array:24 [
  "pii" => "S2341287914000271"
  "issn" => "23412879"
  "doi" => "10.1016/j.anpede.2013.08.001"
  "estado" => "S300"
  "fechaPublicacion" => "2014-06-01"
  "aid" => "1390"
  "copyright" => "Asociación Española de Pediatría"
  "copyrightAnyo" => "2013"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "fla"
  "cita" => "An Pediatr (Barc). 2014;80:370-8"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 1883
    "formatos" => array:3 [
      "EPUB" => 152
      "HTML" => 1133
      "PDF" => 598
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S1695403313003779"
      "issn" => "16954033"
      "doi" => "10.1016/j.anpedi.2013.08.009"
      "estado" => "S300"
      "fechaPublicacion" => "2014-06-01"
      "aid" => "1390"
      "copyright" => "Asociación Española de Pediatría"
      "documento" => "article"
      "crossmark" => 0
      "subdocumento" => "fla"
      "cita" => "An Pediatr (Barc). 2014;80:370-8"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 14133
        "formatos" => array:3 [
          "EPUB" => 183
          "HTML" => 12114
          "PDF" => 1836
        ]
      ]
      "es" => array:12 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL</span>"
        "titulo" => "Demandas y expectativas de padres y madres que rechazan la vacunaci&#243;n y perspectiva de los profesionales sanitarios sobre la negativa a vacunar"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "370"
            "paginaFinal" => "378"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Demands and expectations of parents who refuse vaccinations and perspective of health professional on the refusal to vaccinate"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "S&#46; Mart&#237;nez-Diz, M&#46; Mart&#237;nez Romero, M&#46; Fern&#225;ndez-Prada, M&#46; Cruz Piqueras, R&#46; Molina Ruano, M&#46;A&#46; Fern&#225;ndez Sierra"
            "autores" => array:6 [
              0 => array:2 [
                "nombre" => "S&#46;"
                "apellidos" => "Mart&#237;nez-Diz"
              ]
              1 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Mart&#237;nez Romero"
              ]
              2 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Fern&#225;ndez-Prada"
              ]
              3 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Cruz Piqueras"
              ]
              4 => array:2 [
                "nombre" => "R&#46;"
                "apellidos" => "Molina Ruano"
              ]
              5 => array:2 [
                "nombre" => "M&#46;A&#46;"
                "apellidos" => "Fern&#225;ndez Sierra"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2341287914000271"
          "doi" => "10.1016/j.anpede.2013.08.001"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287914000271?idApp=UINPBA00005H"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403313003779?idApp=UINPBA00005H"
      "url" => "/16954033/0000008000000006/v1_201405300012/S1695403313003779/v1_201405300012/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2341287914000283"
    "issn" => "23412879"
    "doi" => "10.1016/j.anpede.2013.08.002"
    "estado" => "S300"
    "fechaPublicacion" => "2014-06-01"
    "aid" => "1389"
    "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "An Pediatr &#40;Barc&#41;. 2014;80:379-86"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 1467
      "formatos" => array:3 [
        "EPUB" => 107
        "HTML" => 949
        "PDF" => 411
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Obesity and overweight&#46; An assessment of the effectiveness of a public health intervention"
      "tienePdf" => "en"
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "379"
          "paginaFinal" => "386"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Obesidad y sobrepeso&#46; Aproximaci&#243;n a la efectividad de una intervenci&#243;n sanitaria"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "X&#46; Txakartegi Etxebarria, M&#46; L&#243;pez Mateo, J&#46;J&#46; Aurrekoetxea"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "X&#46; Txakartegi"
              "apellidos" => "Etxebarria"
            ]
            1 => array:2 [
              "nombre" => "M&#46; L&#243;pez"
              "apellidos" => "Mateo"
            ]
            2 => array:2 [
              "nombre" => "J&#46;J&#46;"
              "apellidos" => "Aurrekoetxea"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1695403313003767"
        "doi" => "10.1016/j.anpedi.2013.08.008"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403313003767?idApp=UINPBA00005H"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287914000283?idApp=UINPBA00005H"
    "url" => "/23412879/0000008000000006/v1_201406260028/S2341287914000283/v1_201406260028/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S234128791400026X"
    "issn" => "23412879"
    "doi" => "10.1016/j.anpede.2013.06.003"
    "estado" => "S300"
    "fechaPublicacion" => "2014-06-01"
    "aid" => "1375"
    "copyright" => "Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "An Pediatr &#40;Barc&#41;. 2014;80:365-9"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 2124
      "formatos" => array:3 [
        "EPUB" => 132
        "HTML" => 1262
        "PDF" => 730
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Complex febrile seizures&#58; Study of the associated pathology and practical use of complementary tests"
      "tienePdf" => "en"
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "365"
          "paginaFinal" => "369"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Crisis febriles complejas&#58; estudio de la patolog&#237;a asociada y utilidad de las pruebas complementarias"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "R&#46; Berzosa L&#243;pez, J&#46;M&#46; Ramos Fern&#225;ndez, J&#46; Mart&#237;nez Ant&#243;n, M&#46;G&#46; Espinosa Fern&#225;ndez, A&#46; Urda Cardona"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "R&#46; Berzosa"
              "apellidos" => "L&#243;pez"
            ]
            1 => array:2 [
              "nombre" => "J&#46;M&#46; Ramos"
              "apellidos" => "Fern&#225;ndez"
            ]
            2 => array:2 [
              "nombre" => "J&#46; Mart&#237;nez"
              "apellidos" => "Ant&#243;n"
            ]
            3 => array:2 [
              "nombre" => "M&#46;G&#46; Espinosa"
              "apellidos" => "Fern&#225;ndez"
            ]
            4 => array:2 [
              "nombre" => "A&#46; Urda"
              "apellidos" => "Cardona"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1695403313003585"
        "doi" => "10.1016/j.anpedi.2013.06.038"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403313003585?idApp=UINPBA00005H"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S234128791400026X?idApp=UINPBA00005H"
    "url" => "/23412879/0000008000000006/v1_201406260028/S234128791400026X/v1_201406260028/en/main.assets"
  ]
  "en" => array:16 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Demands and expectations of parents who refuse vaccinations and perspective of health professional on the refusal to vaccinate"
    "tieneTextoCompleto" => 0
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "370"
