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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El tabaquismo es&#44; con diferencia&#44; la causa m&#225;s frecuente de enfermedad pulmonar obstructiva cr&#243;nica &#40;EPOC&#41; en el mundo&#44; siendo responsable de m&#225;s del 80-90&#37; de los nuevos casos<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a>&#46; Cl&#225;sicamente&#44; su desarrollo ha sido atribuido a una inflamaci&#243;n cr&#243;nica desencadenada por el humo de tabaco&#44; que libera sustancias proteol&#237;ticas y radicales libres favoreciendo el da&#241;o de las v&#237;as a&#233;reas y la degradaci&#243;n del par&#233;nquima pulmonar hasta originar una limitaci&#243;n al flujo a&#233;reo &#40;LFA&#41; con repercusi&#243;n sintom&#225;tica<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a>&#46; Sin embargo&#44; desde hace ya varias d&#233;cadas&#44; se reconoce que la afectaci&#243;n precoz de las peque&#241;as v&#237;as a&#233;reas desempe&#241;a un importante papel patog&#233;nico<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">3&#44;4</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Diversos estudios han explorado a fumadores que todav&#237;a no han desarrollado LFA mediante tomograf&#237;a computarizada &#40;TC&#41;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">5&#44;6</span></a>&#46; Sin embargo&#44; este procedimiento no permite evaluar directamente las peque&#241;as v&#237;as a&#233;reas&#44; sino que analiza la pared de bronquiolos de mayor tama&#241;o o la probable repercusi&#243;n de la disfunci&#243;n de las peque&#241;as v&#237;as &#40;DPV&#41; sobre la atenuaci&#243;n del par&#233;nquima pulmonar<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a>&#46; Frente a ello&#44; la oscilaci&#243;n forzada u oscilometr&#237;a de impulsos &#40;IOS&#41; proporciona una evaluaci&#243;n funcional espec&#237;fica de las peque&#241;as v&#237;as a&#233;reas&#44; adecuadamente sistematizada y con un patr&#243;n de afectaci&#243;n caracter&#237;stico de la DPV<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">8&#44;9</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">En los &#250;ltimos a&#241;os&#44; se ha reconocido que los fumadores sin LFA constituyen un grupo heterog&#233;neo con diferentes manifestaciones sintom&#225;ticas y repercusi&#243;n sobre la calidad de vida relacionada con la salud &#40;CVRS&#41;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">10&#44;11</span></a>&#46; Sin embargo&#44; se dispone de poca informaci&#243;n sobre par&#225;metros funcionales o morfol&#243;gicos que puedan discriminar a dichos fumadores y&#44; en cierto modo&#44; contribuir a su afectaci&#243;n sintom&#225;tica&#46; Dada su potencial relevancia patog&#233;nica&#44; resulta atractivo considerar que la presencia de DPV podr&#237;a constituir un paso previo al desarrollo de LFA<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a> y mostrar incipientes repercusiones sobre la calidad de vida&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Por tanto&#44; establecemos como hip&#243;tesis que los fumadores sin LFA tienen una peor calidad de vida cuando han desarrollado DPV&#46; Nuestro objetivo principal ha sido comparar la calidad de vida de fumadores sin LFA pero con evidencia de DPV mediante IOS con la de no fumadores&#44; fumadores sin DPV y fumadores con LFA compatible con EPOC&#46; Como objetivos secundarios hemos pretendido determinar la frecuencia de DPV en fumadores sin LFA y comparar las densidades de atenuaci&#243;n del par&#233;nquima pulmonar entre los 4 grupos de sujetos&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Sujetos del estudio</span><p id="par0025" class="elsevierStylePara elsevierViewall">En las consultas de deshabituaci&#243;n tab&#225;quica de nuestro centro&#44; se seleccionaron de forma consecutiva 53 fumadores activos sin evidencia de LFA y 20 fumadores activos con LFA compatible con EPOC&#46; En ambos casos&#44; los sujetos deb&#237;an tener de 40 a 70 a&#241;os y un consumo de tabaco acumulado medio de al menos 20 paquetes<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>a&#241;o&#46; Como grupo control&#44; se seleccionaron 20 sujetos de 40 a 70 a&#241;os del grupo de referencia de nuestro laboratorio&#46; El estudio fue aprobado por el Comit&#233; de &#201;tica de Investigaci&#243;n del Hospital Universitario La Paz &#40;PI-1261&#41; y todos los participantes firmaron su consentimiento informado&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">En el <a class="elsevierStyleCrossRef" href="#sec0060">material suplementario</a> se proporciona informaci&#243;n m&#225;s detallada de los criterios de selecci&#243;n y de los procedimientos realizados&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Determinaciones</span><p id="par0035" class="elsevierStylePara elsevierViewall">La CVRS fue evaluada mediante la autoadministraci&#243;n de la versi&#243;n espa&#241;ola de los cuestionarios gen&#233;ricos <span class="elsevierStyleItalic">Short Form 36 Health Survey</span> &#40;SF-36&#41; y <span class="elsevierStyleItalic">European Quality of Life-5 Dimensions</span> &#40;EQ-5D&#41;&#44; y en los fumadores se utilizaron los test de Fagerstr&#246;m y Glover-Nilsson&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Se realiz&#243; una TC de t&#243;rax de alta resoluci&#243;n volum&#233;trica&#44; en inspiraci&#243;n y espiraci&#243;n m&#225;ximas&#44; mediante un equipo de 16 detectores &#40;Somatom Emotion 16&#44; Siemens Medical Solutions&#44; Erlangen&#44; Alemania&#41;&#46; Mediante un programa de an&#225;lisis semiautom&#225;tico &#40;Software syngo InSpace4D&#44; Siemens&#41;&#44; se determin&#243;&#44; tanto en inspiraci&#243;n como en espiraci&#243;n m&#225;ximas&#44; la densidad pulmonar media &#40;MLD&#41;&#44; el porcentaje de v&#243;xeles con valores de atenuaci&#243;n por debajo de &#8722;950 unidades Hounsfield &#40;UH&#41; &#40;LAV&#41; o entre &#8722;1&#46;000 y &#8722;951 UH &#40;subrango 1&#41; y los umbrales de atenuaci&#243;n correspondientes al percentil 15 &#40;P15&#41;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Todas las pruebas de funci&#243;n