array:24 [
  "pii" => "S2254887418300730"
  "issn" => "22548874"
  "doi" => "10.1016/j.rceng.2018.03.011"
  "estado" => "S300"
  "fechaPublicacion" => "2018-11-01"
  "aid" => "1505"
  "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)"
  "copyrightAnyo" => "2018"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "ssu"
  "cita" => "Rev Clin Esp. 2018;218:426-34"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 1
    "PDF" => 1
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0014256518301115"
      "issn" => "00142565"
      "doi" => "10.1016/j.rce.2018.03.017"
      "estado" => "S300"
      "fechaPublicacion" => "2018-11-01"
      "aid" => "1505"
      "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "ssu"
      "cita" => "Rev Clin Esp. 2018;218:426-34"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 174
        "formatos" => array:2 [
          "HTML" => 119
          "PDF" => 55
        ]
      ]
      "es" => array:12 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Revisi&#243;n</span>"
        "titulo" => "El viajero mayor"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "426"
            "paginaFinal" => "434"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "The elderly traveller"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "V&#46; Ramos-Sesma, M&#46; G&#243;rgolas-Hern&#225;ndez Mora, J&#46;M&#46; Ramos-Rinc&#243;n"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "V&#46;"
                "apellidos" => "Ramos-Sesma"
              ]
              1 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "G&#243;rgolas-Hern&#225;ndez Mora"
              ]
              2 => array:2 [
                "nombre" => "J&#46;M&#46;"
                "apellidos" => "Ramos-Rinc&#243;n"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2254887418300730"
          "doi" => "10.1016/j.rceng.2018.03.011"
          "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/S2254887418300730?idApp=WRCEE"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256518301115?idApp=WRCEE"
      "url" => "/00142565/0000021800000008/v1_201810300611/S0014256518301115/v1_201810300611/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2254887418301267"
    "issn" => "22548874"
    "doi" => "10.1016/j.rceng.2018.05.007"
    "estado" => "S300"
    "fechaPublicacion" => "2018-11-01"
    "aid" => "1525"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "ssu"
    "cita" => "Rev Clin Esp. 2018;218:435-44"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 1
      "PDF" => 1
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Review</span>"
      "titulo" => "Pain assessment in individuals with dementia and communication problems in Spain&#46; A systematic review"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "435"
          "paginaFinal" => "444"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Valoraci&#243;n del dolor en personas con demencia y problemas de comunicaci&#243;n en Espa&#241;a&#46; Revisi&#243;n sistem&#225;tica"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 2685
              "Ancho" => 2492
              "Tamanyo" => 301388
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flow diagram following the PRISM recommendations&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46;&#193;&#46; de Juan Pardo, M&#46; Saracibar-Razquin, I&#46; Crespo, P&#46; Fuster Linares"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "M&#46;&#193;&#46;"
              "apellidos" => "de Juan Pardo"
            ]
            1 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Saracibar-Razquin"
            ]
            2 => array:2 [
              "nombre" => "I&#46;"
              "apellidos" => "Crespo"
            ]
            3 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Fuster Linares"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0014256518301553"
        "doi" => "10.1016/j.rce.2018.05.002"
        "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/S0014256518301553?idApp=WRCEE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887418301267?idApp=WRCEE"
    "url" => "/22548874/0000021800000008/v1_201810300615/S2254887418301267/v1_201810300615/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2254887418301206"
    "issn" => "22548874"
    "doi" => "10.1016/j.rceng.2018.05.003"
    "estado" => "S300"
    "fechaPublicacion" => "2018-11-01"
    "aid" => "1537"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "edi"
    "cita" => "Rev Clin Esp. 2018;218:424-5"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 1
      "PDF" => 1
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
      "titulo" => "Thromboembolic disease in orthopedic surgery and non-surgical trauma"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "424"
          "paginaFinal" => "425"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Enfermedad tromboemb&#243;lica en cirug&#237;a ortop&#233;dica y traumatismos no quir&#250;rgicos"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46; Ena"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Ena"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0014256518301693"
        "doi" => "10.1016/j.rce.2018.05.009"
        "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/S0014256518301693?idApp=WRCEE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887418301206?idApp=WRCEE"
    "url" => "/22548874/0000021800000008/v1_201810300615/S2254887418301206/v1_201810300615/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Review</span>"
    "titulo" => "The elderly traveler"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "426"
        "paginaFinal" => "434"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "V&#46; Ramos-Sesma, M&#46; G&#243;rgolas-Hern&#225;ndez Mora, J&#46;M&#46; Ramos-Rinc&#243;n"
        "autores" => array:3 [
          0 => array:3 [
            "nombre" => "V&#46;"
            "apellidos" => "Ramos-Sesma"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "G&#243;rgolas-Hern&#225;ndez Mora"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:4 [
            "nombre" => "J&#46;M&#46;"
            "apellidos" => "Ramos-Rinc&#243;n"
            "email" => array:1 [
              0 => "jramosrincon&#64;yahoo&#46;es"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital Marina Alta&#44; Denia&#44; Alicante&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Divisi&#243;n de Enfermedades Infecciosas&#44; Hospital Universitario Fundaci&#243;n Jim&#233;nez D&#237;az&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital General Universitario de Alicante&#59; Departamento de Medicina Cl&#237;nica&#44; Universidad Miguel Hern&#225;ndez de Elche&#59; ISABIAL &#8211; FISABIO&#44; Alicante&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "El viajero mayor"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Despite the economic crisis in recent years&#44; the number of trips has not fallen&#46; According to the United Nations World Tourism Organization &#40;UNWTO&#41;&#44; 1235 million trips were recorded in 2016&#46; It is estimated that this figure will increase in the coming years&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">1&#44;2</span></a> The improved quality of life&#44; the greater control of chronic disease and financial stability after retirement have resulted in an increase in the number of trips among the elderly population&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;4</span></a> Generally&#44; the elderly population who travel have been traveling since their youth&#44; and age is not a restriction for traveling&#46; We should therefore distinguish between cognitive and chronological age&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">4</span></a> The age at which we considered a population &#8220;elderly&#8221; is not well-defined&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">5</span></a> For the purposes of this review&#44; we will set the threshold at 65 years&#46; Elderly travelers currently have greater ease of traveling&#44; a certain financial solvency and free time offered by retirement&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;6&#44;7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In terms of health during travel&#44; we need to differentiate between problems resulting from chronic disease &#40;such as diabetes mellitus and cardiopulmonary disease&#41; and the limitations resulting from age &#40;such as memory loss&#44; loss of understanding&#44; hearing loss and vision loss&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;5</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Pathophysiology of the elderly</span><p id="par0015" class="elsevierStylePara elsevierViewall">Time changes many biologic processes&#46; Aging is not a homogeneous process and depends on genetic and lifestyle factors and environmental exposures&#46; Aging is characterized by progressive changes that are associated with increased susceptibility to numerous diseases&#46; Age-related hearing loss and vision loss can create problems for elderly travelers&#44; preventing them from seeing signs and posters and hearing airport warnings and explanations in crowded locations&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">5&#44;6&#44;8&#44;9</span></a> This loss of ability to adapt to new situations can lead to a confusional state or anxiety in the traveler&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">6&#44;10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">From the respiratory standpoint&#44; the total lung capacity is reduced due to the decrease in the number of alveoli that enable gas exchange&#46; This reduction also increases the respiratory effort by decreasing lung distensibility&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;4</span></a> The adaptation capacity is therefore lower in conditions of hypoxia&#44; such as at high altitude or after cabin depressurization in airplanes&#46; Elderly travelers are therefore more susceptible to cardiopulmonary diseases such as respiratory failure and pulmonary edema and to exacerbations of these diseases&#46; If appropriate measures are taken&#44; however&#44; even individuals with some type of cardiopulmonary disease barely develop symptoms&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;4&#44;6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Acclimatization to extreme temperatures triggers problems that can be avoided with common sense &#40;e&#46;g&#46;&#44; drinking water abundantly&#44; avoiding the hottest time of the day and staying in rooms with air conditioning&#41;&#46; Age reduces renal filtration capacity and produces a loss of homeostasis by reducing the feeling of thirst and the peripheral vascularization&#39;s ability to adapt&#46; These travelers are more susceptible to dehydration and acute renal failure&#44; especially if aggravated with diarrhea&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;4&#44;6&#8211;9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Immunosenescence is a common pathophysiological change in elderly individuals&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">11</span></a> The aging of the immune system promotes the loss of mature T-cells and antibodies that protect against diseases the patients had experienced or for which they were vaccinated&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">11</span></a> Moreover&#44; this deregulated immunity can cause administered vaccines to lose their effectiveness &#40;i&#46;e&#46;&#44; not generate the same quantity of protective antibodies<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;9&#44;11</span></a>&#41;&#46; The efficacy of vaccines in young adults is 70&#8211;90&#37;&#44; while the efficacy in the elderly is 17&#8211;35&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">12&#44;13</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The yellow fever vaccine is formed by attenuated living viruses&#44; and although it is considered a safe vaccine&#44; caution and even contraindication is advised for immunosuppressed individuals&#46; The vaccine is not contraindicated for individuals older than 65 years&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">8</span></a> but a delay in the immune response and greater viremia have been observed in these patients&#44;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;4&#44;14&#44;15</span></a> and the vaccine should therefore be indicated individually in each case&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Precautions before starting the trip</span><p id="par0040" class="elsevierStylePara elsevierViewall">Elderly travelers should plan their trip well in advance&#46; They should not only consider the places they wish to visit&#44; the hotels to reserve and the monuments they want to enter but also visit a general practitioner for a physical check-up&#46; The elderly traveler can thereby bring with them on the trip a medical report that summarizes their history and medication&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">4&#44;16&#44;17</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Elderly travelers with heart disease should bring a copy of the electrocardiogram&#46; If they have an implanted pacemaker or defibrillator&#44; they should attach a report that explains the type of device&#46; The traveler should have sufficient medication for the entire trip and extra in case the trip is unexpectedly extended&#46; Doctors should advise these travelers about prophylactic medication and assess the potential interactions&#46; Some of the basic issues to consider are information on the health education standards for the prevention of insect bites and how to procure travel insurance&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;4&#44;9&#44;17</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Recommended vaccines by geographical area</span><p id="par0050" class="elsevierStylePara elsevierViewall">The traveler&#39;s consultation can be an important opportunity to update their vaccine calendar&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">9</span></a> The