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Families of the economic crisis in paediatric primary care clinics: Descriptive observational study
Las familias de la crisis en las consultas pediátricas de Atención Primaria: estudio descriptivo observacional
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Gancedo García, M.C. Teruel de Francisco, A. Coullaut López" "autores" => array:5 [ 0 => array:3 [ "nombre" => "R." "apellidos" => "Martín Martín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "M." "apellidos" => "Sánchez Bayle" "email" => array:1 [ 0 => "msanba@terra.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "C." "apellidos" => "Gancedo García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "M.C." 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"apellidos" => "Coullaut López" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Centro de Salud Reina Victoria, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Fundación para la Investigación, Estudio y Desarrollo de la Salud Pública, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Centro de Salud Infanta Mercedes, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Centro de Salud Cea Bermúdez, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Las familias de la crisis en las consultas pediátricas de Atención Primaria: estudio descriptivo observacional" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The current financial and economic crisis that afflicts Europe, and Spain in particular, officially started in 2008. In January 2009, the Banco Exterior de España announced that Spain had entered a recession<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">1</span></a>; since then, numerous measures have been taken by governments at the national, regional and local levels, most of them austerity-based, containing and cutting costs in social services.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">2</span></a> Many scientific societies and national and international organisations have warned of the deleterious and counterproductive effects that such measures can have on the welfare and health of society at large and especially of vulnerable collectives.<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">3–7</span></a> To date, few studies have provided data on the adverse effects of these measures on child health. Children, along with immigrants and the elderly, are the social collectives most at risk of suffering the negative effects of the crisis.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The relationship between the economic crisis, social inequality and health is complex, and its effects are therefore not clear<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">8</span></a>; furthermore, what truly matters is the impact on health of the public policies that are being implemented, keeping in mind that chains usually break at their weakest links.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of our study was to analyse the impact of the economic crisis on the individuals receiving care at paediatric primary care (PC) clinics, and study how this impact correlates with the socioeconomic status of their households.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">We conducted a descriptive observational study, analysing data obtained by means of a survey. The survey was first validated, assessing its reliability (Cronbach's <span class="elsevierStyleItalic">α</span>, 0.749; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.0001) and construct validity (confirmatory factor analysis and calculation of the item-test correlation coefficient). The survey was administered to a total of 453 children aged 1–7 years that visited the four paediatric clinics of three urban health care centres in Madrid. The total number of children in this age group that were holders of health care cards in the caseloads of these four clinics was 3486, of which a randomly selected sample of the patients that attended a routine or non-routine visit between March and October 2014 was offered to participate; the final sample consisted of all that accepted. Only one patient refused participation in the survey.</p><p id="par0025" class="elsevierStylePara elsevierViewall">We collected the following data: age and sex of the children, age and country of origin of the mother and father, employment status of the parents, and household characteristics. The latter included whether the parents lived together or apart, parental educational attainment, household income level, number of members in the household, perception of having reduced expenditures in food, leisure and vacations or travel, perception of the impact of employment and economic factors in parental health, financial difficulty in acquiring prescribed medications, and doses of rotavirus and pneumococcal vaccines administered to the child and paid by the parents.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Households were classified into three categories by income level: (1) Monthly income less than 1000 euro; (2) monthly income between 1000 and 2000 euro, and (3) monthly income more than 2000 euro. They were also classified into three categories based on educational attainment: parents with no education or that only completed primary education, that completed secondary education, or with higher education degrees.</p><p id="par0035" class="elsevierStylePara elsevierViewall">We performed the survey in four different paediatric clinics so that the three income groups under study would be sufficiently represented.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The statistical analysis of the data was performed by means of the commercial application SPSS<span class="elsevierStyleSup">®</span> 15.0. We expressed the main data as means and standard deviations in the case of quantitative variables and as absolute frequencies and percentages in the case of qualitative variables. We calculated the 95% confidence intervals (CIs).</p><p id="par0045" class="elsevierStylePara elsevierViewall">We used the Mann–Whitney <span class="elsevierStyleItalic">U</span> test to compare quantitative variables after finding that they did not fit a normal distribution (Kolmogorov–Smirnov test). The chi squared test was used to compare qualitative variables. Statistical significance was defined as <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.05.