respiratoria fueron llevadas a cabo por una &#250;nica investigadora &#40;CGQ&#41; con un equipo MasterScreen &#40;Viasys Healthcare&#44; W&#252;rzburg&#44; Alemania&#41;&#46; La IOS se realiz&#243; seg&#250;n las recomendaciones vigentes<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">8</span></a>&#46; Se solicit&#243; a los participantes que&#44; con una pinza nasal y sentados con la cabeza en una posici&#243;n neutral&#44; respiraran a volumen corriente con los labios sellados alrededor de una boquilla mientras apretaban firmemente sus mejillas con las manos&#46; Al menos&#44; se realizaron 3 registros aceptables &#40;valores de coherencia a 5 y 20<span class="elsevierStyleHsp" style=""></span>Hz<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>0&#44;7 y 0&#44;9&#44; respectivamente&#41; con una duraci&#243;n de 30 segundos&#44; utilizando para el an&#225;lisis el promedio de 3 pruebas aceptables y repetibles &#40;variabilidad &#60;<span class="elsevierStyleHsp" style=""></span>10&#37;&#41;&#46; Como &#237;ndices de resistencia total y proximal de las v&#237;as a&#233;reas&#44; se utilizaron las resistencias respiratorias a 5 y 20<span class="elsevierStyleHsp" style=""></span>Hz &#40;R5 y R20&#41;&#44; mientras que la ca&#237;da en la resistencia de 5 a 20<span class="elsevierStyleHsp" style=""></span>Hz &#40;R5-R20&#41; fue considerada un indicador de la resistencia de las v&#237;as a&#233;reas perif&#233;ricas&#46; Adem&#225;s&#44; se determin&#243; la reactancia a 5<span class="elsevierStyleHsp" style=""></span>Hz &#40;X5&#41; y el &#237;ndice de &#225;rea de reactancia de baja frecuencia &#40;AX&#41; como indicadores de la funci&#243;n de las v&#237;as respiratorias perif&#233;ricas&#46; Los datos obtenidos fueron interpretados en funci&#243;n de los valores de referencia europeos de Oostveen<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">14</span></a>&#46; Inmediatamente despu&#233;s&#44; se realiz&#243; una espirometr&#237;a pre- y posbroncodilatador&#44; seg&#250;n la normativa vigente<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a>&#44; utilizando los valores de referencia <span class="elsevierStyleItalic">GLI</span><a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Clasificaci&#243;n de los pacientes</span><p id="par0050" class="elsevierStylePara elsevierViewall">Se defini&#243; LFA compatible con EPOC un FEV<span class="elsevierStyleInf">1</span>&#47;FVC posbroncodilatador menor del l&#237;mite inferior de la normalidad<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a>&#46; La DPV fue definida por la presencia de una R5&#44; R5-R20 y AX mayores de su l&#237;mite superior de la normalidad<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">18</span></a>&#46; En ausencia de LFA y DPV&#44; los sujetos fueron considerados control&#46; Seg&#250;n estos criterios&#44; los sujetos del estudio fueron clasificados en 4 grupos mutuamente excluyentes&#58; no fumadores control&#44; fumadores sin DPV&#44; fumadores con DPV y fumadores con LFA &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Por &#250;ltimo&#44; los pacientes con LFA fueron clasificados por gravedad&#44; grupo de riesgo y fenotipo de EPOC&#44; seg&#250;n las recomendaciones vigentes<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">19&#44;20</span></a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">An&#225;lisis estad&#237;stico</span><p id="par0055" class="elsevierStylePara elsevierViewall">La estimaci&#243;n del tama&#241;o muestral se realiz&#243; en funci&#243;n de una puntuaci&#243;n del componente f&#237;sico del cuestionario SF-36 de 49&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;7 obtenida en un estudio piloto en fumadores sin LFA &#40;datos no publicados&#41;&#46; Para detectar una diferencia de al menos 5 unidades&#44; mediante contraste bilateral&#44; con un riesgo alfa de 0&#44;05 y un riesgo beta de 0&#44;10&#44; se necesitar&#237;an 20 sujetos por cada grupo&#46; Seg&#250;n un estudio previo que refiri&#243; una prevalencia de DPV del 26&#44;3&#37; entre fumadores o exfumadores con cardiopat&#237;a isqu&#233;mica&#44; alcanzando el 38&#37; en fumadores activos<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">21</span></a>&#44; para obtener 2 subgrupos de fumadores sin LFA comparables seg&#250;n la existencia o no de DPV&#44; se necesitar&#237;an 53 sujetos&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Los datos se presentan como n&#250;mero &#40;porcentaje&#41; o media<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>desviaci&#243;n est&#225;ndar&#44; seg&#250;n sus caracter&#237;sticas y una vez comprobado su ajuste a la distribuci&#243;n normal&#44; mediante la prueba de Shapiro-Wilk&#46; Para las comparaciones entre grupos se utiliz&#243; la prueba de chi-cuadrado y el an&#225;lisis de varianza con comparaciones m&#250;ltiples post-hoc mediante la prueba de Bonferroni&#46; La relaci&#243;n entre variables fue evaluada utilizando el an&#225;lisis de correlaci&#243;n de Pearson&#46; Aquellas variables que alcanzaron una relaci&#243;n significativa fueron introducidas en un an&#225;lisis de regresi&#243;n lineal m&#250;ltiple&#44; que utiliz&#243; el m&#233;todo de pasos escalonados hacia delante&#46; Un valor de p menor de 0&#44;05 fue considerado significativo y todos los an&#225;lisis fueron realizados con el programa SPSS 15&#46;0 &#40;SPSS Inc&#46;&#44; Chicago&#44; IL&#44; EE&#46;<span class="elsevierStyleHsp" style=""></span>UU&#46;&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Resultados</span><p id="par0065" class="elsevierStylePara elsevierViewall">Seg&#250;n los criterios establecidos&#44; fueron reclutados 20 sujetos no fumadores&#44; 53 fumadores activos sin LFA y 20 fumadores activos con LFA compatible con EPOC &#40;<a class="elsevierStyleCrossRef" href="#sec0060">tabla S1 del material suplementario</a>&#41;&#46; Los tres grupos resultaron homog&#233;neos en sexo&#44; edad&#44; talla&#44; peso e &#237;ndice de masa corporal &#40;<a class="elsevierStyleCrossRef" href="#sec0060">tabla S2 del material suplementario</a>&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">En el grupo de fumadores sin LFA&#44; se