AimThe study objective was to determine the levels of self-care (including domains of behaviour, motivation, self-efficacy) and health literacy, and study their associations amongst patients with chronic kidney disease (CKD) in primary care setting in Singapore.MethodA cross-sectional, questionnaire-based study was conducted in one public-sector primary care clinic. Participants aged 21 to 80 years with hypertension were recruited from the clinic CKD register with 5,500 patients. Self-care profile (including behaviour, motivation and self-efficacy) were measured using Hypertension Self-Care Profile (HTN-SCP, range 0-240, domain range 0-80). Health literacy was measured using Short-Form Health Literacy Scale (HLS-SF12, range 0-50, limited literacy ≤33).ResultsA total of 347 out of 354 randomly selected patients consented to participate in the study. Two hundred and eighty-nine fully-completed responses were analysed. The mean self-care (HTN-SCP) score was 182.7 (SD 23.2), while mean scores were 55.3 (SD 8.6), 63.3 (SD 8.7), 64.0 (SD 9.3), for behaviour, self-efficacy and motivation domains respectively. The mean health literacy score was 36.1 (SD 7.7), and 31.1% of participants had limited health literacy. Limited health literacy was associated with self-efficacy (OR= −7.2, 95%CI=−9.1 to −5.2, p<0.001), motivation (OR= −6.1, 95%CI=−8.3 to −3.9, p<0.001) and behaviour (OR= −4.5, 95%CI=−6.6 to −2.4, p<0.001). Self-care was not associated with age, CKD status, household income and education but was associated with gender and limited health literacy. In the final regression model only limited health literacy was associated with self-care scores (Adjusted beta −17.4, p<0.001).ConclusionOne-third of the patients with CKD in primary care had limited health literacy. Self-care was not associated with age, gender, CKD status, household income or education. Limited health literacy was associated with self-care, with strongest association with self-efficacy, followed by motivation and behaviour. More targeted approach can be adopted to improve self-care and health literacy amongst patients with CKD.
Introduction: Since the introduction of Haemophilus Influenza type B (Hib) vaccine about 20 years ago, the incidence of infections from Hib has significantly reduced. However there has been an increasing trend of infections from Non Typeable Haemophilus Influenza (NTHi) in the last decade. We report a case of bacteremia from NTHi. Case: A 38 year old male with past medical history of diabetes, hypertension and end stage renal disease, presented with shortness of breath, dry cough and fever for 3 days. Physical examination revealed a well nourished man with respiratory distress, using accessory muscles of respiration, with an otherwise normal exam. Vital signs were remarkable for temperature of 100.3 F and respiratory rate of 22 per minute. Initial laboratory findings included a white blood cell count of 18000, with 82 percent neutrophils, potassium of 6.1 and pro-brain natriuretic peptide of 76000. Chest X-ray showed a bilateral airspace opacification. Patient was saturating around 76 percent on room air and hence was placed on non re-breathable mask with 100 percent oxygen. Initial differential diagnoses were pulmonary edema versus multifocal pneumonia. Despite getting an urgent dialysis session, patient continued requiring oxygen support. Hence Computed Tomography of the chest (figure 1) was obtained which also showed bilateral patchy airway opacities of lung. Patient was started on broad spectrum antibiotics, Ceftriaxone and Azithromycin. Legionella and Pneumocystis Jiroveci were ruled out. Blood cultures were then reported to be positive for NTHi, which was sensitive to Ceftriaxone. Blood cultures repeated after 48 hours of antibiotics were negative. Patient's oxygen requirements improved and was then discharged on oral cefuroxime to complete total 14 day course. Patient had a complete resolution of symptoms and radiographic findings on 2 month follow up visit. Discussion: NTHi is a frequent colonizer of the nasopharynx in humans, known to cause opportunistic infections in immunocompromised individuals mostly through invasion of respiratory tract. Most infections from NTHi are non invasive mucosal infections. However the incidence of invasive infections like sepsis and meningitis are increasing in the last decade, likely from increasing resistance from production of B-lactamase and improved serological typing methods for detection. Due to the prevalence of these resistant strains, sometimes treatment of invasive infections becomes challenging and can cause significant morbidity and mortality. Hence clinicians should be mindful of NTHi as a potential cause of invasive and non invasive infections in immunocompromised individuals. Figure 1:
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