</p><p id="par0050" class="elsevierStylePara elsevierViewall">We performed a multivariate logistic regression analysis starting with the maximum border and removing variables one at a time until only those that were statistically significant remained.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">We collected data for 453 children, of whom 217 (47.90%) were male and the rest female, with a mean age of 3.60 years (range, 1–7 years; SD, 1.93). The mean maternal age was 36.36 years (SD, 5.73) and the mean paternal age 39.61 years (SD, 6.62). The mean number of household members was 4.67 (range, 2–7; SD, 0.89).</p><p id="par0060" class="elsevierStylePara elsevierViewall">In 176 families (32.41%) one of the parents was an immigrant. Thirty-eight households (8.38%) were of single parents, with the mother as the head in all cases.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Both parents were unemployed in 21 households (4.63%).</p><p id="par0070" class="elsevierStylePara elsevierViewall">Regarding income, we found 127 households (28.03%) in the low-income bracket, 144 households (31.78%) in the medium-income bracket, and 182 households (40.17%) in the high-income bracket.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The high-income households were concentrated in one of the three health care centres where we conducted the study, the low-income households in another centre, and the middle-income households in the last of the three centres.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Purchasing prescribed medication was financially difficult for the families of 93 children (20.52%; 95% CI, 16.98–24.40).</p><p id="par0085" class="elsevierStylePara elsevierViewall">With regard to parental educational attainment, 120 of those surveyed (26.59%) had completed basic studies, 159 (35.09%) secondary education, and 174 (38.41%) higher education degrees.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Of all households, 177 reported having reduced expenditures in food (39.07%; 95% CI, 34.68–43.64), 288 in leisure (63.57%; 95% CI, 59.04–67.87) and 289 in vacations and travel (63.79%; 95% CI, 59.26–68.08).</p><p id="par0095" class="elsevierStylePara elsevierViewall">Parents reported having developed health problems due to their employment and economic circumstances in 173 cases (38.18%; 95% CI, 33.83–42.74).</p><p id="par0100" class="elsevierStylePara elsevierViewall">When it came to vaccines that are not publicly funded, 165 children (36.42%; 95% CI, 32.12–40.95) were vaccinated against rotavirus, while 37 of the 71 children born after the funding for the pneumococcal vaccine had been discontinued had been vaccinated against pneumococcus (52.11%; 95% CI, 40.65–63.35).</p><p id="par0105" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> presents the epidemiological characteristics of the sample.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> presents the percentages of households in each of the three income groups under study that had reduced expenditures in food, leisure and vacations in the past year, showing that while reductions occurred in every group, the low-income group had been most affected. <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> also presents the data pertaining to the difficulty paying for medication, which was inversely correlated with income level.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">The same was true of the percentage of individuals that reported health problems in the household since the start of the crisis: 70.07% (95%CI, 61.59–77.35) in the low-income group; 38.88% (95%CI, 31.30–47.05) in the middle-income group; and 15.38% (95%CI, 10.87–21.34) in the high-income group.</p><p id="par0120" class="elsevierStylePara elsevierViewall">The presence of health problems since the start of the crisis was less frequent in individuals in the middle-income (1000–2000 euro; OR, 0.27; 95% CI, 0.45–0.16) and high-income brackets (>2000 euro; OR, 0.07; 95% CI, 0.13–0.04).</p><p id="par0125" class="elsevierStylePara elsevierViewall">Likewise, individuals with a middle educational attainment (OR, 0.27; 95% CI, 0.14–0.52) and high educational attainment (OR, 0.033; 95% CI, 0.014–0.07) experienced less difficulty affording medications not funded by the public health care system.</p><p id="par0130" class="elsevierStylePara elsevierViewall">The purchase of the rotavirus vaccine is directly correlated to middle and high income levels (OR, 1.13 and 3.84; 95% CI, 2–0.64 and 6.25–2.32, respectively) as well as middle and high educational attainment (OR, 1.92 and 9.97; 95% CI, 0.71–5.18 and 4.14–23.9, respectively).</p><p id="par0135" class="elsevierStylePara elsevierViewall">We performed a multivariate analysis (binary logistic regression, see <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>) of the variables that influenced non-purchase of prescribed medications (lower income and educational attainment), a reduction in food expenditures (lower income and number of members in the household), vaccination against rotavirus (higher income and educational attainment and non-immigrant status) and the presence of health problems in the family since the beginning of the crisis (unemployed status, lower educational attainment and lower income). In every instance, models were considered statistically significant if <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.0001. We validated the logistic regression models by means of the Hosmer–Lemeshow test and ROC curves.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0140" class="elsevierStylePara elsevierViewall">Primary care is the foundation of the national health care system of Spain, and thus far it has been considered a model to follow due to its excellent outcomes.<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">9,10</span></a> The policies undertaken to manage economic crises have an impact on the health of ordinary people.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">11</span></a> Countries such as Spain, Portugal and Greece have taken approaches based on budget cuts that have a negative impact on their health care systems and consequently on the well-being and quality of life of families.