following vaccines are recommended for those older than 65 years&#58; seasonal influenza vaccine&#44; if planning to travel to a country in winter&#59; the pneumococcal vaccine&#59; a dose of the diphtheria&#47;tetanus toxoid vaccine if they have not received it at 60 years&#59; and&#44; eventually&#44; the herpes zoster vaccine&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">8</span></a> Generally&#44; vaccines in those older than 65 years have lower antibody seroconversion rates and are therefore less immunogenic&#44; compared with the response of younger individuals&#46; The elderly also have more adverse effects&#46; Nevertheless&#44; there are no studies sufficiently focused on elderly populations that examine the effectiveness of the vaccines&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">18</span></a><a class="elsevierStyleCrossRef" href="#tbl0010">Table 1</a> summarizes the recommended vaccines depending on the trip&#39;s destination&#46; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 2</a> shows the considerations for the vaccines in elderly travelers&#46; It is advisable to administer vaccines more than 15 days prior to the trip&#44; avoiding the simultaneous administration of attenuated vaccines&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">3</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Traveling with medication</span><p id="par0055" class="elsevierStylePara elsevierViewall">Studies<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;19</span></a> have indicated that the long-term use of medication influences the trip duration but only among younger populations&#46; These differences are not observed in older travelers&#46; However&#44; in the population older than 60 years&#44; it is estimated that 11&#8211;59&#37; of travelers who visit the doctor before a trip take at least one type of long-term medication&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">20</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">As a rule&#44; individuals should travel with the original packaging of the medication and an updated medical report as mentioned above&#46; It is advisable to translate the report into the destination country&#39;s language&#46; It is advisable to carry sufficient medication for the entire trip and carry it in the hand luggage&#44; to prevent its loss if the checked baggage is lost&#46; Travelers should not rely on finding the same active ingredient at the destination&#44; especially if traveling to developing countries or remote areas&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;9&#44;17&#44;20</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Some drugs can create problems&#44; such as those that can be confused with illegal drugs and those with some type of special control&#44; e&#46;g&#46;&#44; anxiolytics&#44; antiepileptics and opioid analgesics&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;9&#44;20&#44;21</span></a> The International Narcotics Control Board provides a guide on their website about the regulation of drugs and countries in which carrying narcotics could present a problem&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">22</span></a> The Spanish Air Navigation Agency &#40;AENA&#41;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">23</span></a> provides information on the current regulations for any airport in the European Union and allows passengers to travel with medication provided they are accompanied by its medical prescription&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Medication should not be shipped by mail and should not be bought at the destination because&#44; in certain countries&#44; the medication does not have the same safety controls&#44; and fake drugs or drugs with nonequivalent doses are sold instead&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;4&#44;9</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Drug interactions among long-term drugs</span><p id="par0075" class="elsevierStylePara elsevierViewall">Up to 45&#37; of travelers who take some type of long-term medication can experience some interaction with traveler&#39;s diarrhea medication&#44; malaria prophylaxis or altitude sickness drugs&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">19&#44;20</span></a> The interactions can vary the drug concentrations&#44; producing hyperglycemia&#44; seizures&#44; QT prolongation or arrhythmias&#46; The interactions with dicoumarin agents are important&#44; and their levels depend not only on the drug but also on the ingested food&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">As a rule&#44; malaria prophylaxis is always indicated for elderly individuals traveling to at-risk areas&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;9&#44;16</span></a> The dose does not need to be adjusted for age and should only be adjusted if there is some comorbidity or insufficiency&#46; <a class="elsevierStyleCrossRef" href="#tbl0020">Table 3</a> summarizes the potential interactions between the drugs that are used in antimalarial prophylaxis and drugs most commonly used by the elderly&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Time zone and jet lag</span><p id="par0085" class="elsevierStylePara elsevierViewall">Jet lag not only causes abnormal sleep cycles but can also create confusion on when to take medication&#46; The time change can lead to skipping or duplicating doses&#46; Based on the concept of drug forgiveness whereby missing a dose does not mean achieving infratherapeutic levels of the drug in blood&#44; travelers have the option of skipping a dose and adapting the dosing to the new time zone&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">20&#44;21</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Elderly travelers and flights</span><p id="par0090" class="elsevierStylePara elsevierViewall">The elderly are more likely to have restricted physical mobility or diseases that limit movements&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">23</span></a> Certain airlines have developed recommendations and advice aimed at helping elderly travelers&#44; allowing them to reserve a seat and board before other travelers&#44; offering comprehensive assistance to the elderly at airports&#44; offering special menus aboard the flight&#44; providing a &#8220;doctor on board&#8221; program with supplemental oxygen and responding to health-related questions regarding travel&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">24&#44;25</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Travel insurance for elderly travelers</span><p id="par0095" class="elsevierStylePara elsevierViewall">It has been estimated that 30&#8211;50&#37; of travelers incur some injury or need to consult with a doctor during the trip&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">24</span></a> Due to the high cost of healthcare coverage abroad&#44; it is advisable to request insurance with good coverage before any trip&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;8&#44;17</span></a> Procuring good insurance with broad coverage is not usually excessively expensive&#44; compared with the overall price of the trip&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">5&#44;26</span></a><a class="elsevierStyleCrossRef" href="#tbl0025">Table 4</a> summarizes the basic coverage provided by an insurance plan&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Other risks and recommendations</span><p id="par0100" class="elsevierStylePara elsevierViewall">Criminals often see elderly individuals as more vulnerable&#46; They usually assume that the elderly wear more objects of value&#44; carry money and have reduced reaction capacity&#46; In tourism zones&#44; people need to be more alert&#46; Elderly individuals should therefore avoid placing themselves at risk and generally be more prudent&#46; Having an unlocked mobile phone and always having it at hand is a good safety measure in case of something unexpected&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">27</span></a> Physical&#44; hearing and visual limitations should also be considered&#44; arriving on time at locations and avoiding long lines and the hottest part of the day&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Elderly travelers with chronic disease</span><p id="par0105" class="elsevierStylePara elsevierViewall">Travelers with pre-existing diseases should be warned that they can only travel when their diseases are stable&#46; Travelers should wait 2&#8211;3 weeks before starting a trip in case of a recent infarction&#46; Cabin depressurization and changes in the pressure partial of oxygen can trigger respiratory disease decompensations&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;17</span></a> Individuals who take diuretic drugs should be advised to reduce their dosage during the flight and to perform the necessary exercises to prevent deep vein thrombosis if taking a trip longer than 5<span class="elsevierStyleHsp" style=""></span>h&#46; <a class="elsevierStyleCrossRef" href="#tbl0030">Table 5</a> lists the needs and characteristics of chronic diseases in elderly travelers and their recommendations&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;16&#44;17&#44;27</span></a></p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">In general&#44; elderly travelers with stable immunosuppression can travel&#59; however&#44; these travelers should receive individual counseling and obtain travel insurance with good health coverage&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">27</span></a> Examples of immunosuppression include the long-term administration of steroids&#44; human immunodeficiency virus infection with CD4 values greater than 350<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">3</span> and having undergone cancer treatment more than 12 weeks ago&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Elderly travelers who have recently undergone surgery</span><p id="par0115" class="elsevierStylePara elsevierViewall">It is generally advisable to avoid travel up to 2 weeks following any type of operation&#44; due to the potential complications of the surgery&#46; Similarly&#44; patients who have undergone spinal anesthesia should wait at least 10 days before traveling&#44; due to the possibility of severe headaches&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">27</span></a></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Getting sick during the trip&#46; Differences between elderly and young travelers</span><p id="par0120" class="elsevierStylePara elsevierViewall">There are few studies that have compared the various comorbidities among travelers according to age&#46; The clinical cohort of GeoSentinel travelers&#44; with a broad worldwide distribution&#44; included 2992 travelers from 1999 to 2009 and analyzed the various ways travelers get sick&#44; classifying them by age group&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">28</span></a> The diseases that most often affect older travelers are respiratory tract and genitourinary infections&#44; high-altitude pulmonary edema&#44; pulmonary thromboembolism&#44; heart disease&#44; severe malaria&#44; gastritis and peptic ulcers&#46; Older travelers are also more susceptible to insect bites and accidents and have higher mortality&#46; In contrast&#44; younger travelers were more likely to experience acute diarrhea&#44; upper respiratory tract infections&#44; influenza&#44; nonsevere malaria&#44; dengue&#44; genital infections&#44; sexually transmitted diseases and schistosomiasis&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">28</span></a></p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Elderly travelers upon return</span><p id="par0125" class="elsevierStylePara elsevierViewall">Health problems when returning from trips should be dealt with in the same manner as with younger travelers&#46; The case history should include the destination visit&#44; the activities conducted and the degree of previous immunization&#46; Travelers with pre-existing diseases are more susceptible to developing trip-related diseases&#44; which deteriorates their physical condition and decompensates the pre-existing disease&#46; When a patient has returned from a trip&#44; it is important to conduct an overall approach of the disease<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;16&#44;17&#44;27</span></a> and not just focus on the syndrome acquired during the vacation&#46; For example&#44; comorbidity can include fever due to malaria in a patient with underlying heart disease such as chronic heart failure and chronic obstructive pulmonary disease&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">16</span></a> All medical problems during and after a trip can trigger an acute confusional syndrome in elderly travelers&#44; which will interfere with the correct management of the underlying disease&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Final considerations and conclusions</span><p id="par0130" class="elsevierStylePara elsevierViewall">Elderly travelers require special care&#46; <a class="elsevierStyleCrossRef" href="#tbl0025">Table 4</a> summarizes the main advice for elderly travelers&#44;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;16&#44;17&#44;27</span></a> and there are various websites that offer additional information on the recommendations for this type of traveler&#46; Most are in English&#59; however&#44; very few of them focus exclusively on elderly travelers &#40;<a class="elsevierStyleCrossRef" href="#sec0085">Appendix A</a>&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Age is not a restriction or impediment for traveling&#46; Prevention&#44; planning and common sense are the basis of a good trip&#46; However&#44; elderly travelers should follow a number of recommendations before the trip&#44; take special precautions during the trip and receive proper care upon their return&#46; A proper understanding of the problems that might arise during the trip will enable better care for these adventurous patients&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:21 [