evidenci&#243; DPV en 19 sujetos&#44; lo que supone una frecuencia del 35&#44;8&#37; &#40;IC95&#37;&#58; 22&#44;9-48&#44;81&#37;&#41;&#46; En ning&#250;n sujeto del grupo de no fumadores se evidenci&#243; DPV&#44; por lo que todos fueron considerados como sujetos control&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#44; se muestran las caracter&#237;sticas antropom&#233;tricas y de consumo de tabaco de los 4 grupos finalmente constituidos&#46; Los par&#225;metros antropom&#233;tricos resultaron similares y no se apreciaron diferencias en las caracter&#237;sticas del consumo de tabaco&#44; dependencia de la nicotina ni dependencia psicol&#243;gica&#44; social o gestual entre los fumadores&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Al margen de las l&#243;gicas diferencias en las variables de la oscilaci&#243;n forzada utilizadas para definir los grupos&#44; los &#250;nicos par&#225;metros espirom&#233;tricos que resultaron menores en los fumadores con DPV que en los fumadores sin DPV fueron el FEF<span class="elsevierStyleInf">25&#37;</span> y el FEF<span class="elsevierStyleInf">25-75&#37;</span> &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">La afectaci&#243;n morfol&#243;gica del par&#233;nquima pulmonar evidenci&#243; una menor densidad de atenuaci&#243;n en los fumadores con LFA con respecto a los otros 3 grupos &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; Tanto en inspiraci&#243;n como en espiraci&#243;n&#44; los pacientes con EPOC mostraban una menor densidad pulmonar media&#44; mayores porcentajes de volumen de baja atenuaci&#243;n y vol&#250;menes de atenuaci&#243;n de entre &#8722;1&#46;000 a &#8722;951<span class="elsevierStyleHsp" style=""></span>UH y de entre &#8722;950 a &#8722;901<span class="elsevierStyleHsp" style=""></span>UH&#44; as&#237; como un menor P15&#46; Sin embargo&#44; no se detectaron diferencias en las densidades de atenuaci&#243;n entre fumadores con o sin DPV&#46; A su vez&#44; tampoco se evidenci&#243; relaci&#243;n alguna entre las medidas de atenuaci&#243;n del par&#233;nquima pulmonar y las variables de oscilaci&#243;n forzada en los 2 grupos de fumadores sin LFA&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a> muestra la comparaci&#243;n de la CVRS entre los 4 grupos del estudio&#46; Adem&#225;s de las previsibles diferencias entre fumadores con LFA y los otros grupos&#44; resulta interesante destacar que los fumadores con DPV tienen una peor puntuaci&#243;n en las escalas componente f&#237;sico y componente mental del cuestionario SF-36 y en el term&#243;metro del cuestionario EQ-5D&#44; tanto con respecto a los controles no fumadores como a los fumadores sin DPV&#44; lo que evidencia una situaci&#243;n intermedia de deterioro de la calidad de vida entre estos sujetos y los fumadores con EPOC &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 2</a>&#41;&#46; El an&#225;lisis de los distintos dominios del cuestionario SF-36 muestra un comportamiento similar&#44; que afecta principalmente a los dominios relacionados con el componente f&#237;sico &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a> y <a class="elsevierStyleCrossRef" href="#fig0025">fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">En los fumadores sin LFA&#44; tanto con DPV como sin ella&#44; no se hall&#243; relaci&#243;n alguna entre la CVRS y las caracter&#237;sticas antropom&#233;tricas&#44; edad de inicio&#44; intensidad del consumo de tabaco&#44; a&#241;os de tabaquismo ni con las puntuaciones de los test de Fagerstr&#246;m o Glover-Nilsson&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Sin embargo&#44; la calidad de vida de estos sujetos se relacion&#243; con diversos par&#225;metros funcionales y morfol&#243;gicos &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46; As&#237; la puntuaci&#243;n de la escala componente f&#237;sico del cuestionario SF-36 alcanz&#243; una moderada relaci&#243;n inversamente proporcional con R5&#44; R20&#44; X5 y AX y una d&#233;bil relaci&#243;n directamente proporcional con la FVC&#44; FEV<span class="elsevierStyleInf">1</span> y FEF<span class="elsevierStyleInf">25-75&#37;</span>&#44; as&#237; como con diversas medidas de atenuaci&#243;n del par&#233;nquima &#40;MLD y P15&#41; en inspiraci&#243;n&#46; A su vez&#44; la puntuaci&#243;n obtenida en el term&#243;metro del EQ-5D se relacion&#243; de forma inversamente proporcional con R5 y X5 &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">tabla 5</a>&#41;&#46; Finalmente&#44; los modelos de regresi&#243;n lineal m&#250;ltiple solo retuvieron a la R5 y X5 como predictores independientes del componente f&#237;sico del cuestionario SF-36 y del term&#243;metro EQ-5D&#44; respectivamente &#40;<a class="elsevierStyleCrossRef" href="#fig0035">fig&#46; 4</a> y <a class="elsevierStyleCrossRef" href="#tbl0030">tabla 6</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="fig0035"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discusi&#243;n</span><p id="par0100" class="elsevierStylePara elsevierViewall">Los principales resultados de nuestro estudio consisten en la demostraci&#243;n que la DPV resulta frecuente en fumadores sin LFA&#44; afectando a m&#225;s de un tercio de los mismos&#46; Aunque la presencia de esta alteraci&#243;n no tiene repercusi&#243;n sobre la espirometr&#237;a ni sobre los cambios en la atenuaci&#243;n del par&#233;nquima pulmonar&#44; se asocia a un deterioro incipiente de la CVRS&#44; hasta el punto de identificar una relaci&#243;n independiente entre la misma y algunos par&#225;metros de oscilaci&#243;n forzada&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">La frecuencia de DPV detectada en nuestros fumadores es superior a la identificada en estudios previos&#44; que refer&#237;an que un 5-13&#37; de fumadores con espirometr&#237;a normal pod&#237;an tener una IOS alterada<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">22&#44;23</span></a>&#46; Sin embargo&#44; en dichos estudios no se establec&#237;a un punto de corte concreto para la detecci&#243;n de DPV y se mezclaban fumadores activos con exfumadores de distinto tiempo de evoluci&#243;n&#46; En contraste&#44; empleando puntos de corte