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">12</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Primary care paediatric clinics provide a privileged vantage point to assess how individuals and families face the current crisis in Spain.<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">13,14</span></a> As paediatricians caring for children and their families in PC clinics, we have the responsibility and the duty to promote social awareness of the rights of children and adolescents, so that they are acknowledged and protected.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">15</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Certain collectives, such as children and immigrants, are particularly vulnerable during a crisis. Birth rates among immigrant populations are considerably higher than those in the native Spanish population, so this collective is well represented in our study, amounting to 32.41% of survey participants.</p><p id="par0155" class="elsevierStylePara elsevierViewall">Children suffer the consequences of the economic crisis at home when their parents’ employment is affected: precarious employment, uncertainty and unemployment affect the physical and mental health of parents, leading to an increase in psychosocial disorders.<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">16</span></a> The impoverishment of families due to precarious employment leads to difficulty affording a healthy diet or prescribed medications, especially if the latter are not funded by the public health care system, consistent with the findings of our study. There are still few studies on the impact of the economic crisis on individual health, and most of them have addressed the impact on mental health.<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">17–19</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">The results of our study reflect the high unemployment rate in the population under study, which in many families affects both parents, with parents reporting health problems derived from their employment status and thus their economic situation. Broadly speaking, the immigrant population has a lower educational attainment, more members per household and higher rates of unemployment, and this economic precariousness entails difficulty affording prescribed medications and vaccinating children with vaccines that are not publicly funded, as well as reducing the budget for food.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">19</span></a> Most of the surveyed parents, including immigrants and native Spaniards, reported a reduction in their expenditures in leisure and travel.</p><p id="par0165" class="elsevierStylePara elsevierViewall">At present and despite the crisis, immigrants continue to be a significant proportion of the Spanish population, and in fact the children of immigrants are part of the native Spanish paediatric population.<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">20–24</span></a> The birth rate in the immigrant population far exceeds that of the native Spanish population,<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">25</span></a> so this collective was well represented in our study. The current macroeconomic and job market situation are not the same as in the mid-eighties, when immigrants came attracted by the somewhat fictitious prosperity of Spain. Between 1995 and 2007, immigration was one of the main elements in the economic activity of Spain, whose model of development was based on labour-intensive sectors characterised by low productivity and little added value (construction, hospitality), and with immigrants coming from poor countries with weak health care systems who are most affected by discrimination, poor working conditions and unemployment while enduring xenophobic attitudes that have been exacerbated by the crisis in recent years.<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">26–30</span></a> Nearly all immigrants in our study fit the pattern we have just described.</p><p id="par0170" class="elsevierStylePara elsevierViewall">Along the lines of the reports of specialised foundations and institutions,<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">31</span></a> we can conclude that the loss of income experienced by households is affecting the weakest and most vulnerable members of society, and that Spain is transitioning from a social model of “precarious integration” to a model of social welfare privatization<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">32</span></a> in which the protective role of the state seems to be disappearing.<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">33</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">There are limitations to our study, chief of which is the small sample size.</p><p id="par0180" class="elsevierStylePara elsevierViewall">In the future, it would be advisable to conduct studies with larger samples and to reinforce that economic crises pose new challenges to society and the health authorities, chief among which is prioritising the protection of the health of the general population and of children in particular, as failing to protect children from poverty is one of the costliest mistakes a society can make.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Funding</span><p id="par0185" class="elsevierStylePara elsevierViewall">This study did not receive any type of external funding.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflict of interests</span><p id="par0190" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres623575" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec637204" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres623576" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec637205" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interests" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-01-27" "fechaAceptado" => "2015-06-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec637204" "palabras" => array:3 [ 0 => "Economic crisis" 1 => "Childhood" 2 => "Paediatric primary care" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec637205" "palabras" => array:3 [ 0 => "Crisis económica" 1 => "Infancia" 2 => "Pediatría Atención Primaria" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To study the impact of the economic crisis on the families of the children who attend Primary Health Care and its relationship with their socioeconomic status.