly city can help improve the public's view on ageing, and thus improve their life satisfaction. It is important for government to consider the improvement of people's attitudes to ageing when developing policies regarding AFC.

Reliability and Validation Study of Advance Care Planning Practice Scale among Health and Social Care Professionals.

Advance care planning (ACP) is a crucial process in clinical practice, enabling individuals to articulate their care preferences and goals, with significant implications for future healthcare. However, ACP practice of health and social care professionals (HSCPs) concerning patients, or their family members are rarely explored. The objective of the study was to adapt and validate a four-item scale assessing ACP practices of HSCPs toward patients or their family members. The ACP Practice Scale was evaluated through a cross-sectional online survey administered to HSCPs in Macao, assessing its factor structure, validity, and reliability. Based on a sample of 186 valid responses, the ACP Practice Scale demonstrated satisfactory levels of validity and reliability among HSPCs in Macao. The four-item scale explained 65.87% of the variance in ACP practice and exhibited strong internal consistency, with Cronbach's alpha and McDonald's omega coefficients of 0.82. Furthermore, item factor loadings ranged from 0.71 to 0.90. The ACP Practice Scale provides reliable and valid measurements of ACP practice among HSCPs. This instrument can help to enhance our understanding of ACP practices in clinical settings and support the advancement of advance care planning.

Home or hospital as the place of end-of-life care and death: A survey among Chinese residents of Macao.

Objectives: The study was the first to explore Chinese residents' preferred place of care at the end of life and preferred place of death in Macao. Methods: A cross-sectional questionnaire survey was conducted online and face-to-face. The questionnaire was designed in Chinese, and both online and face-to-face surveys were conducted in Chinese. The study was conducted in Macao. Macao residents aged 18 years and older were recruited. Results: A total of 737 responses were valid, 65% were female, aged between 19 and 101 years; 43.4% of respondents preferred to be cared for at home in the last 6 months; however, less than one-fifth preferred to die at home. One-third of respondents chose to die in the hospice, and over a quarter of them preferred to die in hospitals. Compared with people aged between 18 and 39 years, people aged between 40 and 64 years did not want to be cared for at home in the last 6 months, and they did not want to die at home either. Conclusion: The results of the study suggested that there is a need for palliative home care in Macao, and the government should consider developing such a service and review current laws and regulations in supporting the service. Education is equally important for healthcare professionals, enabling them to support palliative care development in the community.

The Willingness to Help People With Dementia Symptoms Among Four Occupation Practitioners in Macao.

BACKGROUND: Dementia-friendly community has been promoted in Macao since 2016. There is no study investigating the understanding of nor attitudes towards dementia among public contact staff in Macao. This study aimed to (i) understand the level of knowledge of dementia, (ii) examine the attitudes towards people living with dementia, and (iii) explore the associated factors of the willingness to help people with dementia symptoms among police officers, bank officers, bus drivers, and building superintendents. METHODS: A cross-sectional survey was conducted between January and May 2019 using a structured questionnaire. RESULTS: A total of 351 valid questionnaires were received. Building superintendents had more knowledge while police officers and bank officers had more positive attitudes. All practitioners were more willing to help people with dementia symptoms when they were on official duty. Participants who had more knowledge about dementia were associated with a higher willingness to help people with dementia symptoms.

Comparisons of Dementia Knowledge and Attitudes among the Youth and Older Adults: Insights from the Construal Level Theory Perspective.

Based on Construal Level Theory (CLT), the youth and older adults have different psychological distances towards dementia that may lead to different dementia knowledge and attitudes. A cross-sectional survey among 239 youth and 62 older adults using a two-step sampling approach in Macao aimed to examine the hypothesis. Results showed older adults had a higher score of dementia knowledge (F(1,299) = 45.692, p <0.001) but a lower score of dementia attitudes (F(1,299) = 161.887, p <0.001) compared to the youth. Age group explained the majority of the variances in the hierarchical multiple regressions for dementia knowledge (R2 = 0.178, F = 9.059, p < 0.001) and for dementia attitudes (R2 = 0.399, F = 24.233, p < 0.001), which are ß = 0.47 and -0.56, respectively. Thus, the hypothesis was supported and revealed an interesting pattern of dementia knowledge and attitudes among the youth and older adults. From the CLT perspective, the study implies that reducing and bridging the psychological distance of dementia would probably be an effective strategy to increase dementia awareness among young people, and intergenerational programs may be a good option to increase community acceptance and support for people with dementia.

