{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T22:01:18Z","timestamp":1763071278345,"version":"3.37.3"},"reference-count":28,"publisher":"Federa\u00e7\u00e3o das Associa\u00e7\u00f5es de Ginecologia e Obstetr\u00edcia","issue":"07","license":[{"start":{"date-parts":[[2023,8,18]],"date-time":"2023-08-18T00:00:00Z","timestamp":1692316800000},"content-version":"vor","delay-in-days":48,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev Bras Ginecol Obstet"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Objective\u2003To assess the potential relationship of clinical status upon admission and distance traveled from geographical health district in women with gestational trophoblastic disease (GTD).<\/jats:p><jats:p>\n          Methods\u2003This is a cross-sectional study including women with GTD from the 17 health districts from the S\u00e3o Paulo state (I\u2013XVII), Brazil, referred to the Botucatu Trophoblastic Disease Center (specialized center, district VI), between 1990 and 2018. At admission, hydatidiform mole was assessed according to the risk score system of Berkowitz et al. Gestational trophoblastic neoplasia was evaluated using the International Federation of Gynecology and Obstetrics \/ World Health Organization (FIGO\/WHO) staging\/risk score. Data on demographics, clinical status and distance traveled were collected. Multiple regression analyses were performed.<\/jats:p><jats:p>\n          Results\u2003This study included 366 women (335 hydatidiform mole, 31 gestational trophoblastic neoplasia). The clinical status at admission and distance traveled significantly differed between the specialized center district and other districts. Patients referred from health districts IX (\u03b2\u2009=\u20092.38 [0.87\u20133.88], p\u2009=\u20090.002) and XVI (\u03b2\u2009=\u20090.78 [0.02\u20131.55], p\u2009=\u20090.045) had higher hydatidiform mole scores than those from the specialized center district. Gestational trophoblastic neoplasia patients from district XVI showed a 3.32 increase in FIGO risk scores compared with those from the specialized center area (\u03b2\u2009=\u20093.32, 95% CI\u2009=\u20090.78\u20135.87, p\u2009=\u20090.010). Distance traveled by patients from districts IX (200km) and XVI (203.5km) was significantly longer than that traveled by patients from the specialized center district (76km).<\/jats:p><jats:p>\n          Conclusion\u2003Patients from health districts outside the specialized center area had higher risk scores for both hydatidiform mole and gestational trophoblastic neoplasia at admission. Long distances (&gt;80\u2009km) seemed to adversely influence gestational trophoblastic disease clinical status at admission, indicating barriers to accessing specialized centers.<\/jats:p>","DOI":"10.1055\/s-0043-1772179","type":"journal-article","created":{"date-parts":[[2023,8,18]],"date-time":"2023-08-18T22:35:35Z","timestamp":1692398135000},"page":"e384-e392","source":"Crossref","is-referenced-by-count":2,"title":["Geographical Health District and Distance Traveled Influence on Clinical Status at Admission of Patients with Gestational Trophoblastic Disease"],"prefix":"10.61622","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0708-2788","authenticated-orcid":false,"given":"Valdete Aparecida Ribeiro da","family":"Silva","sequence":"additional","affiliation":[{"name":"Postgraduation Program in Tocogynecology, Botucatu Medical School, S\u00e3o Paulo State University, Botucatu, SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5875-7335","authenticated-orcid":false,"given":"Izildinha","family":"Maest\u00e1","sequence":"additional","affiliation":[{"name":"Postgraduation Program in Tocogynecology, Botucatu Medical School, S\u00e3o Paulo State University, Botucatu, SP, Brazil."},{"name":"Botucatu Trophoblastic Disease Center, Botucatu Medical School Hospital, S\u00e3o Paulo State University, Botucatu, SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4074-252X","authenticated-orcid":false,"given":"Roberto Antonio de Ara\u00fajo","family":"Costa","sequence":"additional","affiliation":[{"name":"Postgraduation Program in Tocogynecology, Botucatu Medical School, S\u00e3o Paulo State University, Botucatu, SP, Brazil."},{"name":"Scientific Initiation Program by the S\u00e3o Paulo Research Foundation, Botucatu Medical School, S\u00e3o Paulo, SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1996-6772","authenticated-orcid":false,"given":"Aline de \u00c1vila","family":"Campos","sequence":"additional","affiliation":[{"name":"Postgraduation Program in Tocogynecology, Botucatu Medical School, S\u00e3o Paulo State University, Botucatu, SP, Brazil."},{"name":"Scientific Initiation Program by the S\u00e3o Paulo Research Foundation, Botucatu Medical School, S\u00e3o Paulo, SP, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2942-6182","authenticated-orcid":false,"given":"Antonio","family":"Braga","sequence":"additional","affiliation":[{"name":"Rio de Janeiro Trophoblastic Disease Center, Maternity School of the Rio de Janeiro Federal University, Rio de Janeiro, RJ, Brazil."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4854-0642","authenticated-orcid":false,"given":"Neil","family":"Horowitz","sequence":"additional","affiliation":[{"name":"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."},{"name":"Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Brigham and Women's Hospital, Boston, MA, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1502-5553","authenticated-orcid":false,"given":"Kevin M.","family":"Elias","sequence":"additional","affiliation":[{"name":"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."},{"name":"Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Brigham and Women's Hospital, Boston, MA, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7569-898X","authenticated-orcid":false,"given":"Ross","family":"Berkowitz","sequence":"additional","affiliation":[{"name":"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."},{"name":"Division of Gynaecologic Oncology, Department of Obstetrics and Gynaecology, Brigham and Women's Hospital, Boston, MA, USA."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"47794","published-online":{"date-parts":[[2023,8,18]]},"reference":[{"key":"ref1","first-page":"145","article-title":"Worldwide survey of the results of treating gestational trophoblastic disease","volume":"59","author":"E I 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