        "paginaFinal" => "378"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "S&#46; Mart&#237;nez-Diz, M&#46; Mart&#237;nez Romero, M&#46; Fern&#225;ndez-Prada, M&#46; Cruz Piqueras, R&#46; Molina Ruano, M&#46;A&#46; Fern&#225;ndez Sierra"
        "autores" => array:6 [
          0 => array:4 [
            "nombre" => "S&#46;"
            "apellidos" => "Mart&#237;nez-Diz"
            "email" => array:1 [
              0 => "silviamartinezdiz&#64;hotmail&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">¿</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "M&#46; Mart&#237;nez"
            "apellidos" => "Romero"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Fern&#225;ndez-Prada"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "M&#46; Cruz"
            "apellidos" => "Piqueras"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "R&#46; Molina"
            "apellidos" => "Ruano"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "M&#46;A&#46; Fern&#225;ndez"
            "apellidos" => "Sierra"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:5 [
          0 => array:3 [
            "entidad" => "Unidad de Gesti&#243;n Cl&#237;nica Medicina Preventiva&#44; Vigilancia y Promoci&#243;n de la Salud&#44; Hospital Universitario Virgen de las Nieves&#44; Granada&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Paediatrician&#44; Centro de Salud Albayc&#237;n&#44; Granada&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Unidad de Gesti&#243;n Cl&#237;nica Medicina Preventiva&#44; Vigilancia y Promoci&#243;n de la Salud&#44; Hospital Universitario San Cecilio&#44; Granada&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Escuela Andaluza de Salud P&#250;blica&#44; Granada&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Unidad de Gesti&#243;n Cl&#237;nica Cuidados Cr&#237;ticos y Urgencias&#44; Hospital Universitario Virgen de las Nieves&#44; Granada&#44; Spain"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Demandas y expectativas de padres y madres que rechazan la vacunaci&#243;n y perspectiva de los profesionales sanitarios sobre la negativa a vacunar"
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2013-06-10"
    "fechaAceptado" => "2013-08-26"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec330033"
          "palabras" => array:7 [
            0 => "Vaccines"
            1 => "Treatment refusal"
            2 => "Mandatory vaccination"
            3 => "Immunisation coverage"
            4 => "Public health"
            5 => "Informed consent"
            6 => "Qualitative research"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec330034"
          "palabras" => array:7 [
            0 => "Vacunas"
            1 => "Rechazo al tratamiento"
            2 => "Vacunaci&#243;n obligatoria"
            3 => "Cobertura de vacunaci&#243;n"
            4 => "Salud p&#250;blica"
            5 => "Consentimiento informado"
            6 => "Investigaci&#243;n cualitativa"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To examine the opinions&#44; beliefs and attitudes about vaccination&#44; of parents who decide not to vaccinate their children&#46; To determine the opinions and attitudes of the health professionals on the behaviour towards childhood vaccination&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Qualitative research based on semi-structured interviews and focal groups in Granada&#44; Spain&#44; including parents who chose to not vaccinate their children&#44; and healthcare professionals who can provide a technical point of view&#46; An analysis was made of the semantic content&#44; and answers were categorised in thematic units&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The parents argued on the benefit of suffering vaccine-preventable diseases in a natural way&#44; without non-natural&#44; aggressive or toxic products&#46; Vaccination was considered unnecessary&#44; if given adequate hygienic-sanitary conditions&#44; effectiveness unproven and more dangerous than the diseases they prevent&#44; especially the polyvalent vaccines&#46; They believed that vaccination programs are moved by biased studies and interests other than prevention&#46; Health care professionals believe that they had fears without scientific basis&#44; which requires improving information systems&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Non-vaccinators are unaware of the benefit&#47;risk ratio between the vaccination and the individual risk for preventable diseases&#44; and ask for informed consent&#46; Health care professionals believe that non-vaccinators&#8217; arguments are not correctly contrasted and expose the existence of failures in actual vaccination coverage and information registration systems&#46; It was suggested to centralise registers and compare them in schools&#44; working with local leaders and reporting regularly on the status of vaccine-preventable diseases&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Explorar las opiniones&#44; creencias y actitudes sobre la vacunaci&#243;n&#44; de padres y madres que deciden no vacunar a sus hijos&#47;as&#46; Conocer las opiniones y las actitudes de profesionales sanitarios sobre el comportamiento de estas personas hacia la vacunaci&#243;n&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Investigaci&#243;n cualitativa basada en entrevistas semiestructuradas y grupo focal a padres&#47;madres de Granada que deciden no vacunar a sus hijos&#47;as y a profesionales sanitarios implicados en la vacunaci&#243;n infantil&#46; An&#225;lisis de contenido de tipo sem&#225;ntico con categorizaci&#243;n de respuestas en unidades tem&#225;ticas&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Los padres argumentan el beneficio de presentar enfermedades inmunoprevenibles de un modo natural&#44; sin productos antinaturales&#44; t&#243;xicos o agresivos&#46; Consideran la vacunaci&#243;n innecesaria si se dan adecuadas condiciones higi&#233;nico-sanitarias&#44; de eficacia no demostrada&#44; y m&#225;s peligrosa que las enfermedades que evitan&#44; especialmente las vacunas polivalentes&#46; Piensan que los programas de vacunaci&#243;n est&#225;n movidos por estudios sesgados e intereses distintos de la prevenci&#243;n de perfil comercial&#46; Los profesionales opinan que los que rechazan la vacunaci&#243;n tienen temores de base seudocient&#237;fica&#44; que es necesario mejorar los sistemas de informaci&#243;n&#47;comunicaci&#243;n&#44; tener una postura conciliadora y una s&#243;lida formaci&#243;n sobre seguridad vacunal&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Los no vacunadores han perdido la percepci&#243;n del balance beneficio de la vacunaci&#243;n frente al riesgo individual de presentar enfermedades inmunoprevenibles y plantean la necesidad del consentimiento informado&#46; Los profesionales consideran poco contrastadas las argumentaciones de los no vacunadores y exponen la existencia de fallos en las coberturas reales de vacunaci&#243;n y en los sistemas de registro de la informaci&#243;n&#46; Como mejoras se plantea centralizar los registros&#44; compararlos con los listados de educaci&#243;n&#44; trabajar con l&#237;deres locales e informar peri&#243;dicamente sobre la situaci&#243;n de las enfermedades inmunoprevenibles&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Mart&#237;nez-Diz S&#44; Mart&#237;nez Romero M&#44; Fern&#225;ndez-Prada M&#44; Cruz Piqueras M&#44; Molina Ruano R&#44; Fern&#225;ndez Sierra MA&#46; Demandas y expectativas de padres y madres que rechazan la vacunaci&#243;n y perspectiva de los profesionales sanitarios sobre la negativa a vacunar&#46; An Pediatr &#40;Barc&#41;&#46; 2014&#59;80&#58;370-378&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:33 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "&#91;1&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Consentimiento informado"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46; Sim&#243;n"
