A influência do distrito de saúde e da distância viajada sobre o estado clínico na apresentação de pacientes com doença trofoblástica gestacional

Silva, Valdete Aparecida Ribeiro da; Maestá, Izildinha; Costa, Roberto Antonio de Araújo; Campos, Aline de Ávila; Braga, Antonio; Horowitz, Neil; Elias, Kevin M.; Berkowitz, Ross

Valdete Aparecida Ribeiro da Silva

reviewed the literature

collected and managed data from the databases of Botucatu Trophoblastic Disease Center (São Paulo State University)

wrote the initial draft of the manuscript

Postgraduation Program in Tocogynecology, Botucatu Medical School, São Paulo State University, Botucatu, SP, Brazil.

https://orcid.org/0000-0002-0708-2788

Izildinha Maestá Address for correspondence Izildinha Maesta, MD, PhD Department of GYNOB, Botucatu Medical School, UNESP- Sao Paulo State University Av. Prof. Montenegro s/n, Botucatu, SP 18.618-687 Brazil (e-mail: i.maesta@unesp.br)

conceived

designed the study

revised the manuscript

audited data collected from Botucatu Trophoblastic Disease Center database (São Paulo State University)

Postgraduation Program in Tocogynecology, Botucatu Medical School, São Paulo State University, Botucatu, SP, Brazil.

Botucatu Trophoblastic Disease Center, Botucatu Medical School Hospital, São Paulo State University, Botucatu, SP, Brazil.

https://orcid.org/0000-0002-5875-7335

Roberto Antonio de Araújo Costa

data analysis and interpretation

reviewed the literature for discussion

Postgraduation Program in Tocogynecology, Botucatu Medical School, São Paulo State University, Botucatu, SP, Brazil.

Scientific Initiation Program by the São Paulo Research Foundation, Botucatu Medical School, São Paulo, SP, Brazil.

https://orcid.org/0000-0003-4074-252X

Aline de Ávila Campos

reviewed the literature

collected and managed data from the databases of Botucatu Trophoblastic Disease Center (São Paulo State University)

wrote the initial draft of the manuscript

Postgraduation Program in Tocogynecology, Botucatu Medical School, São Paulo State University, Botucatu, SP, Brazil.

Scientific Initiation Program by the São Paulo Research Foundation, Botucatu Medical School, São Paulo, SP, Brazil.

https://orcid.org/0000-0003-1996-6772

Antonio Braga

data management and analysis

revised the manuscript

Rio de Janeiro Trophoblastic Disease Center, Maternity School of the Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil.

https://orcid.org/0000-0002-2942-6182

Neil Horowitz

data analysis

interpretation

revised the manuscript

Division of Gynaecologic Oncology, Department of Obstetrics, Gynaecology and Reproductive Biology, New England Trophoblastic Disease Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Brigham and Women's Hospital, Boston, MA, USA.

https://orcid.org/0000-0002-4854-0642

Kevin M. Elias

conceived the analysis strategy

manuscript

Division of Gynaecologic Oncology, Department of Obstetrics, Gynaecology and Reproductive Biology, New England Trophoblastic Disease Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Brigham and Women's Hospital, Boston, MA, USA.

https://orcid.org/0000-0003-1502-5553

Ross Berkowitz

supervised the study

revised the manuscript

Division of Gynaecologic Oncology, Department of Obstetrics, Gynaecology and Reproductive Biology, New England Trophoblastic Disease Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Brigham and Women's Hospital, Boston, MA, USA.

https://orcid.org/0000-0002-7569-898X

Address for correspondence Izildinha Maesta, MD, PhD Department of GYNOB, Botucatu Medical School, UNESP- Sao Paulo State University Av. Prof. Montenegro s/n, Botucatu, SP 18.618-687 Brazil (e-mail: i.maesta@unesp.br)

Conflict of Interests

The authors have no conflict of interests to declare.