predeterminados para R5-R20&#44; se ha referido la presencia de DPV en un 33-42&#37; de sujetos con asma y una espirometr&#237;a normal<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">24&#44;25</span></a>&#46; Aunque la informaci&#243;n disponible en fumadores sin LFA resulta escasa&#44; Jetmalani et al&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a> encontraron que hasta un 51&#37; de dichos sujetos ten&#237;an al menos una anomal&#237;a en&#44; predominantemente en la resistencia respiratoria&#44; mientras que Berger et al&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">27</span></a> describen que un 56&#37; de fumadores asintom&#225;ticos con espirometr&#237;a normal tienen una R5 elevada&#46; En cualquier caso&#44; el porcentaje de DPV identificada en fumadores sin LFA resulta concordante con la hallada mediante lavado m&#250;ltiple de nitr&#243;geno&#44; que permite identificar afectaci&#243;n de las v&#237;as a&#233;reas de conducci&#243;n en un 24&#37; de los sujetos y de las v&#237;as accinares en un 38&#37;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">28</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Un an&#225;lisis previo de una submuestra del estudio ECLIPSE puso de manifiesto la potencial utilidad de la IOS en las fases preliminares del da&#241;o pulmonar inducido por el tabaco<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">22</span></a>&#46; Aunque en dicho estudio no se detectaron diferencias en los valores absolutos de los par&#225;metros oscilom&#233;tricos entre pacientes con EPOC&#44; fumadores sin LFA y no fumadores&#44; probablemente por las notables diferencias en las caracter&#237;sticas antropom&#233;tricas y de tabaquismo entre los grupos&#44; el estudio demostr&#243; que la variabilidad intraindividual a corto y medio plazo de la impedancia del sistema respiratorio es muy discreta y aceptable cl&#237;nicamente<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">22</span></a>&#46; Pero lo m&#225;s interesante&#44; fue la identificaci&#243;n de un grupo de fumadores &#171;aparentemente sanos&#187; que ten&#237;an una AX elevada&#44; lo que llev&#243; a los autores a plantear la existencia de una alteraci&#243;n de las peque&#241;as v&#237;as a&#233;reas&#44; que constituir&#237;a una evidencia precoz de LFA no detectada con los par&#225;metros espirom&#233;tricos convencionales<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">22</span></a>&#46; En la misma l&#237;nea&#44; Frantz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">29</span></a> compararon a pacientes con una espirometr&#237;a normal y un diagn&#243;stico autorreferido de bronquitis cr&#243;nica o enfisema con sujetos sin dicho diagn&#243;stico&#44; comprobando que los primeros ten&#237;an valores m&#225;s elevados de R5&#44; R5-R20&#44; X5 y AX&#44; adem&#225;s de una mayor utilizaci&#243;n de medicaci&#243;n respiratoria&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Es interesante destacar que en nuestros fumadores sin evidencia de LFA no se hall&#243; relaci&#243;n alguna entre los par&#225;metros oscilom&#233;tricos y las medidas de atenuaci&#243;n del par&#233;nquima pulmonar en inspiraci&#243;n o espiraci&#243;n&#44; al igual que se ha descrito en el estudio ECLIPSE con respecto a las medidas de TC realizadas en inspiraci&#243;n<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">22</span></a>&#46; Para justificar esta discrepancia&#44; se ha propuesto la existencia de 3 tipos de afectaci&#243;n pulmonar evidenciada por TC&#58; engrosamiento de la pared de las v&#237;as a&#233;reas&#44; aumento de la atenuaci&#243;n pulmonar &#40;enfisema&#41; y mixto<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a>&#46; Las alteraciones de R5&#44; R5-R20&#44; <span class="elsevierStyleItalic">f</span>res y X5 se corresponder&#237;an sobre todo a la afectaci&#243;n de las v&#237;as a&#233;reas y a la mixta&#44; por lo que no es previsible su relaci&#243;n con los cambios de atenuaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a>&#46; Otra explicaci&#243;n complementaria podr&#237;a radicar en que la IOS y la TC son sensibles a cambios de la mec&#225;nica pulmonar producidos en distintas etapas de progresi&#243;n del da&#241;o de las v&#237;as a&#233;reas&#46; La resistencia se ve afectada por m&#250;ltiples factores&#44; entre los que destaca el calibre de las v&#237;as a&#233;reas&#44; particularmente cuando su estrechamiento es heterog&#233;neo&#44; generalizado e involucra a v&#237;as a&#233;reas centrales y perif&#233;ricas<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">14</span></a>&#46; La reactancia tambi&#233;n es sensible al estrechamiento heterog&#233;neo y generalizado de la luz bronquial y bronquiolar&#44; pero adem&#225;s depende del cierre de las v&#237;as a&#233;reas<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">9</span></a>&#44; por lo que tambi&#233;n podr&#237;a verse comprometida en caso de atrapamiento a&#233;reo&#46; Sin embargo&#44; se ha descrito que el atrapamiento a&#233;reo de los fumadores sin LFA es mucho menor al de los asm&#225;ticos<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">31</span></a>&#44; por lo que probablemente esta alteraci&#243;n es muy discreta para inducir cambios relevantes en la atenuaci&#243;n pulmonar y generar un incremento adicional de la X5&#46; En definitiva&#44; se podr&#237;a plantear que la TC permite evaluar la afectaci&#243;n distal de par&#233;nquima&#44; mientras que la impedancia respiratoria&#44; y particularmente las resistencias respiratorias&#44; reflejan el calibre de las peque&#241;as v&#237;as a&#233;reas&#44; incluso mejor que el grosor de la pared bronquial&#44; puesto que esta &#250;ltima medida se realiza sobre generaciones bronquiales anteriores<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">31</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">En nuestra opini&#243;n&#44; el resultado m&#225;s novedoso del presente estudio es el deterioro de la CVRS en fumadores activos con DPV que todav&#237;a no han desarrollado LFA&#46; Previamente&#44; se hab&#237;a descrito que los sujetos con una R5 elevada refieren sibilancias con mayor