                            1 => "J&#46; J&#250;dez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;&#46;"
                        "fecha" => "2001"
                        "volumen" => "117"
                        "paginaInicial" => "99"
                        "paginaFinal" => "106"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11459579"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "&#91;2&#93;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Ley sobre medidas especiales en materia de Salud P&#250;blica&#46; LO&#46; N¿&#46;3&#47;1986&#44; de 24 de abril&#46; Bolet&#237;n oficial del Estado n&#46; 102&#44;&#46;&#40;29-4-1986&#41;&#46;"
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "&#91;3&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A key medical decision maker&#58; The patient"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;A&#46; Deyo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "BMJ&#46;"
                        "fecha" => "2001"
                        "volumen" => "323"
                        "paginaInicial" => "466"
                        "paginaFinal" => "467"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11532825"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "&#91;4&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Content and design attributes of antivaccination web sites"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Wolfe"
                            1 => "L&#46; Sharp"
                            2 => "M&#46; Lipsky"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "JAMA&#46;"
                        "fecha" => "2002"
                        "volumen" => "287"
                        "paginaInicial" => "3245"
                        "paginaFinal" => "3248"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12076221"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "&#91;5&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Understanding those who do not understand&#58; A brief review of the anti-vaccine movement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "G&#46; Poland"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Vaccine&#46;"
                        "fecha" => "2001"
                        "volumen" => "19"
                        "paginaInicial" => "2440"
                        "paginaFinal" => "2445"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11257375"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "&#91;6&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The anti-vaccination movement and resistance to allergen-immunotherapy&#58; A guide for clinical allergists"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46; Berhmann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1710-1492-6-26"
                      "Revista" => array:5 [
                        "tituloSerie" => "Allergy Asthma Clin Immunol&#46;"
                        "fecha" => "2010"
                        "volumen" => "6"
                        "paginaInicial" => "26"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20843332"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "&#91;7&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A postmodern Pandora&#39;s box&#58; Anti-vaccination misinfor- mation on the Internet"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46; Kata"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.vaccine.2009.12.022"
                      "Revista" => array:6 [
                        "tituloSerie" => "Vaccine&#46;"
                        "fecha" => "2010"
                        "volumen" => "28"
                        "paginaInicial" => "1709"
                        "paginaFinal" => "1716"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20045099"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "&#91;8&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Integrating experimental &#40;in vitro and in vivo&#41; neuro- toxicity studies of low-dose thimerosal relevant to vaccines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;G&#46; D&#243;rea"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11064-011-0427-0"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurochem Res&#46;"
                        "fecha" => "2011"
                        "volumen" => "36"
                        "paginaInicial" => "927"
                        "paginaFinal" => "938"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21350943"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "&#91;9&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Calendario de vacuna- ciones de la Asociaci&#243;n Espa&#241;ola de Pediatr&#237;a&#58; recomendaciones 2011"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Mar&#232;s"
                            1 => "D&#46; Arbolave"
                            2 => "D&#46; Moreno-P&#233;rez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.anpedi.2010.10.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "An Pediatr &#40;Barc&#41;&#46;"
                        "fecha" => "2011"
                        "volumen" => "74"
                        "paginaInicial" => "132"
                        "paginaFinal" => "159"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21215719"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "&#91;10&#93;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Redondo E&#44; editor&#46; Evidencia cient&#237;fica en valor de las vacunas&#46; Madrid&#58; IMC&#59; 2011&#46;"
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "&#91;11&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spotlight on measles 2010&#58; An ongoing outbreak of measles in an unvaccinated population in Granada&#44; Spain October to No- vember 2010"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46; L&#243;pez"
                            1 => "J&#46; Laguna"
                            2 => "I&#46; Mar&#237;n"
                            3 => "V&#46; Gallardo"
                            4 => "E&#46; P&#233;rez"
                            5 => "J&#46;M&#46; Mayoral"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Euro Surveill&#46;"
                        "fecha" => "2010"
                        "volumen" => "15"
                        "paginaInicial" => "19746"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21172172"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "&#91;12&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#191;Por qu&#233; los padres no vacu- nan a sus hijos&#63; Reflexiones tras un brote de sarampi&#243;n en un barrio de Granada"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Mart&#237;nez"
                            1 => "S&#46; Mart&#237;nez"
                            2 => "F&#46; Garc&#237;a"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.anpedi.2011.04.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "An Pediatr &#40;Barc&#41;&#46;"