        0 => array:3 [
          "identificador" => "xres1100568"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1041563"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1100567"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1041564"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Background"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Pathophysiology of the elderly"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Precautions before starting the trip"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Recommended vaccines by geographical area"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Traveling with medication"
        ]
        9 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Drug interactions among long-term drugs"
        ]
        10 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Time zone and jet lag"
        ]
        11 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Elderly travelers and flights"
        ]
        12 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Travel insurance for elderly travelers"
        ]
        13 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Other risks and recommendations"
        ]
        14 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Elderly travelers with chronic disease"
        ]
        15 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Elderly travelers who have recently undergone surgery"
        ]
        16 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Getting sick during the trip&#46; Differences between elderly and young travelers"
        ]
        17 => array:2 [
          "identificador" => "sec0070"
          "titulo" => "Elderly travelers upon return"
        ]
        18 => array:2 [
          "identificador" => "sec0075"
          "titulo" => "Final considerations and conclusions"
        ]
        19 => array:2 [
          "identificador" => "sec0080"
          "titulo" => "Conflict of interest"
        ]
        20 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2018-01-07"
    "fechaAceptado" => "2018-03-20"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1041563"
          "palabras" => array:4 [
            0 => "Travelers"
            1 => "Elderly"
            2 => "Immunosenescence"
            3 => "Chronic diseases"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1041564"
          "palabras" => array:4 [
            0 => "Viajero"
            1 => "Anciano"
            2 => "Inmunosenescencia"
            3 => "Enfermedades cr&#243;nicas"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Improved living conditions and advances in medicine have extended life expectancy and quality of life&#44; resulting in an increasing number of elderly travelers&#46; Pathophysiological changes and treatments can reduce the efficacy of vaccines and facilitate drug interactions&#46; Elderly travelers have various characteristics that should be considered when offering pre-trip counseling&#44; which should include proper management of chronic diseases that are susceptible to worsening during the trip&#44; as well as an appropriate study and follow-up after the trip&#46; We performed a narrative review of the main problems of elderly travelers&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La mejora de las condiciones de vida y los avances de la medicina han prolongado la esperanza y la calidad de vida&#44; de tal forma que cada vez es mayor el n&#250;mero de viajeros de avanzada edad&#46; Los cambios fisiopatol&#243;gicos o los tratamientos pueden reducir la eficacia de las vacunas o facilitar interacciones medicamentosas&#46; El viajero mayor presenta una serie de particularidades que se deben tener en cuenta a la hora de ofrecer un buen consejo pre-viaje&#46; Esto debe incluir un correcto manejo de sus enfermedades cr&#243;nicas susceptibles de agravarse durante el viaje&#44; as&#237; como un adecuado estudio y seguimiento despu&#233;s del mismo&#46; Se ha realizado una revisi&#243;n narrativa de los principales problemas del viajero mayor&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; Ramos-Sesma V&#44; G&#243;rgolas-Hern&#225;ndez Mora M&#44; Ramos-Rinc&#243;n JM&#46; El viajero mayor&#46; Rev Clin Esp&#46; 2018&#59;218&#58;426&#8211;434&#46;</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0145" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Travel websites and blogs that provide tips for elderly travelers"
            "identificador" => "sec0085"
          ]
        ]
      ]
    ]
    "multimedia" => array:6 [
      0 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "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">&nbsp;\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">North Africa&nbsp;\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">Sub-Saharan Africa&nbsp;\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">Southeast Asia&nbsp;\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">India&nbsp;\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">Near East&nbsp;\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">Latin America&nbsp;\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">Oceania&nbsp;\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">Europe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yellow fever<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Panama toward the south&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Typhoid fever&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Meningococcal meningitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">November&#8211;June&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">If epidemic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pilgrimage to Mecca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">If epidemic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cholera&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hepatitis A and B<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Japanese encephalitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rural&#44; long stay&#44; epidemics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Some islands&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tick-borne encephalitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rabies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Long stay&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Long stay&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Long stay&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Long stay&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Polio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Malaria<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&#43;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">August-October&#46; Rural area&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&#43;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&#43;&#43;<br>Rural If long stay&#44; treatment&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Certain islands&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1883038.png"
              ]
            ]
          ]
          "notaPie" => array:3 [
            0 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Not contraindicated for individuals older than 65 years but should be indicated individually in each case&#46; One single dose offers sufficient life-long immunity&#44; memory doses are unnecessary&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">It is recommended that the immune state of the hepatitis B vaccine be assessed&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Not a vaccine but included to illustrate the indication for prophylaxis&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Recommended vaccines depending on the destination and malaria prophylaxis&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "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=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yellow fever&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The immunosenescence of the elderly favors an increase in viral replication&#46; Severe adverse effects therefore occur more frequently&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diphtheria and tetanus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The vaccine dose should be repeated every 10 years&#44; up to 65 years&#46; Has good effectiveness in individuals older than 65 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Influenza&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Seroconversion depends on the type of vaccination&#44; varying between 17&#37; and 58&#37;&#46; Advantages&#58; decreases the number of hospitalizations by 10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pneumococcus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The sequential use of the pneumococcal vaccine is recommended&#44; starting with the 13-valent pneumococcal conjugate vaccine&#44; followed by the 23-valent pneumococcal polysaccharide vaccine&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hepatitis A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The approximate seroconversion rate of 60&#37; in individuals older than 50 years&#44; compared with 90&#8211;100&#37; in younger individuals after the first dose&#46; The rate increases to 97&#37; after the second dose&#46; At least 2 doses are recommended for elderly travelers&#46; The vaccine should be administered to elderly individuals up to 4 weeks before traveling&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hepatitis B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The seroconversion rates are lower for individuals older than 65 years&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rabies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Has an adequate response after completing the full immunization&#44; but the antibody levels reached are lower than those in younger individuals&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Typhoid fever&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">There have been no studies that have shown the efficacy in the elderly traveler&#59; the effectiveness is therefore unknown&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1883039.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Main differences in the effect of vaccines in populations younger and older than 65 years&#46;</p>"
        ]
      ]
      2 => array:9 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "Source&#58; Medscape&#46; <a class="elsevierStyleInterRef" target="_blank" id="intr0005" href="https://reference.medscape.com/drug-interactionchecker">https&#58;&#47;&#47;reference&#46;medscape&#46;com&#47;drug-interactionchecker</a>&#41;&#46;"
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Drug&nbsp;\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">Interactions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mefloquine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The combination with the following drugs causes no interactions&#58; warfarin&#44; metformin&#44; levofloxacin&#44; acetazolamide&#44; digoxin&#44; analgesics&#46;<br>The combination with the following drugs increases the risk of arrhythmias&#58; calcium antagonists&#46;<br>Fluoxetine&#47;olanzapine&#46; The combination of these drugs increases the QT interval&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chloroquine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The combination with the following drugs causes no interactions&#58; calcium antagonists&#44; metformin&#44; digoxin&#44; levofloxacin&#44; acetazolamide&#44; citalopram&#46;<br>Fluoxetine&#47;olanzapine&#46; The combination of these drugs produces minor interactions such as increased fluoxetine levels&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Atovaquone&#47;proguanil&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The combination with the following drugs causes no interactions&#58; calcium antagonists&#44; metformin&#44; digoxin&#44; levofloxacin&#44; acetazolamide&#44; citalopram&#44; fluoxetine&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Doxycycline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The combination with the following drugs causes no interactions&#58; calcium antagonists&#44; metformin&#44; digoxin&#44; levofloxacin&#44; acetazolamide&#44; citalopram&#44; fluoxetine&#46;<br>Warfarin&#46; The combination of these drugs produces minor interactions such as hypocoagulability&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Quinolones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The combination with the following drugs causes no interactions&#58; atorvastatin&#44; calcium antagonists&#44; acetazolamide&#46;<br>Warfarin&#44; metformin&#44; digoxin&#46; The combination of these drugs produces minor interactions&#46;<br>Fluoxetine&#47;olanzapine&#46; The combination of these drugs increases the QT interval&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1883037.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Interactions between the main drugs for long-term use and the drugs employed as prophylaxis for malaria or for traveler&#39;s diarrhea&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "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=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Main tips for elderly travelers</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Plan the trip in advance &#40;if traveling abroad&#44; go to a specialized center at least 1 month before traveling to assess the vaccine state and schedule the vaccine calendar&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Carry with you an updated report with your personal history and baseline situation&#44; as well as a summary of the medication you are taking&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Carry the necessary medication in your hand luggage for the duration of the trip and some extra in case of loss&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Take in account the time changes when taking your medication&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Be careful of drug interactions among vaccines and prophylactic medication&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Basic coverage of the health insurance</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>The payment of emergency care&#44; either emergency hospitalization or surgery&#46; The diagnostic tests resulting from emergency hospitalization&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>The prescription of medication for a period of time&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Use of ambulances for transfers&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Usually exclude&#58;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pre-existing medical conditions&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Injuries resulting from risky activities&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Injuries resulting from alcohol consumption or the abuse of illegal drugs&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Psychological problems such as panic attacks&#44; anxiety&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Injuries resulting from exposure to contamination or radiation&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sexually transmitted diseases acquired during the trip&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cosmetic and dental operations&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1883036.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Summary of the main tips for elderly travelers and the basic coverage that the health insurance should cover&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0030"