frecuencia<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">28</span></a>&#46; La disminuci&#243;n de la CVRS en los fumadores con DPV&#44; situ&#225;ndose en una posici&#243;n intermedia entre los no fumadores o fumadores sin DPV y los fumadores con LFA&#44; podr&#237;a justificar las diferencias en la percepci&#243;n subjetiva de salud de los fumadores&#46; Resulta conocido que los fumadores tienen peor CVRS que los no fumadores<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">32</span></a> y que la persistencia del tabaquismo se asocia a un deterioro progresivo de la misma<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">11</span></a>&#44; mientras que su abandono origina una mejor&#237;a de la calidad de vida<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">33</span></a>&#46; Al igual que en nuestro estudio&#44; la afectaci&#243;n de la CVRS se puede detectar mediante cambios en las tarifas del cuestionario EQ-5D y en todos los dominios de los cuestionarios SF-12 y SF-36<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">33-35</span></a>&#44; aunque con un grado de afectaci&#243;n ligeramente superior al de nuestros pacientes&#44; probablemente por tratarse de sujetos de mayor edad&#44; con un mayor predominio de hombres&#44; sin una tasa acumulada de tabaquismo conocida y procedentes de otras &#225;reas geogr&#225;ficas&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Sin embargo&#44; lo m&#225;s destacado de la afectaci&#243;n de la CVRS en fumadores con espirometr&#237;a normal es la heterogeneidad de su intensidad&#44; que hasta el momento no ha podido ser adecuadamente justificada solo por una mayor intensidad del h&#225;bito<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">34</span></a> o una mayor dependencia de la nicotina<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">35</span></a>&#46; La identificaci&#243;n que los fumadores con DPV son los que realmente experimentan un deterioro de su calidad de vida permite identificar un potencial riesgo de esta alteraci&#243;n funcional y es concordante con informaci&#243;n procedente de pacientes con EPOC&#44; en los que la DPV evaluada mediante IOS se relaciona con su estado de salud y con su nivel de disnea<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">36</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Resulta razonable asumir que la presencia de DPV en fumadores sin LFA es debida al estr&#233;s oxidativo y al da&#241;o directo originado por la inflamaci&#243;n local en las v&#237;as a&#233;reas perif&#233;ricas<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">37</span></a>&#46; De hecho&#44; en fumadores con espirometr&#237;a normal&#44; se ha comprobado que aquellos que tienen DPV presentan un mayor recuento de linfocitos y neutr&#243;filos en su lavado broncoalveolar y mayores niveles de las citocinas IL-8 y eotaxina&#44; as&#237; como de la quimioquina CD3CL1<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">27</span></a>&#44; que resulta particularmente importante por estar implicada en la diferenciaci&#243;n de c&#233;lulas Th17<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">38</span></a> y&#44; por lo tanto&#44; en la progresi&#243;n de las enfermedades respiratorias cr&#243;nicas&#46; A su vez&#44; la existencia de una relaci&#243;n directamente proporcional entre la R5 y los niveles en lavado broncoalveolar de IL-8&#44; eotaxina&#44; CD3CL1&#44; IL-12p70 y TGFalfa soporta su asociaci&#243;n con el grado de inflamaci&#243;n de las v&#237;as a&#233;reas distales<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">27</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">La informaci&#243;n disponible sobre el significado pron&#243;stico de la DPV en fumadores sin LFA todav&#237;a es incipiente&#44; aunque en fumadores y exfumadores sin EPOC del estudio COPDGene se ha comprobado que la alteraci&#243;n de las peque&#241;as v&#237;as a&#233;reas se relaciona con la tasa de deterioro anual del FEV<span class="elsevierStyleInf">1</span>&#44; que llega a equipararse con la de los pacientes con EPOC moderada&#44; aunque podr&#237;a resultar reversible si se controla la inflamaci&#243;n de las v&#237;as a&#233;reas m&#225;s distales<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">39</span></a>&#46; Estos resultados parecen concordantes con los obtenidos en un peque&#241;o grupo de pacientes con EPOC moderada seguidos durante 5 a&#241;os&#44; en los que la X5&#44; AX y <span class="elsevierStyleItalic">f</span>res tambi&#233;n se relacionaron con la tasa de deterioro anual del FEV<span class="elsevierStyleInf">1</span><a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">40</span></a>&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Nuestro estudio presenta diversas limitaciones&#46; Se trata de un estudio unic&#233;ntrico y con un limitado tama&#241;o muestral&#44; aunque suficiente para detectar diferencias en la CVRS entre los distintos grupos de sujetos&#46; Ello hace dif&#237;cil la extrapolaci&#243;n de los resultados a la poblaci&#243;n de fumadores en general&#46; A diferencia de otros an&#225;lisis&#44; hemos incluido un elevado n&#250;mero de mujeres y de sujetos en la edad media de la vida para disponer de una muestra m&#225;s representativa de la poblaci&#243;n fumadora actual&#44; aunque esto hace que la comparaci&#243;n con otros estudios deba ser cautelosa&#46; La evaluaci&#243;n de la atenuaci&#243;n del par&#233;nquima pulmonar se realiz&#243; mediante un software de uso cl&#237;nico&#44; que no proporciona medidas del grosor del calibre de las v&#237;as a&#233;reas&#46; A su vez&#44; tampoco se dispone de mediciones de la capacidad de difusi&#243;n pulmonar&#44; aunque la posibilidad de hallar alteraciones en este par&#225;metro entre los fumadores con o sin DPV parece poco probable por no mostrar diferencias en sus densidades de atenuaci&#243;n&#46; Por &#250;ltimo&#44; se trata de un estudio transversal&#44; por lo que del mismo no se pueden establecer inferencias pron&#243;sticas ni demostrar asociaci&#243;n o causalidad&#46; En esta misma l&#237;nea&#44; nuestros resultados no permiten establecer una recomendaci&#243;n sobre el