                        "fecha" => "2011"
                        "volumen" => "75"
                        "paginaInicial" => "209"
                        "paginaFinal" => "210"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21676666"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "&#91;13&#93;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Pose C&#46; &#191;C&#243;mo decidir&#233; el tratamiento de mis pacientes&#63; Reflex- iones de Bio&#233;tica Cl&#237;nica&#46; Jano &#91;online series&#93; 2011 &#91;accessed 9 Sep 2011&#93;&#46; Available at&#58; <a id="intr0005" class="elsevierStyleInterRef" href="http://www.jano.es/jano/humanidades/medicas/humanidades/medicas/carlos/pose/como/decidire/tratamiento/mis/pacientes/_f-303+iditem-4412+idtabla-4+tipo-10">http&#58;&#47;&#47;www&#46;jano&#46;es&#47;jano&#47;humanidades&#47;medicas&#47;humanidades&#47;medicas&#47;carlos&#47;pose&#47;como&#47;decidire&#47;tratamiento&#47;mis&#47;pacientes&#47;&#95;f-303&#43;iditem-4412&#43;idtabla-4&#43;tipo-10</a>"
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "&#91;14&#93;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Conde F&#44; editor&#46; An&#225;lisis sociol&#243;gico del sistema de discursos&#46; Madrid&#58; Centro de Investigaciones Sociol&#243;gicas&#59; 2010&#46;"
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "&#91;15&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "El grupo focal como t&#233;cnica de investi- gaci&#243;n cualitativa en salud&#58; dise&#241;o y puesta en pr&#225;ctica"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;M&#46; Garc&#237;a"
                            1 => "I&#46; Mateo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Aten Primaria&#46;"
                        "fecha" => "2000"
                        "volumen" => "25"
                        "paginaInicial" => "115"
                        "paginaFinal" => "122"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "&#91;16&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Confidence about vaccines in the United States&#58; Understanding parents&#8217; perceptions"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Kennedy"
                            1 => "K&#46; LaVail"
                            2 => "G&#46; Nowak"
                            3 => "M&#46; Basket"
                            4 => "S&#46; Landry"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Health Aff&#46;"
                        "fecha" => "2011"
                        "volumen" => "30"
                        "paginaInicial" => "61151"
                        "paginaFinal" => "61159"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "&#91;17&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Individual freedom versus collective responsibility&#58; An ethicist&#39;s perspective"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;E&#46; Ashcroft"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1742-7622-3-11"
                      "Revista" => array:5 [
                        "tituloSerie" => "Emerg Themes Epidemiol&#46;"
                        "fecha" => "2006"
                        "volumen" => "3"
                        "paginaInicial" => "11"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16999864"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "&#91;18&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Further efforts needed to achieve measles elimi- nation in Germany&#58; Results of an outbreak investigation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "O&#46; Wichmann"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Bull World Health Organ&#46;"
                        "fecha" => "2009"
                        "volumen" => "87"
                        "paginaInicial" => "108"
                        "paginaFinal" => "115"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19274362"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "&#91;19&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spotlight on measles 2010&#58; Timely ad- ministration of the first dose of measles vaccine in the context of an ongoing measles outbreak in France"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Gagneur"
                            1 => "D&#46; Pinquier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Euro Surveill&#46;"
                        "fecha" => "2010"
                        "volumen" => "15"
                        "paginaInicial" => "19689"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20961512"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "&#91;20&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Who gets measles in Europe&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46; Mark"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Infect Dis&#46;"
                        "fecha" => "2011"
                        "volumen" => "204"
                        "paginaInicial" => "353"
                        "paginaFinal" => "365"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "&#91;21&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Back to basics&#58; The miracle and tragedy of measles vaccine"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Z&#46; Jakab"
                            1 => "D&#46;M&#46; Salisbury"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(13)60908-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet&#46;"
                        "fecha" => "2013"
                        "volumen" => "381"
                        "paginaInicial" => "1433"
                        "paginaFinal" => "1434"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23623213"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "&#91;22&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vacunaci&#243;n para ma&#241;ana&#58; la necesidad de mejorar las tasas de inmunizaci&#243;n"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "G&#46; Kassianos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Salud Fam&#46;"
                        "fecha" => "2010"
                        "volumen" => "20"
                        "paginaInicial" => "13"
                        "paginaFinal" => "16"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "&#91;23&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The controver- sial relationship between NLRP3&#44; alum&#44; danger signals and the next-generation adjuvants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Spreafico"
                            1 => "P&#46; Ricciardi-Castagnoli"
                            2 => "A&#46; Mortellaro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/eji.200940039"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Immunol&#46;"
                        "fecha" => "2010"
                        "volumen" => "40"
                        "paginaInicial" => "638"
                        "paginaFinal" => "642"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20201020"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "&#91;24&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Imperfect vac- cine-induced immunity and whooping cough transmission to in- fants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46; Lavine"