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Observational descriptive study was conducted by analysing the results of 453 questionnaires, given to the parents of children between 1 and 7 years old who attended 4 paediatric clinics in Madrid. The raw data was analysed, and comparisons between groups and multivariate analysis were performed.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In the multivariate analysis, the variables related to the non-acquisition of prescribed medication are: lower income level OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.118, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.0001 and lower educational level OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.464, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.001; the variables related to the reduction of food expenditure are: lower income level OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.100, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.0001 and a higher number of family members OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.308, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.045; the variables related to anti-pneumococcal vaccination without public funding are: higher income level OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2.170, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=.0001, higher educational level OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1.835, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.013, and not being an immigrant OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.532, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.037. The presence of health problems from the beginning of the economic crisis is related to unemployment OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4.079, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.032, lower educational level <span class="elsevierStyleItalic">R</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.678, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.042, and income level OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.342, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.0001. In all cases, the models achieved a statistical significance of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.0001.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The economic crisis has greater impact on the group with the lowest income level in all analysed variables. The lower educational level and higher number of family members has an impact on the reduction in food expenditure. The fact of being an immigrant has an impact on not receiving the anti-pneumococcal and rotavirus vaccination. Unemployment leads to an increase in health problems in the family. To sum up, the economic crisis has increased inequalities according to socioeconomic status.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Estudiar el impacto de la crisis económica sobre las familias de los niños que acuden a las consultas de Atención Primaria y su relación con el nivel socioeconómico.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo observacional mediante cuestionario. Se han recogido 453 encuestas de niños entre 1 y 7 años de edad pertenecientes a 4 consultas de Atención Primaria de Madrid. Se analizaron datos crudos, comparaciones entre grupos y análisis multivariante.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En el análisis multivariante, las variables relacionadas con no comprar medicamentos prescritos son: tener menor nivel de ingresos OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,118 p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,0001 y de estudios OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,464, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,001; con la disminución del gasto en alimentación: tener menos ingresos OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,100, p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,0001 y el número de miembros de la familia OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1,308, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,045; con vacunarse frente a rotavirus sin financiación influye el tener mayor nivel de ingresos OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>2,170, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,0001 y de estudios OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1,835, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,013 y no ser inmigrante OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,532, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,037. La presencia de problemas de salud desde la crisis está relacionada con encontrarse en paro OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>4,079, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,032 y tener menor nivel de estudios R<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,678, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,042 y de ingresos OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,342, p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,0001. En todos los casos los modelos presentaron una significación estadística para p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,0001.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La crisis tiene mayor impacto en el grupo con menor nivel de ingresos en todas las variables analizadas. Influye el tener menor nivel de estudios y el número de miembros de la familia en la disminución de gasto en alimentación, el ser inmigrante en la no vacunación por rotavirus y el estar en paro en la presencia de problemas de salud en la familia. En resumen la crisis ha aumentado las desigualdades de acuerdo con el nivel socioeconómico.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martín Martín R, Sánchez Bayle M, Gancedo García C, Teruel de Francisco MC, Coullaut López A. Las familias de la crisis en las consultas pediátricas de Atención Primaria: estudio descriptivo observacional. An Pediatr (Barc). 2016;84:189–194.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">CI, confidence interval; SD, standard deviation.