manejo o tratamiento de los fumadores activos con DPV&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; la DPV en fumadores activos que todav&#237;a no han desarrollado LFA ni alteraciones en la densidad de atenuaci&#243;n pulmonar tiene impacto en la percepci&#243;n sintom&#225;tica de la salud&#44; puesto que los fumadores con DPV presentan un deterioro de su CVRS&#44; situ&#225;ndose en una posici&#243;n intermedia entre los no fumadores o fumadores sin DPV y los fumadores que han desarrollado una EPOC&#46; La utilizaci&#243;n de la oscilaci&#243;n forzada constituye un procedimiento simple&#44; r&#225;pido&#44; inocuo y de escaso coste que permite identificar DPV en m&#225;s de un tercio de fumadores activos&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Financiaci&#243;n</span><p id="par0150" class="elsevierStylePara elsevierViewall">Proyecto de investigaci&#243;n parcialmente financiado por Chiesi&#46; Dicho patrocinador no ha participado en el dise&#241;o del estudio&#44; la recolecci&#243;n&#44; el an&#225;lisis y la interpretaci&#243;n de los datos&#44; la redacci&#243;n del manuscrito o la decisi&#243;n de enviar el art&#237;culo para su publicaci&#243;n&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicto de intereses</span><p id="par0155" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introducci&#243;n</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La disfunci&#243;n de las peque&#241;as v&#237;as a&#233;reas &#40;DPV&#41; inducida por el tabaco contribuye precozmente a la patogenia de la limitaci&#243;n al flujo a&#233;reo &#40;LFA&#41;&#44; aunque resulta poco conocida su repercusi&#243;n en la percepci&#243;n de salud&#46; Se pretende evaluar la frecuencia de DPV en fumadores activos sin LFA y comparar la calidad de vida relacionada con la salud &#40;CVRS&#41; de no fumadores&#44; fumadores sin DPV&#44; fumadores con DPV y fumadores con LFA&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">En 53 fumadores activos sin LFA&#44; 20 fumadores con LFA y 20 no fumadores&#44; se utilizaron los cuestionarios SF-36 y EuroQoL y se realiz&#243; oscilometr&#237;a de impulsos&#44; espirometr&#237;a y determinaci&#243;n de las densidades de atenuaci&#243;n del par&#233;nquima pulmonar en inspiraci&#243;n y espiraci&#243;n m&#225;ximas&#46; Se consider&#243; que exist&#237;a DPV cuando la resistencia a 5<span class="elsevierStyleHsp" style=""></span>Hz &#40;R5&#41;&#44; la diferencia R5-R20 y el &#225;rea de reactancia &#40;AX&#41; exced&#237;an su l&#237;mite superior de la normalidad&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El 35&#44;8&#37; de los fumadores sin LFA ten&#237;a DPV&#46; No se detectaron diferencias en los par&#225;metros espirom&#233;tricos ni la atenuaci&#243;n pulmonar entre los fumadores con o sin DPV y los no fumadores&#46; Sin embargo&#44; los fumadores con DPV presentaban una peor puntuaci&#243;n en los cuestionarios de CVRS que los fumadores sin DPV o los no fumadores&#44; e intermedia a los fumadores con LFA&#46; R5 y X5 fueron identificados como determinantes independientes de la CVRS en los fumadores sin LFA&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La DPV es frecuente en fumadores sin LFA&#44; afectando a un tercio de los mismos&#44; y condicionando de forma independiente su percepci&#243;n de salud&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Small airway dysfunction &#40;SAD&#41; caused by smoking contributes to the early onset of airflow limitation &#40;AFL&#41;&#44; although its impact on patients&#8217; perception of health is largely unknown&#46; We aimed to evaluate the frequency of SAD in active smokers without AFL&#44; and to compare health-related quality of life &#40;HRQoL&#41; of non-smokers&#44; smokers without SAD&#44; smokers with SAD&#44; and smokers with AFL&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A total of 53 active smokers without AFL&#44; 20 smokers with AFL&#44; and 20 non-smokers completed the SF-36 and EuroQoL questionnaires and performed impulse oscillometry and spirometry&#46; Pulmonary parenchymal attenuation was determined in inspiration and expiration&#46; SAD was determined to exist when resistance at 5<span class="elsevierStyleHsp" style=""></span>Hz &#40;R5&#41;&#44; the difference between R5 and R20&#44; and reactance area &#40;AX&#41; exceeded the upper limit of normal&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">In total&#44; 35&#46;8&#37; of smokers without AFL had SAD&#46; No differences were detected in spirometric parameters or pulmonary attenuation between smokers with or without AFL and non-smokers&#46; However&#44; smokers with SAD had worse scores on HRQoL questionnaires than smokers without SAD or non-smokers&#44; and scores compared to smokers with AFL were intermediate&#46; R5 and X5 were identified as independent determinants of HRQoL in smokers without AFL&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">SAD is common in smokers without AFL&#44; affecting one third of this population&#44; and independently affecting their perception of health&#46;</p></span>"
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            "apendice" => "<p id="par0165" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia></p>"
            "etiqueta" => "Anexo A"
            "titulo" => "Material suplementario"
            "identificador" => "sec0060"
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      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
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          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Distribuci&#243;n de los sujetos del estudio&#46;AX&#58; &#237;ndice de &#225;rea de reactancia de baja frecuencia&#59; DPV&#58; disfunci&#243;n peque&#241;as v&#237;as a&#233;reas&#59; FEV<span class="elsevierStyleInf">1</span>&#58; volumen espiratorios forzado en el primer segundo&#59; FVC&#58; capacidad vital forzada&#59; LFA&#58; limitaci&#243;n al flujo a&#233;reo&#59; LIN&#58; l&#237;mite inferior de la normalidad&#59; LSN&#58; l&#237;mite superior de la normalidad&#59; R5&#58; resistencia respiratoria a 5<span class="elsevierStyleHsp" style=""></span>Hz&#59; R20&#58; resistencia respiratoria a 20<span class="elsevierStyleHsp" style=""></span>Hz&#46;</p>"