Prevalence and Predictors of Willingness to Make Advance Directives among Macao Chinese.

While advance directives (ADs) are considered to be part of government's healthcare agenda, there has not been any public consultation for legislation, nor investigation regarding the public's views about ADs in the Chinese culture of Macao. The current study explored the Macao Chinese people's willingness to make ADs. Data were collected from 724 residents aged 18 years and above. Results showed that 533 respondents (73.6%) claimed that they were willing to complete an AD if the document was recognized legally. The experience of caring for relatives or friends with terminal illnesses, palliative care as the preferred end-of-life treatment option, and scoring higher in the Hospice Care Attitude Scale were the predictors of willingness to make ADs. Results of the study suggested that there was a relatively high number of people who would consider setting up ADs. Our study recommends that healthcare professionals should equip themselves to raise ADs-related discussions with patients. Moreover, the Macao Government is responsible for facilitating the introduction and implementation of ADs in order to improve overall end-of-life care quality in Macao.

Knowledge of palliative care and preference of end of life care: a cross-sectional survey of residents in the Chinese socio-cultural background of Macao.

BACKGROUND: Since the establishment of a hospice in the year 2000 and the development of a palliative care ward in 2019, there is no study examining public's knowledge of palliative care, nor preference of end of life care in Macao. AIM: Targeting Chinese residents of Macao, the current study has 3 goals: i) to understand the level of knowledge of palliative care, ii) to explore the preference of end of life treatments, and iii) to identify the associated factors of the preference of end of life treatments. METHODS: A cross-sectional questionnaire survey was conducted using a structured questionnaire. The study employed non-probability quota sampling through which Macao residents aged 18 and above were recruited between July and September 2020. RESULTS: A total of 737 responses were valid. The average correct rate of palliative care knowledge ranged from 40.4% to 85.5%. Pertaining to end of life treatments, 62.0% of the respondents chose comfort care. However, almost half of the respondents agreed that life-sustaining treatments should not be stopped under any circumstances. Respondents who scored higher in palliative care knowledge and those with secondary and tertiary education were associated factors of choosing comfort care rather than life-sustaining treatments. In addition, respondents who agreed that futile life-sustaining treatments should be stopped were also associated with preference for comfort care. CONCLUSION: The understanding of palliative care amongst Macao residents is inadequate. Despite the public's inclination towards comfort care, it is generally believed that life-sustaining treatments should not be stopped at the end of life. The study results suggest that not only the knowledge of palliative care should be enhanced amongst the general public in Macao, but information about life-sustaining treatments should also be offered to patients and families by healthcare professionals, in aiding end of life treatment decision making.

The Six-Month and One-Year Outcome of a Chronic Disease Self-Management Program Among Older Adults in Macao: A Quasi-Experimental Study.

INTRODUCTION: Promoting older adults to self-manage their chronic conditions is a major focus of the Macao government and healthcare professionals since more than 80% of older adults have suffered chronic conditions. OBJECTIVES: This study evaluated the effect of the Chronic Disease Self-management Program (CDSMP) on self-management behaviors, self-efficacy, health status, and healthcare services utilization among Macao older adults with chronic disease over six months, and assessed whether the intervention effect persisted for one year. METHODS: A longitudinal and quasi-experimental design was used in this study. A total number of 158 older adults with at least one chronic disease were recruited from three Macao community centers. Participants in the study group engaged in a six-session CDSMP in the community centers and participants in the control group received usual care. The Chronic Disease Self-management Questionnaire was used to assess the outcome measures for baseline, six-month and one-year assessment. RESULTS: The age of subjects ranged from 60 to 88, 64.6% had three or more chronic diseases. The results showed that the subjects in the study group had significant improvement in self-management behaviors, self-efficacy, and some health-related indicators at the point of six months, and these improvements were still observable at the point of one year when comparing to the control group. The results also showed that the study group had a decrease in healthcare services utilization, but there was no significant difference between the two groups. CONCLUSION: This study confirmed that the community-dwelling older adults in Macao can acquire positive outcomes in self-management and health-related indicators from the CDSMP. Hence, it is worth promoting this program as a health promotion activity in community.