                            1 => "H&#46; Broutin"
                            2 => "E&#46;T&#46; Harvill"
                            3 => "O&#46;N&#46; Bj&#248;rnstad"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.vaccine.2010.10.029"
                      "Revista" => array:6 [
                        "tituloSerie" => "Vaccine&#46;"
                        "fecha" => "2010"
                        "volumen" => "29"
                        "paginaInicial" => "11"
                        "paginaFinal" => "16"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21034823"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "&#91;25&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "ASIA&#58; Autoimmune&#47;inflammatory syndrome induced by adjuvants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "Y&#46; Shoenfeld"
                            1 => "N&#46; Agmon-Levin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaut.2010.07.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Autoimmun&#46;"
                        "fecha" => "2011"
                        "volumen" => "36"
                        "paginaInicial" => "4"
                        "paginaFinal" => "8"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20708902"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "&#91;26&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aluminum vaccine adjuvants&#58; Are they safe&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46; Tomljenovic"
                            1 => "C&#46;A&#46; Shaw"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Med Chem&#46;"
                        "fecha" => "2011"
                        "volumen" => "18"
                        "paginaInicial" => "2630"
                        "paginaFinal" => "2637"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21568886"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "&#91;27&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Debunking vaccination myths&#58; Strong risk negations can increase perceived vaccination risks"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46; Betsch"
                            1 => "K&#46; Sachse"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Health Psy- chol&#46;"
                        "fecha" => "2013"
                        "volumen" => "32"
                        "paginaInicial" => "146"
                        "paginaFinal" => "155"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "&#91;28&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A taxonomy of reasoning flaws in the anti-vaccine movement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46;M&#46; Jacobson"
                            1 => "P&#46;V&#46; Targonski"
                            2 => "G&#46;A&#46; Poland"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Vaccine&#46;"
                        "fecha" => "2007"
                        "paginaInicial" => "25"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "&#91;29&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recommendations for making decisions when parents refuse to vaccinate their children&#58; Ethi- cal analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "I&#46; Ria&#241;o"
                            1 => "C&#46; Mart&#237;nez"
                            2 => "M&#46; S&#225;nchez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.anpedi.2012.11.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "An Pediatr &#40;Barc&#41;&#46;"
                        "fecha" => "2013"
                        "volumen" => "79"
                        "paginaInicial" => "51"
                        "paginaFinal" => "55"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23266243"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "&#91;30&#93;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Garc&#237;a-Ruiz Y&#46; &#191;Vacunaciones obligatorias de menores contra la voluntad de los padres&#63; Humanitas &#91;online series&#93; 2009 &#91;ac- cessed March 5&#44; 2013&#93;&#46; Available at&#58; <a id="intr0010" class="elsevierStyleInterRef" href="http://www.fundacionm-hm.org/www_humanitas_es_numero35/articulo.pdf">http&#58;&#47;&#47;www&#46;fundacionm-hm&#46;org&#47;www&#95;humanitas&#95;es&#95;numero35&#47;articulo&#46;pdf</a>"
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "&#91;31&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Anti-vaccine activists&#44; Web 2&#46; 0&#44; and the postmodern paradigm-an overview of tactics and tropes used online by the anti-vaccination movement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46; Kata"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.vaccine.2011.11.112"
                      "Revista" => array:6 [
                        "tituloSerie" => "Vaccine&#46;"
                        "fecha" => "2012"
                        "volumen" => "30"
                        "paginaInicial" => "3778"
                        "paginaFinal" => "3789"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22172504"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "&#91;32&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Review of outbreaks and barriers to MMR vaccination coverage among hard-to-reach populations in Eu- rope&#46; Stockholm&#58;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Mereckiene"
                            1 => "S&#46; Cotter"
                            2 => "D&#46; O&#8217;Flanagan"
                            3 => "P&#46; Valentiner-Branth"
                            4 => "M&#46; Mus- cat"
                            5 => "F&#46; D&#8217;Ancona"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "ECDC"
                        "fecha" => "2013"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "&#91;33&#93;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Knowledge and misconceptions about immunizations among medical students&#44; pediatric&#44; and family medicine resident"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "V&#46; Ta&#241;&#243;n"
                            1 => "C&#46; Borrero"
                            2 => "Y&#46; Pedrogo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Bol Asoc Med P R&#46;"
                        "fecha" => "2010"
                        "volumen" => "102"
                        "paginaInicial" => "5"
                        "paginaFinal" => "8"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21766541"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/23412879/0000008000000006/v1_201406260028/S2341287914000271/v1_201406260028/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "26005"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008000000006/v1_201406260028/S2341287914000271/v1_201406260028/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287914000271?idApp=UINPBA00005H"
]
Share
Journal Information
Vol. 80. Issue 6.
Pages 370-378 (1 June 2014)
Vol. 80. Issue 6.
Pages 370-378 (1 June 2014)
Original Article
Full text access
Demands and expectations of parents who refuse vaccinations and perspective of health professional on the refusal to vaccinate
Demandas y expectativas de padres y madres que rechazan la vacunación y perspectiva de los profesionales sanitarios sobre la negativa a vacunar
Visits
5625
S. Martínez-Diza,
Corresponding author
silviamartinezdiz@hotmail.com