        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at5"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Chronic problems&nbsp;\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">Precautions and recommendations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Extreme temperatures and inadequate hydration can lead to the onset of syncope&#44; dizziness&#44; renal failure and electrolyte disturbances&#46;<br><span class="elsevierStyleItalic">Recommendations</span>&#58; Rehydration and reducing the dosage or stop taking the medication for a while&#46;<br><span class="elsevierStyleItalic">Recommendations</span>&#58; Be careful with antihypertension medication during a trip&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Syncope&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Boosting drug-induced hypotension&#44; dehydration&#44; pulmonary thromboembolism&#44; time changes caused by jet lag&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dehydration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Greater susceptibility due to perspiration from the heat&#44; the taking of diuretics and traveler&#39;s diarrhea&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cardiopulmonary disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Should be assessed before starting a trip and should remain stable and free of disease for at least 3 weeks&#46; The blood pressure changes during flight can decompensate the underlying disease&#46;<br><span class="elsevierStyleItalic">Recommendations</span>&#58; request supplemental oxygen&#46;<br><span class="elsevierStyleItalic">Recommendations</span>&#58; hand hygiene or the use of a facemask in crowded locations to avoid respiratory superinfections&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Deep vein thrombosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Greater susceptibility due to an insufficient venous system&#44; dehydration&#44; changes in cabin pressure&#44; the same position for long periods&#44; obesity&#44; congestive heart failure and cancer&#46;<br><span class="elsevierStyleItalic">Recommendations</span>&#58; change positions&#44; appropriate hydration&#44; exercise the legs&#44; walk on the airplane or rest every 2<span class="elsevierStyleHsp" style=""></span>h during car trips or use compression stockings&#46;<br><span class="elsevierStyleItalic">Recommendations</span>&#58; In case of risk factors&#44; use low-molecular-weight heparins before the flight&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes mellitus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Recommendations</span>&#58; Take care with the type of food&#44; physical activity during the trip and the time changes&#44; which especially affect travelers who use insulin&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Osteoarticular disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Falls and blows are very common during trips&#46; Physiological aging and loss of reflexes increases the likelihood of falls&#46;<br><span class="elsevierStyleItalic">Recommendations</span>&#58; Be careful with falls and blows&#46;<br><span class="elsevierStyleItalic">Recommendations</span>&#58; Be careful with excessive physical activity during the trip&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dementia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The stress of a trip&#44; the change in routine&#44; the need to sleep in hotels and jet lag can result in a confusional state for frail elderly travelers&#46;<br><span class="elsevierStyleItalic">Recommendations</span>&#58; Travelers with dementia should travel with a companion&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Constipation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">This is a problem for all ages but increases with age&#44; dehydration and prolonged immobility during the trip&#46;<br><span class="elsevierStyleItalic">Recommendations</span>&#58; dietary and pharmacological measures&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1883041.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Chronic problems in the elderly that can worsen during trips&#46;</p>"
        ]
      ]
      5 => array:5 [
        "identificador" => "tbl0005"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "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" style="border-bottom: 2px solid black">&nbsp;\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">Link&nbsp;\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  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Websites</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Centers for disease Control and Prevention&#44; Senior Citizens&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><a class="elsevierStyleInterRef" target="_blank" id="intr0015" href="https://wwwnc.cdc.gov/travel/page/senior-citizens">https&#58;&#47;&#47;wwwnc&#46;cdc&#46;gov&#47;travel&#47;page&#47;senior-citizens</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Government of Canada&#46; Older Traveler&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><a class="elsevierStyleInterRef" target="_blank" id="intr0020" href="https://travel.gc.ca/travelling/health-safety/older-travellers">https&#58;&#47;&#47;travel&#46;gc&#46;ca&#47;travelling&#47;health-safety&#47;older-travellers</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Travel Health Pro&#46; Older travelers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><a class="elsevierStyleInterRef" target="_blank" id="intr0025" href="https://travelhealthpro.org.uk/factsheet/70/older-travellers">https&#58;&#47;&#47;travelhealthpro&#46;org&#46;uk&#47;factsheet&#47;70&#47;older-travellers</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>U&#46;S&#46; Passports and International Travel&#46; Considerations for Older Travelers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><a class="elsevierStyleInterRef" target="_blank" id="intr0030" href="https://travel.state.gov/content/passports/en/go/older-traveler.html">https&#58;&#47;&#47;travel&#46;state&#46;gov&#47;content&#47;passports&#47;en&#47;go&#47;older-traveler&#46;html</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Australia Government&#46; Department of Foreign Affairs and trade&#46; Smarttraveller&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><a class="elsevierStyleInterRef" target="_blank" id="intr0035" href="http://smartraveller.gov.au/Pages/default.aspx">http&#58;&#47;&#47;smartraveller&#46;gov&#46;au&#47;Pages&#47;default&#46;aspx</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Vaccines and Travel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><a class="elsevierStyleInterRef" target="_blank" id="intr0040" href="http://www.vacunasyviajes.es/vacunasyviajes/Viajeros_especiales_enfermos.html">http&#58;&#47;&#47;www&#46;vacunasyviajes&#46;es&#47;vacunasyviajes&#47;Viajeros&#95;especiales&#95;enfermos&#46;html</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Fundacion io&#46; Elderly travelers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><a class="elsevierStyleInterRef" target="_blank" id="intr0045" href="http://fundacionio.org/viajar/otros/viajeros%20mayores.html">http&#58;&#47;&#47;fundacionio&#46;org&#47;viajar&#47;otros&#47;viajeros&#37;20mayores&#46;html</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Travel blogs for elderly travelers</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>TravelBlog&#46; The Old Age Travelers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><a class="elsevierStyleInterRef" target="_blank" id="intr0050" href="https://www.travelblog.org/Bloggers/The-Old-Age-Travellers">https&#58;&#47;&#47;www&#46;travelblog&#46;org&#47;Bloggers&#47;The-Old-Age-Travellers</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lonely planet Thorn Tree forum&#46; Older Traveler&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><a class="elsevierStyleInterRef" target="_blank" id="intr0055" href="https://www.lonelyplanet.com/thorntree/forums/older-travellers">https&#58;&#47;&#47;www&#46;lonelyplanet&#46;com&#47;thorntree&#47;forums&#47;older-travellers</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1883040.png"
              ]
            ]
          ]
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:28 [
            0 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "Available at&#58; <a class="elsevierStyleInterRef" target="_blank" id="intr0060" href="http://www2.unwto.org/es">http&#58;&#47;&#47;www2&#46;unwto&#46;org&#47;es</a> &#91;accessed 14&#46;12&#46;17&#93;"
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "World Tourism Organization &#40;UNWTO&#41;"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2017"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "Available at&#58; <a class="elsevierStyleInterRef" target="_blank" id="intr0065" href="http://estadisticas.tourspain.es/es-es/estadisticas/familitur/informesdinamicos/paginas/default.aspx">http&#58;&#47;&#47;estadisticas&#46;tourspain&#46;es&#47;es-es&#47;estadisticas&#47;familitur&#47;informesdinamicos&#47;paginas&#47;default&#46;aspx</a> &#91;accessed 14&#46;12&#46;17&#93;"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Subdelegaci&#243;n General de Conocimiento y Estudios Tur&#237;sticos&#46; FAMILITUR"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Ministerio de Energ&#237;a&#44; Turismo y Agencia Digital&#44; Secretaria de Estado de Turismo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2017"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The older traveller&#58; a guide for the health professional"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46; Baker"
                            1 => "G&#46;K&#46; Brink"
                            2 => "S&#46; Lipschitz"
                            3 => "T&#46; Marcolongo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "edicion" => "1st ed&#46;"
                        "fecha" => "2016"
                        "editorial" => "South African Society of Travel Medicine"
                        "editorialLocalizacion" => "Green Stone&#44; South Africa"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The elderly travellers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46;C&#46; Cooper"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.tmaid.2005.06.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Travel Med Infect Dis"
                        "fecha" => "2006"
                        "volumen" => "4"
                        "paginaInicial" => "218"
                        "paginaFinal" => "222"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16887743"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Australian senior adventure travellers to Peru&#58; maximising older tourists&#8217; travel health experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "I&#46; Bauer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.tmaid.2012.03.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Travel Med Infect Dis"
                        "fecha" => "2012"
                        "volumen" => "10"
                        "paginaInicial" => "59"
                        "paginaFinal" => "68"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22459635"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Elderly travellers&#58; review and advices"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46; Eperon"
                            1 => "F&#46; Chappuis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Med Suisse"
                        "fecha" => "2015"
                        "volumen" => "11"
                        "paginaInicial" => "1028"
                        "paginaFinal" => "1032"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26103767"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The elderly travellers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Forest"
                            1 => "M&#46; Brihier"
                            2 => "M&#46; Verny"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.lpm.2012.05.032"
                      "Revista" => array:6 [
                        "tituloSerie" => "Presse Med"
                        "fecha" => "2013"
                        "volumen" => "42"
                        "paginaInicial" => "209"
