Health-related quality of life associated with diabetic retinopathy in patients at a public primary care service in southern Brazil

ABSTRACT Objective This study aimed to establish the utility values of different health states associated with diabetic retinopathy in a Brazilian sample to provide input to model-based economic evaluations. Subjects and methods This cross-sectional study was performed in a sample of patients with type 2 diabetes mellitus (T2D) who underwent teleophthalmology screening at a primary care service from 2014 to 2016. Five diabetic retinopathy health states were defined: absent, non-sight-threatening, sight-threatening, and bilateral blindness. Utility values were estimated using the Brazilian EuroQol five dimensions (EQ-5D) tariffs. Descriptive statistics were calculated. Analysis of covariance was performed to adjust the utility values for potential confounders. Results The study included 206 patients. The mean (± standard deviation [SD]) utility value was 0.765 ± 0.19 (95% confidence interval [CI], 0.740-0.790). The adjusted mean utility value was 0.748 (95% CI, 0.698-0.798) in patients without diabetic retinopathy, 0.752 (95% CI, 0.679-0.825) in those with non-sight-threatening state, 0.628 (95% CI, 0.521-0.736) in those with sight-threatening state, and 0.355 (95% CI, 0.105-0.606) in those with bilateral blindness. A significant utility decrement was found between patients without diabetic retinopathy and those with a sight-threatening health state (0.748 vs. 0.628, respectively, p = 0.04). Conclusions The findings suggest that a later diabetic retinopathy health state is associated with a decrement in utility value compared with the absence of retinopathy in patients with T2D. The results may be useful as preliminary input to model-based economic evaluations. Further research is needed to investigate the impact of diabetic retinopathy on health-related quality of life in a sample more representative of the Brazilian population.

Tratamento restaurador atraumático (Estudo da sua aplicabilidade em escolares de Tangará/SC) / Atraumatic restorative treatment (study about its indication in students from Tangará/SC)

O tratamento restaurador atraumatico, conhecido pela sigla do inglês ART, envolve restaurações atraumáticas e procedimentos educativos-preventivos. É uma formasimplificada de atendimento, que consiste na remoção do tecido cariado com instrumentação manual. Dispensao uso de anestesia e isolamento absoluto, permitindo sua aplicação em locais desprovidos de equipamentos odontológicos. Os estudos publicados sobre o ART abordaram principalmente aspectos relativos à longevidade dessas restaurações e pouco ou nada foi publicado sobre a sua real aplicabilidade ou indicações em relaçãoaos procedimentos convencionais, objetivo do presenteestudo. Foram examinados 348 escolares (6 a 13 anos), estudantes de Tangará-SC. Entre eles, 80,75 porcento apresentavam necessidade de tratamento odontológico invasivo, sendo que 39,94 porcento poderiam ser tratados com o ART e 68,39 porcento precisavam de intervenção convencional. Conclui-se que os escolares examinados apresentavem necessidade acumulada de tratamento odontológico. O tratamento restaurador atraumático apresentou maior indicação para os dentes deciduos que para os permanentes