Corresponding author.
, M. Martínez Romerob, M. Fernández-Pradac, M. Cruz Piquerasd, R. Molina Ruanoe, M.A. Fernández Sierraa
a Unidad de Gestión Clínica Medicina Preventiva, Vigilancia y Promoción de la Salud, Hospital Universitario Virgen de las Nieves, Granada, Spain
b Paediatrician, Centro de Salud Albaycín, Granada, Spain
c Unidad de Gestión Clínica Medicina Preventiva, Vigilancia y Promoción de la Salud, Hospital Universitario San Cecilio, Granada, Spain
d Escuela Andaluza de Salud Pública, Granada, Spain
e Unidad de Gestión Clínica Cuidados Críticos y Urgencias, Hospital Universitario Virgen de las Nieves, Granada, Spain
This item has received
Article information
Abstract
Objectives

To examine the opinions, beliefs and attitudes about vaccination, of parents who decide not to vaccinate their children. To determine the opinions and attitudes of the health professionals on the behaviour towards childhood vaccination.

Method

Qualitative research based on semi-structured interviews and focal groups in Granada, Spain, including parents who chose to not vaccinate their children, and healthcare professionals who can provide a technical point of view. An analysis was made of the semantic content, and answers were categorised in thematic units.

Results

The parents argued on the benefit of suffering vaccine-preventable diseases in a natural way, without non-natural, aggressive or toxic products. Vaccination was considered unnecessary, if given adequate hygienic-sanitary conditions, effectiveness unproven and more dangerous than the diseases they prevent, especially the polyvalent vaccines. They believed that vaccination programs are moved by biased studies and interests other than prevention. Health care professionals believe that they had fears without scientific basis, which requires improving information systems.