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age of children in years<br>Mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.60<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.93 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age of mothers in years<br>Mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">36.36<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>5.73 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Age of fathers in years<br>Mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">39.61<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.62 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Number of members of the household<br>Mean<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>SD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.67<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.89 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Immigrant families<br><span class="elsevierStyleItalic">N</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">176 (32.41%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Single-parent households<br><span class="elsevierStyleItalic">N</span> (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">38 (8.38%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="middle">Income level<br><span class="elsevierStyleItalic">N</span> (%)</td><td class="td" title="table-entry " align="left" valign="top">Low, 127 (28.03%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Middle, 144 (31.78%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">High, 182 (40.17%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="3" align="left" valign="middle">Educational attainment<br><span class="elsevierStyleItalic">N</span> (%)</td><td class="td" title="table-entry " align="left" valign="top">Low, 120 (26.59%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Middle, 159 (35.09%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">High, 174 (38.41%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Difficulty affording medication<br><span class="elsevierStyleItalic">N</span> (%; 95% CI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">93 (20.52%; CI, 16.19–24.40) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Reduction in food expenditures<br><span class="elsevierStyleItalic">N</span> (%; 95% CI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">177 (39.07%; CI, 34.68–43.64) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Reduction in leisure expenditures<br><span class="elsevierStyleItalic">N</span> (%; 95% CI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">288 (63.57%; CI, 59.04–67.87) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Reduction in travel expenditures<br><span class="elsevierStyleItalic">N</span> (%; 95% CI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">289 (63.79%; CI, 59.26–68.08) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Health problems derived from the household economy<br><span class="elsevierStyleItalic">N</span> (%; 95% CI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">173 (38.18%; CI, 33.83–42.74) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Purchase of rotavirus vaccine<br><span class="elsevierStyleItalic">N</span> (%; 95% CI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">165 (36.42%; CI, 32.12–40.95) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Purchase of pneumococcal vaccine<br><span class="elsevierStyleItalic">N</span> (%; 95% CI) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">37 (52.11%; CI, 40.65–63.35) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1023003.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Epidemiological characteristics of the sample.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <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="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Food \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Leisure \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Vacations \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Difficulty affording medication \t\t\t\t\t\t\n \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>%<br>(95% CI)<br>OR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span><br>%<br>(95% CI)<br>OR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span><br>%<br>(95% CI)<br>OR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span><br>%<br>(95% CI)<br>OR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><1000 euro \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">111<br>87.40%<br>(80.99–92.06) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">118<br>92.91%<br>(87.07–96.19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">119<br>93.70%<br>(88.05–96.73) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">79<br>62.20%<br>(53.51–70.16) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">1000–2000 euro \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">52<br>36.11%<br>(28.71–44.23)<br>0.08 (0.04–0.15) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">94<br>65.27%<br>(57.17–72.56)<br>0.14 (0.06–0.30) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">99<br>68.75%<br>(60.75–75.49)<br>0.14 (0.06–0.32) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12<br>8.33%<br>(4.36–14.01)<br>0.05 (0.11–0.02) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">>2000 euro \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">14<br>7.69%<br>(4.66–12.50)<br>0.01 (0.02–0.005) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">76<br>41.75%<br>(34.83–49.03)<br>0.05 (0.02–0.11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">71<br>39.01%<br>(32.21–46.26)<br>0.04 (0.019–0.09)<br> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2<br>1.09%<br>(0.33–3.89)<br>0.006 (0.028–0.001) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">p</span><br>Chi square \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><.0001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><.0001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><.0001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1023001.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Families that reduced their expenditures in the past year and had difficulty buying medicines by income level.