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      1 => array:7 [
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        "etiqueta" => "Figura 2"
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        "mostrarDisplay" => false
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          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Comparaci&#243;n de las puntuaciones globales del componente f&#237;sico del cuestionario SF-36 y del term&#243;metro del cuestionario EQ-5D en los 4 grupos del estudio&#46; Las barras de error corresponden al error est&#225;ndar de la media&#46;DPV&#58; disfunci&#243;n peque&#241;as v&#237;as a&#233;reas&#59; EQ-5D&#58; <span class="elsevierStyleItalic">European Quality of Life-5 Dimensions</span>&#59; LFA&#58; limitaci&#243;n al flujo a&#233;reo&#59; SF-36&#58; <span class="elsevierStyleItalic">Short Form 36 Health Survey</span>&#46;</p>"
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        "etiqueta" => "Figura 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
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            "Alto" => 1872
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          "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Comparaci&#243;n de las puntuaciones de los distintos dominios del cuestionario SF-36 entre los grupos de estudio&#46; Las barras de error corresponden al error est&#225;ndar de la media&#46;DPV&#58; disfunci&#243;n peque&#241;as v&#237;as a&#233;reas&#59; LFA&#58; limitaci&#243;n al flujo a&#233;reo&#59; SF-36&#58; <span class="elsevierStyleItalic">Short Form 36 Health Survey</span>&#46;</p>"
        ]
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      3 => array:7 [
        "identificador" => "fig0035"
        "etiqueta" => "Figura 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 2357
            "Ancho" => 1598
            "Tamanyo" => 94930
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        "descripcion" => array:1 [
          "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Relaci&#243;n entre los par&#225;metros oscilom&#233;tricos y la calidad de vida relacionada con la salud en fumadores sin limitaci&#243;n al flujo a&#233;reo&#46; El panel superior &#40;A&#41; muestra la relaci&#243;n entre la resistencia respiratoria a 5<span class="elsevierStyleHsp" style=""></span>Hz &#40;R5&#41; y el componente f&#237;sico del cuestionario <span class="elsevierStyleItalic">Short Form 36 Health Survey</span> &#40;SF-36&#41;&#44; mientras que el panel inferior &#40;B&#41; presenta la relaci&#243;n entre la reactancia capacitativa a 5<span class="elsevierStyleHsp" style=""></span>Hz &#40;X5&#41; y el term&#243;metro del cuestionario <span class="elsevierStyleItalic">European Quality of Life-5 Dimensions</span> &#40;EQ-5D&#41;&#46;</p>"
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        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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            "identificador" => "at1"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">DPV&#58; disfunci&#243;n peque&#241;as v&#237;as a&#233;reas&#59; IMC&#58; &#237;ndice de masa corporal&#59; LFA&#58; limitaci&#243;n al flujo a&#233;reo&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">163<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">164<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;932&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">FEF<span class="elsevierStyleInf">25-75&#37;</span>&#44; &#37; pred&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">No fumadores &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fumadores sin DPV &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fumadores con DPV &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Fumadores con LFA &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MLD insp&#44; UH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;831<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;826<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;839<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;856<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>30<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0075"><span class="elsevierStyleSup">e</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0085"><span class="elsevierStyleSup">g</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LAV insp&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#44;3<a class="elsevierStyleCrossRef" href="#tblfn0055"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0070"><span class="elsevierStyleSup">d</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0080"><span class="elsevierStyleSup">f</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Subrango 1 &#40;&#8722;1&#46;000 a &#8722;951 UH&#41; insp&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#44;6<a class="elsevierStyleCrossRef" href="#tblfn0055"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0070"><span class="elsevierStyleSup">d</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0080"><span class="elsevierStyleSup">f</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P15 insp&#44; UH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;907<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;902<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;914<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;939<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>28<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0075"><span class="elsevierStyleSup">e</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0090"><span class="elsevierStyleSup">h</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MLD esp&#44; UH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;692<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;685<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;703<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;805<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>50<a class="elsevierStyleCrossRef" href="#tblfn0055"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0070"><span