                        "paginaFinal" => "216"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23305909"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Health advice for older people travelling overseas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;C&#46; Wong"
                            1 => "H&#46; Simons"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.7748/nop2012.11.24.9.14.c9365"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nurs Older People"
                        "fecha" => "2012"
                        "volumen" => "24"
                        "paginaInicial" => "14"
                        "paginaFinal" => "19"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23311276"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for the prevention of travel-associated illness in older adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "T&#46;K&#46; Lee"
                            1 => "J&#46;N&#46; Hutter"
                            2 => "J&#46; Masel"
                            3 => "C&#46; Joya"
                            4 => "T&#46;J&#46; Whitman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s40794-017-0054-0"
                      "Revista" => array:5 [
                        "tituloSerie" => "Trop Dis Travel Med Vaccines"
                        "fecha" => "2017"
                        "volumen" => "3"
                        "paginaInicial" => "10"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28883980"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Health and well-being factors associated with international business travel"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;D&#46; Burkholder"
                            1 => "R&#46; Joines"
                            2 => "M&#46; Cunningham-Hill"
                            3 => "B&#46; Xu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1708-8305.2010.00441.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Travel Med"
                        "fecha" => "2010"
                        "volumen" => "17"
                        "paginaInicial" => "329"
                        "paginaFinal" => "333"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20920054"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Immunosenescence&#58; a product of the environment&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;M&#46; Su"
                            1 => "D&#46; Aw"
                            2 => "D&#46;B&#46; Palmer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.coi.2013.05.018"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Immunol"
                        "fecha" => "2013"
                        "volumen" => "25"
                        "paginaInicial" => "498"
                        "paginaFinal" => "550"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23809359"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Updated recommendations for use of tetanus toxoid&#44; reduced diphtheria toxoid&#44; and acellular pertussis &#40;TDAP&#41; vaccine in adults aged 65 years and older &#8212; Advisory Committee on Immunization Practices &#40;ACIP&#41;&#44; 2012"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "Centers for Disease Control and Prevention &#40;CDC&#41;"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Morb Mortal Wkly Rep"
                        "fecha" => "2012"
                        "volumen" => "29"
                        "paginaInicial" => "468"
                        "paginaFinal" => "470"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inmunidad a la difteria en una poblaci&#243;n anciana"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Velarde-Mayol"
                            1 => "J&#46;&#193;&#46; G&#243;mez de Caso"
                            2 => "&#193;&#46; Gil de Miguel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;"
                        "fecha" => "2005"
                        "volumen" => "125"
                        "paginaInicial" => "409"
                        "paginaFinal" => "411"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Elderly subjects have a delayed antibody response and prolonged viraemia following yellow fever vaccination&#58; a prospective controlled cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;H&#46; Roukens"
                            1 => "D&#46; Soonawala"
                            2 => "S&#46;A&#46; Joosten"
                            3 => "A&#46;W&#46; de Visser"
                            4 => "X&#46; Jiang"
                            5 => "K&#46; Dirksen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "PLoS ONE"
                        "fecha" => "2011"
                        "volumen" => "6"
                        "paginaInicial" => "1"
                        "paginaFinal" => "6"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Centers for Disease Control and Prevention &#40;CDC&#41;&#44; Yellow Fever Vaccine Booster Doses&#58; Recommendations of the Advisory Committee on Immunization Practices&#44; 2015"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;E&#46; Staples"
                            1 => "J&#46;A&#46; Bocchini Jr&#46;"
                            2 => "L&#46; Rubin"
                            3 => "M&#46; Fischer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Morb Mortal Wkly Rep"
                        "fecha" => "2015"
                        "volumen" => "64"
                        "paginaInicial" => "647"
                        "paginaFinal" => "650"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Malaria in the returning older traveler"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "N&#46; Allen"
                            1 => "C&#46; Bergin"
                            2 => "S&#46;P&#46; Kennelly"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s40794-016-0018-9"
                      "Revista" => array:5 [
                        "tituloSerie" => "Trop Dis Travel Med Vaccines"
                        "fecha" => "2016"
                        "volumen" => "2"
                        "paginaInicial" => "2"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28883946"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The older traveller"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;L&#46; Giles"
                            1 => "T&#46;A&#46; Ruff"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Aust J Hosp Pharm"
                        "fecha" => "1999"
                        "volumen" => "29"
                        "paginaInicial" => "222"
                        "paginaFinal" => "226"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Travel vaccines and eldery person&#58; review of vaccines available in the Unites States"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "K&#46; Leder"
                            1 => "P&#46;F&#46; Wellwer"
                            2 => "M&#46;E&#46; Wilson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/322968"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2001"
                        "volumen" => "33"
                        "paginaInicial" => "1553"
                        "paginaFinal" => "1566"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11588700"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chronic illnesses in travelers to developing countries"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Stienlauf"
                            1 => "B&#46; Streltsin"
                            2 => "E&#46; Meltzer"
                            3 => "E&#46; Kopel"
                            4 => "E&#46; Leshem"
                            5 => "G&#46; Segal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.tmaid.2014.10.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Travel Med Infect Dis"
                        "fecha" => "2014"
                        "volumen" => "12"
                        "paginaInicial" => "757"
                        "paginaFinal" => "763"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25457305"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Potential drug interactions in travelers with chronic illnesses&#58; a large retrospective cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Stienlauf"
                            1 => "E&#46; Meltzer"
                            2 => "D&#46; Kurnik"
                            3 => "E&#46; Leshem"
                            4 => "E&#46; Kopel"
                            5 => "B&#46; Streltsin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.tmaid.2014.04.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Travel Med Infect Dis"
                        "fecha" => "2014"
                        "volumen" => "12"
                        "paginaInicial" => "499"
                        "paginaFinal" => "504"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24867407"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dosing antiretroviral medication when crossing time zones"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;M&#46; Lewis"
                            1 => "A&#46; Volny-Anne"
                            2 => "C&#46; Waitt"
                            3 => "M&#46; Boffito"
                            4 => "S&#46; Khoo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/QAD.0000000000000920"
                      "Revista" => array:6 [
                        "tituloSerie" => "AIDS"
                        "fecha" => "2016"
                        "volumen" => "30"
                        "paginaInicial" => "267"
                        "paginaFinal" => "271"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26684823"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "Available at&#58; <a class="elsevierStyleInterRef" target="_blank" id="intr0070" href="http://www.incb.org/incb/en/publications/Guidelines.html">www&#46;incb&#46;org&#47;incb&#47;en&#47;publications&#47;Guidelines&#46;html</a> &#91;accessed 14&#46;12&#46;17&#93;"
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "The International Narcotics Control Board &#40;INCB&#41;"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2017"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "Available at&#58; <a class="elsevierStyleInterRef" target="_blank" id="intr0075" href="http://www.aena.com/">www&#46;AENA&#46;com</a> &#91;accessed 14&#46;12&#46;17&#93;"
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "Agencia Espa&#241;ola de Navegaci&#243;n A&#233;rea &#40;AENA&#41;"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2017"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "Available at&#58; <a class="elsevierStyleInterRef" target="_blank" id="intr0080" href="http://www.lufthansa.com/es/es/Consejos-para-pasajeros-de-la-tercera-edad">http&#58;&#47;&#47;www&#46;lufthansa&#46;com&#47;es&#47;es&#47;Consejos-para-pasajeros-de-la-tercera-edad</a> &#91;accessed 14&#46;12&#46;17&#93;"
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "Lufthansa&#44; Consejos para pasajeros de la tercera edad"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2017"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "Available at&#58; <a class="elsevierStyleInterRef" target="_blank" id="intr0085" href="https://www.finnair.com/se/gb/information-services/before-the-flight/special-services-health/elderly-passengers">https&#58;&#47;&#47;www&#46;finnair&#46;com&#47;se&#47;gb&#47;information-services&#47;before-the-flight&#47;special-services-health&#47;elderly-passengers</a> &#91;accessed 14&#46;12&#46;17&#93;"
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "Finnair&#44; Special services health"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2017"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Travel insurance claims made by travelers from Australia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46;A&#46; Leggat"
                            1 => "F&#46;W&#46; Leggat"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Travel Med"
                        "fecha" => "2002"
                        "volumen" => "9"
                        "paginaInicial" => "59"
                        "paginaFinal" => "65"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12044271"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fitness to travel &#8212; assessment in the elderly and medically impaired"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "P&#46; Fenner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Aust Fam Physician"
                        "fecha" => "2007"
                        "volumen" => "36"
                        "paginaInicial" => "312"
                        "paginaFinal" => "315"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17492063"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Travel-associated illness in older adults &#40;&#62;60 y&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Gautret"
                            1 => "J&#46; Gaudart"
                            2 => "K&#46; Leder"
                            3 => "E&#46; Schwartz"
                            4 => "F&#46; Castelli"
                            5 => "P&#46;L&#46; Lim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1708-8305.2012.00613.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Travel Med"
                        "fecha" => "2012"
                        "volumen" => "19"
                        "paginaInicial" => "169"
                        "paginaFinal" => "177"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22530824"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/22548874/0000021800000008/v1_201810300615/S2254887418300730/v1_201810300615/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "48740"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Reviews"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/22548874/0000021800000008/v1_201810300615/S2254887418300730/v1_201810300615/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887418300730?idApp=WRCEE"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Review
The elderly traveler
El viajero mayor
V. Ramos-Sesmaa, M. Górgolas-Hernández Morab, J.M. Ramos-Rincónc,
Corresponding author
jramosrincon@yahoo.es

Corresponding author.