Conclusions

Non-vaccinators are unaware of the benefit/risk ratio between the vaccination and the individual risk for preventable diseases, and ask for informed consent. Health care professionals believe that non-vaccinators’ arguments are not correctly contrasted and expose the existence of failures in actual vaccination coverage and information registration systems. It was suggested to centralise registers and compare them in schools, working with local leaders and reporting regularly on the status of vaccine-preventable diseases.

Keywords:
Vaccines
Treatment refusal
Mandatory vaccination
Immunisation coverage
Public health
Informed consent
Qualitative research
Resumen
Objetivos

Explorar las opiniones, creencias y actitudes sobre la vacunación, de padres y madres que deciden no vacunar a sus hijos/as. Conocer las opiniones y las actitudes de profesionales sanitarios sobre el comportamiento de estas personas hacia la vacunación.

Método

Investigación cualitativa basada en entrevistas semiestructuradas y grupo focal a padres/madres de Granada que deciden no vacunar a sus hijos/as y a profesionales sanitarios implicados en la vacunación infantil. Análisis de contenido de tipo semántico con categorización de respuestas en unidades temáticas.

Resultados

Los padres argumentan el beneficio de presentar enfermedades inmunoprevenibles de un modo natural, sin productos antinaturales, tóxicos o agresivos. Consideran la vacunación innecesaria si se dan adecuadas condiciones higiénico-sanitarias, de eficacia no demostrada, y más peligrosa que las enfermedades que evitan, especialmente las vacunas polivalentes. Piensan que los programas de vacunación están movidos por estudios sesgados e intereses distintos de la prevención de perfil comercial. Los profesionales opinan que los que rechazan la vacunación tienen temores de base seudocientífica, que es necesario mejorar los sistemas de información/comunicación, tener una postura conciliadora y una sólida formación sobre seguridad vacunal.

Conclusiones

Los no vacunadores han perdido la percepción del balance beneficio de la vacunación frente al riesgo individual de presentar enfermedades inmunoprevenibles y plantean la necesidad del consentimiento informado. Los profesionales consideran poco contrastadas las argumentaciones de los no vacunadores y exponen la existencia de fallos en las coberturas reales de vacunación y en los sistemas de registro de la información. Como mejoras se plantea centralizar los registros, compararlos con los listados de educación, trabajar con líderes locales e informar periódicamente sobre la situación de las enfermedades inmunoprevenibles.