Variable		Overall (n = 354)	HD			p-value
Variable		Overall (n = 354)	HD VI (n = 269)	HD XVI (n = 70)	HD IX (n = 15)	p-value
Age (years)		23 (13–52)	22 (13–47)	25 (15–52)	19 (13–45)	0.017
	10–19	107 (30.2%)	86 (32%)	12 (17.1%)	9 (60%)
	20–39	225 (63.6%)	169 (62.8%)	51 (72.9%)	5 (33.3%)	0.005
	≥ 40	22 (6.2%)	14 (5.2%)	7 (10.0%)	1 (6.7%)
Race
	White	263 (74.5%)	203 (75.7%)	48 (68.6%)	12 (80%)	0.452
	Non-white	90 (25.5%)	65 (24.3%)	22 (31.4%)	3 (20%)
Parity		0 (0–8)	0 (0–8)	0.5 (0–5)	1 (0–2)	0.551
	Nulliparous	180 (50.8%)	139 (51.7%)	35 (50%)	6 (40%)
	Primiparous	103 (29.1%)	81 (30.1%)	17 (24.3%)	5 (33.3%)	0.505
	Multiparous	71 (20.1%)	49 (18.2%)	18 (25.7%)	4 (26.7%)
Education
	Elementary school	179 (51%)	144 (53.9%)	27 (39.1%)	8 (53.3%)
	Highschool	147 (41.9%)	108 (40.4%)	33 (47.8%)	6 (40%)	0.103
	College / Post-graduation ^a a Only 4 patients were post-graduated;	25 (7.1%)	15 (5.6%)	9 (13%)	1 (6.7%)
Had a partner		275 (77.9%)	203 (75.7%)	60 (85.7%)	12 (80.0%)	0.187
Employed (age > 19 years)		122 (49.6%)	89 (48.6%)	29 (50.9%)	4 (66.7%)	0.434
Knowledge of GTD		3 (0.8%)	2 (0.7%)	0 (0.0%)	1 (6.7%)	0.130
HM Score (n = 329)		4 (0–11)	4 (0–11)	5 (0–11)	7 (2–10)	0.048
HM classification (n = 329)
	Low risk	137 (41.6%)	115 (44.9%)	19 (31.7%)	3 (23.1%)	0.07
	High risk	192 (58.4%)	141 (55.1%)	41 (68.3%)	10 (76.9%)
	FIGO score	3 (1–14)	3 (1–7)	4 (2–14)	1.0 (1–2)	0.085
FIGO classification (n = 25)
	Low risk	19 (76%)	11 (84.6%)	6 (60%)	2 (100%)	0.373
	High risk	6 (24%)	2 (15.4%)	4 (40%)	0 (0%)
Distance traveled (km)		92 (2–325)	76.1 (2–244)	203.5 (70.9–325)	200 (159–315)	0.001
Distance traveled > 80 km		209 (59%)	125 (46.5%)	69 (98.6%)	15 (100%)	0.001

Variable		β	95%CI		p-value
Health district (Ref: HD VI)
	XVI	0.78	0.02	1.55	0.045
	IX	2.38	0.87	3.88	0.002
Age (years)		-0.03	-0.08	0.02	0.244
Parity		0.1	-0.21	0.41	0.516
Non-white		0.2	-0.48	0.87	0.569
Education (Ref: Elementary school)
	Secondary school	-0.65	-1.28	0.01	0.045
	College/Postgraduation	-0.12	-1.43	1.19	0.86
Had a partner		-0.36	-1.09	0.33	0.326
Employed		0.2	-0.47	0.9	0.544
Knowledge of GTD		-1.68	-4.78	1.41	0.287

Variable		β	95% CI		p-value
Health district (Ref: HD VI)
	XVI	3.32	0.78	5.87	0.01
	IX	-1.51	-5.72	2.7	0.481
Age (years)		0.16	0	0.33	0.048
Parity		-1.56	-2.87	-0.03	0.046
Nonwhite		-0.37	-3.03	2.31	0.783
Education (Ref: Elementary school)
	Secondary school	0.83	-1.78	3.43	0.534
	College/Postgraduation	-3.24	-6.97	0.5	0.089
	Had a partner	-2.37	-6.5	1.76	0.26
	Employed	0.16	-2.14	2.45	0.892
	Knowledge of GTD	–	–	–	–

[1] Address for correspondence Izildinha Maesta, MD, PhD Department of GYNOB, Botucatu Medical School, UNESP- Sao Paulo State University Av. Prof. Montenegro s/n, Botucatu, SP 18.618-687 Brazil (e-mail: i.maesta@unesp.br)

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A influência do distrito de saúde e da distância viajada sobre o estado clínico na apresentação de pacientes com doença trofoblástica gestacional

Resumo

Objetivo

Métodos

Resultados

Conclusão