The Effect of Using an Electric Fan on Dyspnea in Chinese Patients With Terminal Cancer.

BACKGROUND: Fan therapy is often suggested for relieving the symptom of dyspnea in patients with advanced cancer, but relevant literature among Asians is limited. OBJECTIVE: Phase 2 clinical trial to assess the clinical feasibility and outcome of using an electric fan to alleviate the symptom of dyspnea in Chinese patients with advanced cancer. METHODS: Thirty patients with advanced cancer having unresolved breathlessness were recruited from Hospice and Palliative Care Centre of Kiang Wu Hospital in Macau. Participants were randomly and equally allocated to the experimental group and the control group, respectively. OUTCOME MEASURES: Verbal numerical rating scale (NRS) of breathlessness, respiratory rate (RR), and saturation of peripheral oxygen (SpO2) was collected before and after the intervention. RESULTS: T test was used to analyze the data collected. There was a significant difference in the NRS scores of the experimental group ( P < .01), indicating a significant reduction in the patients' sensation of breathlessness after fan therapy, whereas no significant difference was found in the objective statistic results of RR and SpO2. No significant difference ( P > .05) was found in the control group for all the 3 variables before and after routine treatment. CONCLUSION: The results of the study suggested that fan therapy could be effective in alleviating dyspnea in Chinese patients with advanced cancer. It should be considered as one of the nonpharmacological treatment option. Future large-scale phase 3 clinical trials are warranted.

Exploring the profiles of nurses' job satisfaction in Macau: results of a cluster analysis.

AIMS: To determine whether definable subtypes exist within a cohort of nurses with regard to factors associated with nurses' job satisfaction patterns and to compare whether these factors vary between nurses in groups with different profiles. BACKGROUND: Globally, the health care system is experiencing major changes and influence nurses' job satisfaction and may ultimately affect the quality of nursing care for patients. DESIGN: A descriptive survey. METHODS: Data were collected using a self-reported structured questionnaire. Nurses were recruited in two hospitals in Macao. Two main outcome variables were collected: Predisposing characteristics and five components on job satisfaction outcomes. RESULTS: A cluster analysis yielded two clusters (n = 649). Cluster 1 consisted of 60.6% (n = 393) and Cluster 2 of 39.4% (n = 256) of the nurses. Cluster 1 nurses were younger, more educated and had less work experience and more intention to change their career than nurses in Cluster 2. Cluster 2 nurses had more work experiences, were of more senior grade and were more satisfied with their current job in terms of peer supports, autonomy and professional opportunities, scheduling and relationships with team members than nurses in Cluster 1. CONCLUSIONS: Findings might help by providing important information for health care managers to identify strategies/methods to target a specific group of nurses in hopes of increasing their job satisfaction levels. RELEVANCE TO CLINICAL PRACTICE: As a long-term investment, hospital management has to promote work environments that support job satisfaction to attract nurses and thereby improve the quality of nursing care. The results of this study might provide hospital managers with a model to design specified interventions to improve nurses' job satisfaction.

Factors influencing Macao nurses' intention to leave current employment.