Palabras clave:
Vacunas
Rechazo al tratamiento
Vacunación obligatoria
Cobertura de vacunación
Salud pública
Consentimiento informado
Investigación cualitativa
Full text is only aviable in PDF
References
[1]
P. Simón, J. Júdez.
Consentimiento informado.
Med Clin (Barc)., 117 (2001), pp. 99-106
[2]
Ley sobre medidas especiales en materia de Salud Pública. LO. N¿.3/1986, de 24 de abril. Boletín oficial del Estado n. 102,.(29-4-1986).
[3]
R.A. Deyo.
A key medical decision maker: The patient.
BMJ., 323 (2001), pp. 466-467
[4]
M. Wolfe, L. Sharp, M. Lipsky.
Content and design attributes of antivaccination web sites.
JAMA., 287 (2002), pp. 3245-3248
[5]
G. Poland.
Understanding those who do not understand: A brief review of the anti-vaccine movement.
Vaccine., 19 (2001), pp. 2440-2445
[6]
J. Berhmann.
The anti-vaccination movement and resistance to allergen-immunotherapy: A guide for clinical allergists.
Allergy Asthma Clin Immunol., 6 (2010), pp. 26
[7]
A. Kata.
A postmodern Pandora's box: Anti-vaccination misinfor- mation on the Internet.
Vaccine., 28 (2010), pp. 1709-1716
[8]
J.G. Dórea.
Integrating experimental (in vitro and in vivo) neuro- toxicity studies of low-dose thimerosal relevant to vaccines.
Neurochem Res., 36 (2011), pp. 927-938
[9]
J. Marès, D. Arbolave, D. Moreno-Pérez.
Calendario de vacuna- ciones de la Asociación Española de Pediatría: recomendaciones 2011.
An Pediatr (Barc)., 74 (2011), pp. 132-159
[10]
Redondo E, editor. Evidencia científica en valor de las vacunas. Madrid: IMC; 2011.
[11]
B. López, J. Laguna, I. Marín, V. Gallardo, E. Pérez, J.M. Mayoral.
Spotlight on measles 2010: An ongoing outbreak of measles in an unvaccinated population in Granada, Spain October to No- vember 2010.
Euro Surveill., 15 (2010), pp. 19746
[12]
M. Martínez, S. Martínez, F. García.
¿Por qué los padres no vacu- nan a sus hijos? Reflexiones tras un brote de sarampión en un barrio de Granada.
An Pediatr (Barc)., 75 (2011), pp. 209-210
[13]
Pose C. ¿Cómo decidiré el tratamiento de mis pacientes? Reflex- iones de Bioética Clínica. Jano [online series] 2011 [accessed 9 Sep 2011]. Available at: http://www.jano.es/jano/humanidades/medicas/humanidades/medicas/carlos/pose/como/decidire/tratamiento/mis/pacientes/_f-303+iditem-4412+idtabla-4+tipo-10
[14]
Conde F, editor. Análisis sociológico del sistema de discursos. Madrid: Centro de Investigaciones Sociológicas; 2010.
[15]
M.M. García, I. Mateo.
El grupo focal como técnica de investi- gación cualitativa en salud: diseño y puesta en práctica.
Aten Primaria., 25 (2000), pp. 115-122
[16]
A. Kennedy, K. LaVail, G. Nowak, M. Basket, S. Landry.
Confidence about vaccines in the United States: Understanding parents’ perceptions.
Health Aff., 30 (2011), pp. 61151-61159
[17]
R.E. Ashcroft.
Individual freedom versus collective responsibility: An ethicist's perspective.
Emerg Themes Epidemiol., 3 (2006), pp. 11
[18]
O. Wichmann.
Further efforts needed to achieve measles elimi- nation in Germany: Results of an outbreak investigation.
Bull World Health Organ., 87 (2009), pp. 108-115
[19]
A. Gagneur, D. Pinquier.
Spotlight on measles 2010: Timely ad- ministration of the first dose of measles vaccine in the context of an ongoing measles outbreak in France.
Euro Surveill., 15 (2010), pp. 19689
[20]
M. Mark.
Who gets measles in Europe?.
J Infect Dis., 204 (2011), pp. 353-365
[21]
Z. Jakab, D.M. Salisbury.
Back to basics: The miracle and tragedy of measles vaccine.
Lancet., 381 (2013), pp. 1433-1434
[22]
G. Kassianos.
Vacunación para mañana: la necesidad de mejorar las tasas de inmunización.
J Salud Fam., 20 (2010), pp. 13-16
[23]
R. Spreafico, P. Ricciardi-Castagnoli, A. Mortellaro.
The controver- sial relationship between NLRP3, alum, danger signals and the next-generation adjuvants.
Eur J Immunol., 40 (2010), pp. 638-642
[24]
J. Lavine, H. Broutin, E.T. Harvill, O.N. Bjørnstad.
Imperfect vac- cine-induced immunity and whooping cough transmission to in- fants.
[25]
Y. Shoenfeld, N. Agmon-Levin.
ASIA: Autoimmune/inflammatory syndrome induced by adjuvants.
J Autoimmun., 36 (2011), pp. 4-8
[26]
L. Tomljenovic, C.A. Shaw.
Aluminum vaccine adjuvants: Are they safe?.
Curr Med Chem., 18 (2011), pp. 2630-2637
[27]
C. Betsch, K. Sachse.
Debunking vaccination myths: Strong risk negations can increase perceived vaccination risks.
Health Psy- chol., 32 (2013), pp. 146-155
[28]
R.M. Jacobson, P.V. Targonski, G.A. Poland.
A taxonomy of reasoning flaws in the anti-vaccine movement.
Vaccine., (2007), pp. 25
[29]
I. Riaño, C. Martínez, M. Sánchez.
Recommendations for making decisions when parents refuse to vaccinate their children: Ethi- cal analysis.
An Pediatr (Barc)., 79 (2013), pp. 51-55
[30]
García-Ruiz Y. ¿Vacunaciones obligatorias de menores contra la voluntad de los padres? Humanitas [online series] 2009 [ac- cessed March 5, 2013]. Available at: http://www.fundacionm-hm.org/www_humanitas_es_numero35/articulo.pdf
[31]
A. Kata.
Anti-vaccine activists, Web 2. 0, and the postmodern paradigm-an overview of tactics and tropes used online by the anti-vaccination movement.
Vaccine., 30 (2012), pp. 3778-3789
[32]
J. Mereckiene, S. Cotter, D. O’Flanagan, P. Valentiner-Branth, M. Mus- cat, F. D’Ancona.
Review of outbreaks and barriers to MMR vaccination coverage among hard-to-reach populations in Eu- rope. Stockholm:.
ECDC, (2013),
[33]
V. Tañón, C. Borrero, Y. Pedrogo.
Knowledge and misconceptions about immunizations among medical students, pediatric, and family medicine resident.
Bol Asoc Med P R., 102 (2010), pp. 5-8

Please cite this article as: Martínez-Diz S, Martínez Romero M, Fernández-Prada M, Cruz Piqueras M, Molina Ruano R, Fernández Sierra MA. Demandas y expectativas de padres y madres que rechazan la vacunación y perspectiva de los profesionales sanitarios sobre la negativa a vacunar. An Pediatr (Barc). 2014;80:370-378.

Copyright © 2013. Asociación Española de Pediatría
Download PDF
Idiomas
Anales de Pediatría (English Edition)
Article options
Tools
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?