class="elsevierStyleSup">d</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0080"><span class="elsevierStyleSup">f</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LAV esp&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>8&#44;1<a class="elsevierStyleCrossRef" href="#tblfn0055"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0070"><span class="elsevierStyleSup">d</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0080"><span class="elsevierStyleSup">f</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Subrango 1 &#40;&#8722;1&#46;000 a &#8722;951 UH&#41; esp&#44; &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;7<a class="elsevierStyleCrossRef" href="#tblfn0055"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0070"><span class="elsevierStyleSup">d</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0080"><span class="elsevierStyleSup">f</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">P15 esp&#44; UH&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;817<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;821<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;827<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>48&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;910<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>48<a class="elsevierStyleCrossRef" href="#tblfn0060"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0070"><span class="elsevierStyleSup">d</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0080"><span class="elsevierStyleSup">f</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#8722;132<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>43&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8722;136<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>68&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#44;5<a class="elsevierStyleCrossRef" href="#tblfn0095"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0120"><span class="elsevierStyleSup">f</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;3<a class="elsevierStyleCrossRef" href="#tblfn0105"><span class="elsevierStyleSup">c</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0120"><span class="elsevierStyleSup">f</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Funci&#243;n f&#237;sica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;0<a class="elsevierStyleCrossRef" href="#tblfn0095"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#44;5<a class="elsevierStyleCrossRef" href="#tblfn0095"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0110"><span class="elsevierStyleSup">d</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0125"><span class="elsevierStyleSup">g</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Rol f&#237;sico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>36&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>27&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;021&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dolor corporal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>26&#44;1<a class="elsevierStyleCrossRef" href="#tblfn0095"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0115"><span class="elsevierStyleSup">e</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;0<a class="elsevierStyleCrossRef" href="#tblfn0095"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0110"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Salud general&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&#44;0<a class="elsevierStyleCrossRef" href="#tblfn0105"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&#44;0<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&#44;1<a class="elsevierStyleCrossRef" href="#tblfn0095"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0110"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#44;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>6&#44;0<a class="elsevierStyleCrossRef" href="#tblfn0095"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0110"><span class="elsevierStyleSup">d</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0125"><span class="elsevierStyleSup">g</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vitalidad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;8<a class="elsevierStyleCrossRef" href="#tblfn0095"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#44;7<a class="elsevierStyleCrossRef" href="#tblfn0095"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0120"><span class="elsevierStyleSup">f</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&#44;9<a class="elsevierStyleCrossRef" href="#tblfn0095"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0110"><span class="elsevierStyleSup">d</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0130"><span class="elsevierStyleSup">h</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Funcionamiento social&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">99&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#44;5<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>23&#44;7<a class="elsevierStyleCrossRef" href="#tblfn0095"><span class="elsevierStyleSup">a</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#tblfn0120"><span class="elsevierStyleSup">f</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>5&#44;6<a class="elsevierStyleCrossRef" href="#tblfn0100"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Rol emocional&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>35&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>35&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&#44;4<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>32&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;023&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Salud mental&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;2<a class="elsevierStyleCrossRef" href="#tblfn0095"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>17&#44;7<a class="elsevierStyleCrossRef" href="#tblfn0095"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;3<a class="elsevierStyleCrossRef" href="#tblfn0095"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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