AIMS: To investigate factors associated with nurses' intention to leave current employment in Macao. BACKGROUND: The shortage of nursing staff and nurses voluntarily leaving their jobs has continued to be a problem affecting the delivery of health care all over the world. One way to alleviate this shortfall is via recruitment, but this is not always successful. Another way is to reduce the rate at which nurses voluntarily leave their work places. DESIGN: A descriptive survey was conducted and data were collected using a self-reported structured questionnaire. Nurses were recruited in the Health Bureau and one private hospital in Macao. The status of nurses' intention to leave current employment (yes vs. no) was the dependent variable and nurses' predisposing characteristics, organisational environments and five components on job satisfaction outcomes were independent variables. RESULTS: Of 426 nurses, 166 (39.0%) indicated an intention to leave current employment. The results showed that age (p < 0.001), work experience (p < 0.001), workplace (p = 0.015) and job satisfaction: pay and benefits (p < 0.001) were significant risk factors to predict nurses' intention to leave current employment. CONCLUSIONS: More than one-third of the nurses in Macao indicated an intention to leave current employment. This figure may be a cause of concern for the hospital management and highlights the need to implement strategies to improve the communication between nurses and the organisation, to enhance nurse job satisfaction and commitment to the organisation. RELEVANCE TO CLINICAL PRACTICE: Our findings outline some issues contributing to this problem and provide the nurse manager with information regarding specific influences on nurses' turnover in Macao. Given the complexity of issues outlined in this analysis, nurse managers should assist their nursing staff to deal with those influences, make efforts to address the nursing shortage that will require additional communications and recognise the needs and values of their staff and empower them to create a better work environment. As a consequence, their commitment to the organisation can be fostered.

A time course analysis of the changes in neuropeptide Y immunoreactivity in the rat cuneate nucleus following median nerve transection.

Using median nerve injury and immunocytochemical methods, we examined the temporal changes in neuropeptide Y (NPY) expression in the cuneate nucleus (CN) in rats following median nerve transection. Under normal circumstances, neuropeptide Y-immunoreactive (NPY-IR) fibers was not detectable in the CN. A few NPY-IR fibers were observed in the ipsilateral CN 5 days after the median nerve transection, and peaked at 4 weeks. Thereafter, they were gradually returned to nearly control level after 16 weeks. Quantitative evaluation showed that the mean percentage of area occupied by NPY-IR fibers in entire and three subregions of the CN at 4 weeks were significantly higher than that at other post-operated time points, respectively. The present ultrastructural observations in the middle region of CN showed that the significantly increased NPY immunoreactivity was confined only in the myelinated axons and terminals but not detected in the dendrites, somata, and glial cells. The NPY-IR terminals made axodendritic synaptic contacts with unlabeled elements. The present results indicate that the time course of the increase of NPY immunoreactivity is similar to c-Fos expression as described in a previous study. It is speculated that the increased NPY in the CN after axotomy may affect the excitability of postsynaptic cuneate neurons, however, the functional interaction between NPY and c-Fos-IR neurons needs to be further studied.

Changes in c-Fos protein expression in the rat cuneate nucleus after electric stimulation of the transected median nerve.

In this study we investigate temporal changes in Fos expression in cuneate neurons after a high-threshold electrical stimulation of the transected median nerve in rats. Two hours after injury of the median nerve when given electrical stimulation, c-Fos-immunoreactive (c-Fos-IR) cells were barely detected in the ipsilateral cuneate nucleus (CN). A few c-Fos-IR cells, however, were observed in the ipsilateral CN at 5 days. A marked increase in c-Fos-IR cells was observed at 2, 3, and 4 weeks, but levels subsided thereafter. Labeled cells were totally diminished by 16 weeks. The statistical analysis showed that the mean density of c-Fos-IR cells throughout the CN at 4 weeks was significantly higher than at other post-surgical time points, except for 3 weeks. Furthermore, the mean density of c-Fos-IR cells in the middle region of the CN was markedly higher than in other areas of the nucleus. The mean density of c-Fos-IR cells in the middle region at 4 weeks (mean density = 35.9 +/- 3.0 cells/section) was considerably higher than at other time points. Combined retrograde Fluorogold (FG) labeling and c-Fos immunocytochemistry showed that throughout the CN about 60% (2270/3652) of the c-Fos-IR cells contained FG, confirming that they were cuneothalamic projection neurons (CTNs). Moreover, the percentage of double-labeled cells in the middle region at 2 weeks (78.9 +/- 0.6%) was significantly greater than at 3 (70.2 +/- 3.4%) and 4 weeks (66.0b +/- 1.4%) after injury. Although the mechanism leading to the vigorous c-Fos expression in the CTNs following the electrical stimulation of the transected median nerve remains unclear the hyperexcitable CTNs may transmit the neuropathic nociceptive sensation to the thalamus after the median nerve injury.