a Servicio de Medicina Interna, Hospital Marina Alta, Denia, Alicante, Spain
b División de Enfermedades Infecciosas, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
c Servicio de Medicina Interna, Hospital General Universitario de Alicante; Departamento de Medicina Clínica, Universidad Miguel Hernández de Elche; ISABIAL – FISABIO, Alicante, Spain
Read
12
Times
was read the article
5
Total PDF
7
Total HTML
Share statistics
 array:24 [
  "pii" => "S2254887418300730"
  "issn" => "22548874"
  "doi" => "10.1016/j.rceng.2018.03.011"
  "estado" => "S300"
  "fechaPublicacion" => "2018-11-01"
  "aid" => "1505"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
  "copyrightAnyo" => "2018"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "ssu"
  "cita" => "Rev Clin Esp. 2018;218:426-34"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 1
    "PDF" => 1
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0014256518301115"
      "issn" => "00142565"
      "doi" => "10.1016/j.rce.2018.03.017"
      "estado" => "S300"
      "fechaPublicacion" => "2018-11-01"
      "aid" => "1505"
      "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "ssu"
      "cita" => "Rev Clin Esp. 2018;218:426-34"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 174
        "formatos" => array:2 [
          "HTML" => 119
          "PDF" => 55
        ]
      ]
      "es" => array:12 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Revisi&#243;n</span>"
        "titulo" => "El viajero mayor"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "426"
            "paginaFinal" => "434"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "The elderly traveller"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "V&#46; Ramos-Sesma, M&#46; G&#243;rgolas-Hern&#225;ndez Mora, J&#46;M&#46; Ramos-Rinc&#243;n"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "V&#46;"
                "apellidos" => "Ramos-Sesma"
              ]
              1 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "G&#243;rgolas-Hern&#225;ndez Mora"
              ]
              2 => array:2 [
                "nombre" => "J&#46;M&#46;"
                "apellidos" => "Ramos-Rinc&#243;n"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2254887418300730"
          "doi" => "10.1016/j.rceng.2018.03.011"
          "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/S2254887418300730?idApp=WRCEE"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256518301115?idApp=WRCEE"
      "url" => "/00142565/0000021800000008/v1_201810300611/S0014256518301115/v1_201810300611/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2254887418301267"
    "issn" => "22548874"
    "doi" => "10.1016/j.rceng.2018.05.007"
    "estado" => "S300"
    "fechaPublicacion" => "2018-11-01"
    "aid" => "1525"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "ssu"
    "cita" => "Rev Clin Esp. 2018;218:435-44"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 1
      "PDF" => 1
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Review</span>"
      "titulo" => "Pain assessment in individuals with dementia and communication problems in Spain&#46; A systematic review"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "435"
          "paginaFinal" => "444"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Valoraci&#243;n del dolor en personas con demencia y problemas de comunicaci&#243;n en Espa&#241;a&#46; Revisi&#243;n sistem&#225;tica"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 2685
              "Ancho" => 2492
              "Tamanyo" => 301388
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flow diagram following the PRISM recommendations&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "M&#46;&#193;&#46; de Juan Pardo, M&#46; Saracibar-Razquin, I&#46; Crespo, P&#46; Fuster Linares"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "M&#46;&#193;&#46;"
              "apellidos" => "de Juan Pardo"
            ]
            1 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Saracibar-Razquin"
            ]
            2 => array:2 [
              "nombre" => "I&#46;"
              "apellidos" => "Crespo"
            ]
            3 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Fuster Linares"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0014256518301553"
        "doi" => "10.1016/j.rce.2018.05.002"
        "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/S0014256518301553?idApp=WRCEE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887418301267?idApp=WRCEE"
    "url" => "/22548874/0000021800000008/v1_201810300615/S2254887418301267/v1_201810300615/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2254887418301206"
    "issn" => "22548874"
    "doi" => "10.1016/j.rceng.2018.05.003"
    "estado" => "S300"
    "fechaPublicacion" => "2018-11-01"
    "aid" => "1537"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "edi"
    "cita" => "Rev Clin Esp. 2018;218:424-5"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 1
      "PDF" => 1
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
      "titulo" => "Thromboembolic disease in orthopedic surgery and non-surgical trauma"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "424"
          "paginaFinal" => "425"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Enfermedad tromboemb&#243;lica en cirug&#237;a ortop&#233;dica y traumatismos no quir&#250;rgicos"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46; Ena"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Ena"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0014256518301693"
        "doi" => "10.1016/j.rce.2018.05.009"
        "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/S0014256518301693?idApp=WRCEE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887418301206?idApp=WRCEE"
    "url" => "/22548874/0000021800000008/v1_201810300615/S2254887418301206/v1_201810300615/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Review</span>"
    "titulo" => "The elderly traveler"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "426"
        "paginaFinal" => "434"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "V&#46; Ramos-Sesma, M&#46; G&#243;rgolas-Hern&#225;ndez Mora, J&#46;M&#46; Ramos-Rinc&#243;n"
        "autores" => array:3 [
          0 => array:3 [
            "nombre" => "V&#46;"
            "apellidos" => "Ramos-Sesma"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "G&#243;rgolas-Hern&#225;ndez Mora"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:4 [
            "nombre" => "J&#46;M&#46;"
            "apellidos" => "Ramos-Rinc&#243;n"
            "email" => array:1 [
              0 => "jramosrincon&#64;yahoo&#46;es"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:3 [
          0 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital Marina Alta&#44; Denia&#44; Alicante&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Divisi&#243;n de Enfermedades Infecciosas&#44; Hospital Universitario Fundaci&#243;n Jim&#233;nez D&#237;az&#44; Madrid&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital General Universitario de Alicante&#59; Departamento de Medicina Cl&#237;nica&#44; Universidad Miguel Hern&#225;ndez de Elche&#59; ISABIAL &#8211; FISABIO&#44; Alicante&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "El viajero mayor"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">Despite the economic crisis in recent years&#44; the number of trips has not fallen&#46; According to the United Nations World Tourism Organization &#40;UNWTO&#41;&#44; 1235 million trips were recorded in 2016&#46; It is estimated that this figure will increase in the coming years&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">1&#44;2</span></a> The improved quality of life&#44; the greater control of chronic disease and financial stability after retirement have resulted in an increase in the number of trips among the elderly population&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;4</span></a> Generally&#44; the elderly population who travel have been traveling since their youth&#44; and age is not a restriction for traveling&#46; We should therefore distinguish between cognitive and chronological age&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">4</span></a> The age at which we considered a population &#8220;elderly&#8221; is not well-defined&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">5</span></a> For the purposes of this review&#44; we will set the threshold at 65 years&#46; Elderly travelers currently have greater ease of traveling&#44; a certain financial solvency and free time offered by retirement&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;6&#44;7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In terms of health during travel&#44; we need to differentiate between problems resulting from chronic disease &#40;such as diabetes mellitus and cardiopulmonary disease&#41; and the limitations resulting from age &#40;such as memory loss&#44; loss of understanding&#44; hearing loss and vision loss&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;5</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Pathophysiology of the elderly</span><p id="par0015" class="elsevierStylePara elsevierViewall">Time changes many biologic processes&#46; Aging is not a homogeneous process and depends on genetic and lifestyle factors and environmental exposures&#46; Aging is characterized by progressive changes that are associated with increased susceptibility to numerous diseases&#46; Age-related hearing loss and vision loss can create problems for elderly travelers&#44; preventing them from seeing signs and posters and hearing airport warnings and explanations in crowded locations&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">5&#44;6&#44;8&#44;9</span></a> This loss of ability to adapt to new situations can lead to a confusional state or anxiety in the traveler&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">6&#44;10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">From the respiratory standpoint&#44; the total lung capacity is reduced due to the decrease in the number of alveoli that enable gas exchange&#46; This reduction also increases the respiratory effort by decreasing lung distensibility&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;4</span></a> The adaptation capacity is therefore lower in conditions of hypoxia&#44; such as at high altitude or after cabin depressurization in airplanes&#46; Elderly travelers are therefore more susceptible to cardiopulmonary diseases such as respiratory failure and pulmonary edema and to exacerbations of these diseases&#46; If appropriate measures are taken&#44; however&#44; even individuals with some type of cardiopulmonary disease barely develop symptoms&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;4&#44;6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Acclimatization to extreme temperatures triggers problems that can be avoided with common sense &#40;e&#46;g&#46;&#44; drinking water abundantly&#44; avoiding the hottest time of the day and staying in rooms with air conditioning&#41;&#46; Age reduces renal filtration capacity and produces a loss of homeostasis by reducing the feeling of thirst and the peripheral vascularization&#39;s ability to adapt&#46; These travelers are more susceptible to dehydration and acute renal failure&#44; especially if aggravated with diarrhea&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;4&#44;6&#8211;9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Immunosenescence is a common pathophysiological change in elderly individuals&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">11</span></a> The aging of the immune system promotes the loss of mature T-cells and antibodies that protect against diseases the patients had experienced or for which they were vaccinated&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">11</span></a> Moreover&#44; this deregulated immunity can cause administered vaccines to lose their effectiveness &#40;i&#46;e&#46;&#44; not generate the same quantity of protective antibodies<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;9&#44;11</span></a>&#41;&#46; The efficacy of vaccines in young adults is 70&#8211;90&#37;&#44; while the efficacy in the elderly is 17&#8211;35&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">12&#44;13</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The yellow fever vaccine is formed by attenuated living viruses&#44; and although it is considered a safe vaccine&#44; caution and even contraindication is advised for immunosuppressed individuals&#46; The vaccine is not contraindicated for individuals older than 65 years&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">8</span></a> but a delay in the immune response and greater viremia have been observed in these patients&#44;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;4&#44;14&#44;15</span></a> and the vaccine should therefore be indicated individually in each case&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Precautions before starting the trip</span><p id="par0040" class="elsevierStylePara elsevierViewall">Elderly travelers should plan their trip well in advance&#46; They should not only consider the places they wish to visit&#44; the hotels to reserve and the monuments they want to enter but also visit a general practitioner for a physical check-up&#46; The elderly traveler can thereby bring with them on the trip a medical report that summarizes their history and medication&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">4&#44;16&#44;17</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Elderly travelers with heart disease should bring a copy of the electrocardiogram&#46; If they have an implanted pacemaker or defibrillator&#44; they should attach a report that explains the type of device&#46; The traveler should have sufficient medication for the entire trip and extra in case the trip is unexpectedly extended&#46; Doctors should advise these travelers about prophylactic medication and assess the potential interactions&#46; Some of the basic issues to consider are information on the health education standards for the prevention of insect bites and how to procure travel insurance&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;4&#44;9&#44;17</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Recommended vaccines by geographical area</span><p id="par0050" class="elsevierStylePara elsevierViewall">The traveler&#39;s consultation can be an important opportunity to update their vaccine calendar&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">9</span></a> The following vaccines are recommended for those older than 65 years&#58; seasonal influenza vaccine&#44; if planning to travel to a country in winter&#59; the pneumococcal vaccine&#59; a dose of the diphtheria&#47;tetanus toxoid vaccine if they have