</p>" ] ] 2 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">AUC, area under the curve; Food, decrease in food expenditures; Medication, difficulty affording medication; NI, variable not included in the final model; Rotavirus, vaccination against rotavirus.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <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="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Medication<br>OR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Food<br>OR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Rotavirus*<br>OR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Health problems in parents<br>OR (95% CI) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Income \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.118 (0.064–0.218)<br><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.0001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.100 (0.067–0.149)<br><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.0001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.170 (1.404–3.353)<br><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.0001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.342 (0.235–0.500)<br><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Educational attainment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.464 (0.291–0.741)<br><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.835 (1.137–2.963)<br><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.678 (0.467–0.936)<br><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.042 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Number of household members \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.308 (1.01–1.754)<br><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.045 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NI \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Immigrants \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.532 (0.295–0.961)<br><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.037 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NI \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Unemployed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NI \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4.079 (1.129–14.735)<br><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.032 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">R2/AUC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.528/0.878 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.530/0.691 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.277/0.751 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.328/0.689 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><.0001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><.0001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">=.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1023002.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Results of logistic regression analysis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:33 [ 0 => array:3 [ "identificador" => "bib0170" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Crisis económica y salud" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C.D. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 9 | 14 |
| 2024 October | 29 | 24 | 53 |
| 2024 September | 37 | 24 | 61 |
| 2024 August | 56 | 51 | 107 |
| 2024 July | 72 | 29 | 101 |
| 2024 June | 42 | 21 | 63 |
| 2024 May | 37 | 31 | 68 |
| 2024 April | 38 | 44 | 82 |
| 2024 March | 36 | 22 | 58 |
| 2024 February | 34 | 22 | 56 |
| 2024 January | 25 | 21 | 46 |
| 2023 December | 33 | 25 | 58 |
| 2023 November | 36 | 24 | 60 |
| 2023 October | 31 | 21 | 52 |
| 2023 September | 28 | 22 | 50 |
| 2023 August | 27 | 15 | 42 |
| 2023 July | 30 | 24 | 54 |
| 2023 June | 19 | 22 | 41 |
| 2023 May | 43 | 18 | 61 |
| 2023 April | 20 | 17 | 37 |
| 2023 March | 46 | 21 | 67 |
| 2023 February | 39 | 10 | 49 |
| 2023 January | 18 | 16 | 34 |
| 2022 December | 71 | 28 | 99 |
| 2022 November | 57 | 56 | 113 |
| 2022 October | 59 | 58 | 117 |
| 2022 September | 34 | 35 | 69 |
| 2022 August | 34 | 38 | 72 |
| 2022 July | 23 | 43 | 66 |
| 2022 June | 31 | 26 | 57 |
| 2022 May | 27 | 31 | 58 |
| 2022 April | 25 | 50 | 75 |
| 2022 March | 36 | 49 | 85 |
| 2022 February | 26 | 34 | 60 |
| 2022 January | 43 | 36 | 79 |
| 2021 December | 32 | 42 | 74 |
| 2021 November | 32 | 45 | 77 |
| 2021 October | 40 | 54 | 94 |
| 2021 September | 23 | 45 | 68 |
| 2021 August | 23 | 41 | 64 |
| 2021 July | 22 | 23 | 45 |
| 2021 June | 31 | 26 | 57 |
| 2021 May | 85 | 24 | 109 |
| 2021 April | 49 | 48 | 97 |
| 2021 March | 33 | 27 | 60 |
| 2021 February | 24 | 17 | 41 |
| 2021 January | 30 | 17 | 47 |
| 2020 December | 35 | 30 | 65 |
| 2020 November | 19 | 18 | 37 |
| 2020 October | 19 | 18 | 37 |
| 2020 September | 74 | 22 | 96 |
| 2020 August | 11 | 24 | 35 |
| 2020 July | 27 | 26 | 53 |
| 2020 June | 8 | 24 | 32 |
| 2020 May | 22 | 18 | 40 |
| 2020 April | 23 | 18 | 41 |
| 2020 March | 31 | 13 | 44 |
| 2020 February | 60 | 22 | 82 |
| 2020 January | 49 | 12 | 61 |
| 2019 December | 36 | 12 | 48 |
| 2019 November | 21 | 14 | 35 |
| 2019 October | 16 | 17 | 33 |
| 2019 September | 24 | 8 | 32 |
| 2019 August | 22 | 17 | 39 |
| 2019 July | 23 | 31 | 54 |
| 2019 June | 32 | 18 | 50 |
| 2019 May | 41 | 15 | 56 |
| 2019 April | 32 | 11 | 43 |
| 2019 March | 23 | 12 | 35 |
| 2019 February | 30 | 13 | 43 |
| 2019 January | 21 | 24 | 45 |
| 2018 December | 25 | 23 | 48 |
| 2018 November | 84 | 14 | 98 |
| 2018 October | 174 | 61 | 235 |
| 2018 September | 57 | 14 | 71 |
| 2018 July | 1 | 0 | 1 |
| 2018 June | 4 | 0 | 4 |
| 2018 May | 17 | 0 | 17 |
| 2018 April | 31 | 0 | 31 |
| 2018 March | 117 | 0 | 117 |
| 2018 February | 9 | 0 | 9 |
| 2018 January | 8 | 0 | 8 |
| 2017 December | 9 | 0 | 9 |
| 2017 November | 6 | 0 | 6 |
| 2017 October | 11 | 0 | 11 |
| 2017 September | 8 | 0 | 8 |
| 2017 August | 8 | 0 | 8 |
| 2017 July | 8 | 0 | 8 |
| 2017 June | 22 | 6 | 28 |
| 2017 May | 20 | 5 | 25 |
| 2017 April | 8 | 6 | 14 |
| 2017 March | 6 | 1 | 7 |
| 2017 February | 9 | 4 | 13 |
| 2017 January | 3 | 4 | 7 |
| 2016 December | 26 | 18 | 44 |
| 2016 November | 24 | 8 | 32 |
| 2016 October | 20 | 8 | 28 |
| 2016 September | 25 | 3 | 28 |
| 2016 August | 16 | 4 | 20 |
| 2016 July | 19 | 10 | 29 |
| 2016 June | 1 | 0 | 1 |
| 2016 April | 3 | 0 | 3 |
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