not received it at 60 years&#59; and&#44; eventually&#44; the herpes zoster vaccine&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">8</span></a> Generally&#44; vaccines in those older than 65 years have lower antibody seroconversion rates and are therefore less immunogenic&#44; compared with the response of younger individuals&#46; The elderly also have more adverse effects&#46; Nevertheless&#44; there are no studies sufficiently focused on elderly populations that examine the effectiveness of the vaccines&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">18</span></a><a class="elsevierStyleCrossRef" href="#tbl0010">Table 1</a> summarizes the recommended vaccines depending on the trip&#39;s destination&#46; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 2</a> shows the considerations for the vaccines in elderly travelers&#46; It is advisable to administer vaccines more than 15 days prior to the trip&#44; avoiding the simultaneous administration of attenuated vaccines&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">3</span></a></p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Traveling with medication</span><p id="par0055" class="elsevierStylePara elsevierViewall">Studies<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;19</span></a> have indicated that the long-term use of medication influences the trip duration but only among younger populations&#46; These differences are not observed in older travelers&#46; However&#44; in the population older than 60 years&#44; it is estimated that 11&#8211;59&#37; of travelers who visit the doctor before a trip take at least one type of long-term medication&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">20</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">As a rule&#44; individuals should travel with the original packaging of the medication and an updated medical report as mentioned above&#46; It is advisable to translate the report into the destination country&#39;s language&#46; It is advisable to carry sufficient medication for the entire trip and carry it in the hand luggage&#44; to prevent its loss if the checked baggage is lost&#46; Travelers should not rely on finding the same active ingredient at the destination&#44; especially if traveling to developing countries or remote areas&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;9&#44;17&#44;20</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Some drugs can create problems&#44; such as those that can be confused with illegal drugs and those with some type of special control&#44; e&#46;g&#46;&#44; anxiolytics&#44; antiepileptics and opioid analgesics&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;9&#44;20&#44;21</span></a> The International Narcotics Control Board provides a guide on their website about the regulation of drugs and countries in which carrying narcotics could present a problem&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">22</span></a> The Spanish Air Navigation Agency &#40;AENA&#41;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">23</span></a> provides information on the current regulations for any airport in the European Union and allows passengers to travel with medication provided they are accompanied by its medical prescription&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Medication should not be shipped by mail and should not be bought at the destination because&#44; in certain countries&#44; the medication does not have the same safety controls&#44; and fake drugs or drugs with nonequivalent doses are sold instead&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;4&#44;9</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Drug interactions among long-term drugs</span><p id="par0075" class="elsevierStylePara elsevierViewall">Up to 45&#37; of travelers who take some type of long-term medication can experience some interaction with traveler&#39;s diarrhea medication&#44; malaria prophylaxis or altitude sickness drugs&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">19&#44;20</span></a> The interactions can vary the drug concentrations&#44; producing hyperglycemia&#44; seizures&#44; QT prolongation or arrhythmias&#46; The interactions with dicoumarin agents are important&#44; and their levels depend not only on the drug but also on the ingested food&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">As a rule&#44; malaria prophylaxis is always indicated for elderly individuals traveling to at-risk areas&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;9&#44;16</span></a> The dose does not need to be adjusted for age and should only be adjusted if there is some comorbidity or insufficiency&#46; <a class="elsevierStyleCrossRef" href="#tbl0020">Table 3</a> summarizes the potential interactions between the drugs that are used in antimalarial prophylaxis and drugs most commonly used by the elderly&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Time zone and jet lag</span><p id="par0085" class="elsevierStylePara elsevierViewall">Jet lag not only causes abnormal sleep cycles but can also create confusion on when to take medication&#46; The time change can lead to skipping or duplicating doses&#46; Based on the concept of drug forgiveness whereby missing a dose does not mean achieving infratherapeutic levels of the drug in blood&#44; travelers have the option of skipping a dose and adapting the dosing to the new time zone&#46;<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">20&#44;21</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Elderly travelers and flights</span><p id="par0090" class="elsevierStylePara elsevierViewall">The elderly are more likely to have restricted physical mobility or diseases that limit movements&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">23</span></a> Certain airlines have developed recommendations and advice aimed at helping elderly travelers&#44; allowing them to reserve a seat and board before other travelers&#44; offering comprehensive assistance to the elderly at airports&#44; offering special menus aboard the flight&#44; providing a &#8220;doctor on board&#8221; program with supplemental oxygen and responding to health-related questions regarding travel&#46;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">24&#44;25</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Travel insurance for elderly travelers</span><p id="par0095" class="elsevierStylePara elsevierViewall">It has been estimated that 30&#8211;50&#37; of travelers incur some injury or need to consult with a doctor during the trip&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">24</span></a> Due to the high cost of healthcare coverage abroad&#44; it is advisable to request insurance with good coverage before any trip&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;8&#44;17</span></a> Procuring good insurance with broad coverage is not usually excessively expensive&#44; compared with the overall price of the trip&#46;<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">5&#44;26</span></a><a class="elsevierStyleCrossRef" href="#tbl0025">Table 4</a> summarizes the basic coverage provided by an insurance plan&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Other risks and recommendations</span><p id="par0100" class="elsevierStylePara elsevierViewall">Criminals often see elderly individuals as more vulnerable&#46; They usually assume that the elderly wear more objects of value&#44; carry money and have reduced reaction capacity&#46; In tourism zones&#44; people need to be more alert&#46; Elderly individuals should therefore avoid placing themselves at risk and generally be more prudent&#46; Having an unlocked mobile phone and always having it at hand is a good safety measure in case of something unexpected&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">27</span></a> Physical&#44; hearing and visual limitations should also be considered&#44; arriving on time at locations and avoiding long lines and the hottest part of the day&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Elderly travelers with chronic disease</span><p id="par0105" class="elsevierStylePara elsevierViewall">Travelers with pre-existing diseases should be warned that they can only travel when their diseases are stable&#46; Travelers should wait 2&#8211;3 weeks before starting a trip in case of a recent infarction&#46; Cabin depressurization and changes in the pressure partial of oxygen can trigger respiratory disease decompensations&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;17</span></a> Individuals who take diuretic drugs should be advised to reduce their dosage during the flight and to perform the necessary exercises to prevent deep vein thrombosis if taking a trip longer than 5<span class="elsevierStyleHsp" style=""></span>h&#46; <a class="elsevierStyleCrossRef" href="#tbl0030">Table 5</a> lists the needs and characteristics of chronic diseases in elderly travelers and their recommendations&#46;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;16&#44;17&#44;27</span></a></p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">In general&#44; elderly travelers with stable immunosuppression can travel&#59; however&#44; these travelers should receive individual counseling and obtain travel insurance with good health coverage&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">27</span></a> Examples of immunosuppression include the long-term administration of steroids&#44; human immunodeficiency virus infection with CD4 values greater than 350<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">3</span> and having undergone cancer treatment more than 12 weeks ago&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Elderly travelers who have recently undergone surgery</span><p id="par0115" class="elsevierStylePara elsevierViewall">It is generally advisable to avoid travel up to 2 weeks following any type of operation&#44; due to the potential complications of the surgery&#46; Similarly&#44; patients who have undergone spinal anesthesia should wait at least 10 days before traveling&#44; due to the possibility of severe headaches&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">27</span></a></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Getting sick during the trip&#46; Differences between elderly and young travelers</span><p id="par0120" class="elsevierStylePara elsevierViewall">There are few studies that have compared the various comorbidities among travelers according to age&#46; The clinical cohort of GeoSentinel travelers&#44; with a broad worldwide distribution&#44; included 2992 travelers from 1999 to 2009 and analyzed the various ways travelers get sick&#44; classifying them by age group&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">28</span></a> The diseases that most often affect older travelers are respiratory tract and genitourinary infections&#44; high-altitude pulmonary edema&#44; pulmonary thromboembolism&#44; heart disease&#44; severe malaria&#44; gastritis and peptic ulcers&#46; Older travelers are also more susceptible to insect bites and accidents and have higher mortality&#46; In contrast&#44; younger travelers were more likely to experience acute diarrhea&#44; upper respiratory tract infections&#44; influenza&#44; nonsevere malaria&#44; dengue&#44; genital infections&#44; sexually transmitted diseases and schistosomiasis&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">28</span></a></p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Elderly travelers upon return</span><p id="par0125" class="elsevierStylePara elsevierViewall">Health problems when returning from trips should be dealt with in the same manner as with younger travelers&#46; The case history should include the destination visit&#44; the activities conducted and the degree of previous immunization&#46; Travelers with pre-existing diseases are more susceptible to developing trip-related diseases&#44; which deteriorates their physical condition and decompensates the pre-existing disease&#46; When a patient has returned from a trip&#44; it is important to conduct an overall approach of the disease<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;16&#44;17&#44;27</span></a> and not just focus on the syndrome acquired during the vacation&#46; For example&#44; comorbidity can include fever due to malaria in a patient with underlying heart disease such as chronic heart failure and chronic obstructive pulmonary disease&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">16</span></a> All medical problems during and after a trip can trigger an acute confusional syndrome in elderly travelers&#44; which will interfere with the correct management of the underlying disease&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Final considerations and conclusions</span><p id="par0130" class="elsevierStylePara elsevierViewall">Elderly travelers require special care&#46; <a class="elsevierStyleCrossRef" href="#tbl0025">Table 4</a> summarizes the main advice for elderly travelers&#44;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">3&#44;16&#44;17&#44;27</span></a> and there are various websites that offer additional information on the recommendations for this type of traveler&#46; Most are in English&#59; however&#44; very few of them focus exclusively on elderly travelers &#40;<a class="elsevierStyleCrossRef" href="#sec0085">Appendix A</a>&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Age is not a restriction or impediment for traveling&#46; Prevention&#44; planning and common sense are the basis of a good trip&#46; However&#44; elderly travelers should follow a number of recommendations before the trip&#44; take special precautions during the trip and receive proper care upon their return&#46; A proper understanding of the problems that might arise during the trip will enable better care for these adventurous patients&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflict of interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:21 [
        0 => array:3 [
          "identificador" => "xres1100568"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1041563"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1100567"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1041564"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Background"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Pathophysiology of the elderly"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Precautions before starting the trip"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Recommended vaccines by geographical area"
        ]
        8 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Traveling with medication"
        ]
        9 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Drug interactions among long-term drugs"
        ]
        10 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Time zone and jet lag"
        ]
        11 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Elderly travelers and flights"
        ]
        12 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Travel insurance for elderly travelers"
        ]
        13 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Other risks and recommendations"
        ]
        14 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Elderly travelers with chronic disease"
        ]
        15 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Elderly travelers who have recently undergone surgery"
        ]
        16 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Getting sick during the trip&#46; Differences between elderly and young travelers"
        ]
        17 => array:2 [
          "identificador" => "sec0070"
          "titulo" => "Elderly travelers upon return"
        ]
        18 => array:2 [
          "identificador" => "sec0075"
          "titulo" => "Final considerations and conclusions"
        ]
        19 => array:2 [
          "identificador" => "sec0080"
          "titulo" => "Conflict of interest"
        ]
        20 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2018-01-07"
    "fechaAceptado" => "2018-03-20"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1041563"
          "palabras" => array:4 [
            0 => "Travelers"
            1 => "Elderly"
            2 => "Immunosenescence"
            3 => "Chronic diseases"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1041564"
          "palabras" => array:4 [
            0 => "Viajero"
            1 => "Anciano"
            2 => "Inmunosenescencia"
            3 => "Enfermedades cr&#243;nicas"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Improved living conditions and advances in medicine have extended life expectancy and quality of life&#44; resulting in an increasing number of elderly travelers&#46; Pathophysiological changes and treatments can reduce the efficacy of vaccines and facilitate drug interactions&#46; Elderly travelers have various characteristics that should be considered when offering pre-trip counseling&#44; which should include proper management of chronic diseases that are susceptible to worsening during the trip&#44; as well as an appropriate study and follow-up after the trip&#46; We performed a narrative review of the main problems of elderly travelers&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La mejora de las condiciones de vida y los avances de la medicina han prolongado la esperanza y la calidad de vida&#44; de tal forma que cada vez es mayor el n&#250;mero de viajeros de avanzada edad&#46; Los cambios fisiopatol&#243;gicos o los tratamientos pueden reducir la eficacia de las vacunas o facilitar interacciones medicamentosas&#46; El viajero mayor presenta una serie de particularidades que se deben tener en cuenta a la hora de ofrecer un buen consejo pre-viaje&#46; Esto debe incluir un correcto manejo de sus enfermedades cr&#243;nicas susceptibles de agravarse durante el viaje&#44; as&#237; como un adecuado estudio y seguimiento despu&#233;s del mismo&#46; Se ha realizado una revisi&#243;n narrativa de los principales problemas del viajero mayor&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Please cite this article as&#58; Ramos-Sesma V&#44; G&#243;rgolas-Hern&#225;ndez Mora M&#44; Ramos-Rinc&#243;n JM&#46; El viajero mayor&#46; Rev Clin Esp&#46; 2018&#59;218&#58;426&#8211;434&#46;</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0145" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Travel websites and blogs that provide tips for elderly travelers"
            "identificador" => "sec0085"
          ]
        ]
      ]
    ]
    "multimedia" => array:6 [
      0 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "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">&nbsp;\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">North Africa&nbsp;\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">Sub-Saharan Africa&nbsp;\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">Southeast Asia&nbsp;\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">India&nbsp;\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">Near East&nbsp;\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">Latin America&nbsp;\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">Oceania&nbsp;\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">Europe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yellow fever<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Panama toward the south&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Typhoid fever&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Meningococcal meningitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">November&#8211;June&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">If epidemic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pilgrimage to Mecca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">If epidemic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cholera&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hepatitis A and B<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Japanese encephalitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rural&#44; long stay&#44; epidemics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Some islands&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tick-borne encephalitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rabies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Long stay&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Long stay&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Long stay&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Long stay&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Polio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Malaria<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">c</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&#43;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">August-October&#46; Rural area&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&#43;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#43;&#43;&#43;<br>Rural If long stay&#44; treatment&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Certain islands&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1883038.png"
              ]
            ]
          ]
          "notaPie" => array:3 [
            0 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Not contraindicated for individuals older than 65 years but should be indicated individually in each case&#46; One single dose offers sufficient life-long immunity&#44; memory doses are unnecessary&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">It is recommended that the immune state of the hepatitis B vaccine be assessed&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Not a vaccine but included to illustrate the indication for prophylaxis&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Recommended vaccines depending on the destination and malaria prophylaxis&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "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=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Yellow fever&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The immunosenescence of the elderly favors an increase in viral replication&#46; Severe adverse effects therefore occur more frequently&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diphtheria and tetanus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The vaccine dose should be repeated every 10 years&#44; up to 65 years&#46; Has good effectiveness in individuals older than 65 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Influenza&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Seroconversion depends on the type of vaccination&#44; varying between 17&#37; and 58&#37;&#46; Advantages&#58; decreases the number of hospitalizations by 10&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pneumococcus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The sequential use of the pneumococcal vaccine is recommended&#44; starting with the 13-valent pneumococcal conjugate vaccine&#44; followed by the 23-valent pneumococcal polysaccharide vaccine&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hepatitis A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The approximate seroconversion rate of 60&#37; in individuals older than 50 years&#44; compared with 90&#8211;100&#37; in younger individuals after the first dose&#46; The rate increases to 97&#37; after the second dose&#46; At least 2 doses are recommended for elderly travelers&#46; The vaccine should be administered to elderly individuals up to 4 weeks before traveling&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hepatitis B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The seroconversion rates are lower for individuals older than 65 years&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Rabies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Has an adequate response after completing the full immunization&#44; but the antibody levels reached are lower than those in younger individuals&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Typhoid fever&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">There have been no studies that have shown the efficacy in the elderly traveler&#59; the effectiveness is therefore unknown&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1883039.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Main differences in the effect of vaccines in populations younger and older than 65 years&#46;</p>"
        ]
      ]
      2 => array:9 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "Source&#58; Medscape&#46; <a class="elsevierStyleInterRef" target="_blank" id="intr0005" href="https://reference.medscape.com/drug-interactionchecker">https&#58;&#47;&#47;reference&#46;medscape&#46;com&#47;drug-interactionchecker</a>&#41;&#46;"
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Drug&nbsp;\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">Interactions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mefloquine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The combination with the following drugs causes no interactions&#58; warfarin&#44; metformin&#44; levofloxacin&#44; acetazolamide&#44; digoxin&#44; analgesics&#46;<br>The combination with the following drugs increases the risk of arrhythmias&#58; calcium antagonists&#46;<br>Fluoxetine&#47;olanzapine&#46; The combination of these drugs increases the QT interval&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Chloroquine&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The combination with the following drugs causes no interactions&#58; calcium antagonists&#44; metformin&#44; digoxin&#44; levofloxacin&#44; acetazolamide&#44; citalopram&#46;<br>Fluoxetine&#47;olanzapine&#46; The combination of these drugs produces minor interactions such as increased fluoxetine levels&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Atovaquone&#47;proguanil&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The combination with the following drugs causes no interactions&#58; calcium antagonists&#44; metformin&#44; digoxin&#44; levofloxacin&#44; acetazolamide&#44; citalopram&#44; fluoxetine&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Doxycycline&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The combination with the following drugs causes no interactions&#58; calcium antagonists&#44; metformin&#44; digoxin&#44; levofloxacin&#44; acetazolamide&#44; citalopram&#44; fluoxetine&#46;<br>Warfarin&#46; The combination of these drugs produces minor interactions such as hypocoagulability&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Quinolones&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The combination with the following drugs causes no interactions&#58; atorvastatin&#44; calcium antagonists&#44; acetazolamide&#46;<br>Warfarin&#44; metformin&#44; digoxin&#46; The combination of these drugs produces minor interactions&#46;<br>Fluoxetine&#47;olanzapine&#46; The combination of these drugs increases the QT interval&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1883037.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Interactions between the main drugs for long-term use and the drugs employed as prophylaxis for malaria or for traveler&#39;s diarrhea&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0025"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "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=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Main tips for elderly travelers</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Plan the trip in advance &#40;if traveling abroad&#44; go to a specialized center at least 1 month before traveling to assess the vaccine state and schedule the vaccine calendar&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Carry with you an updated report with your personal history and baseline situation&#44; as well as a summary of the medication you are taking&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Carry the necessary medication in your hand luggage for the duration of the trip and some extra in case of loss&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Take in account the time changes when taking your medication&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Be careful of drug interactions among vaccines and prophylactic medication&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Basic coverage of the health insurance</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>The payment of emergency care&#44; either emergency hospitalization or surgery&#46; The diagnostic tests resulting from emergency hospitalization&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>The prescription of medication for a period of time&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Use of ambulances for transfers&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Usually exclude&#58;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pre-existing medical conditions&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Injuries resulting from risky activities&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Injuries resulting from alcohol consumption or the abuse of illegal drugs&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Psychological problems such as panic attacks&#44; anxiety&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Injuries resulting from exposure to contamination or radiation&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sexually transmitted diseases acquired during the trip&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cosmetic and dental operations&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1883036.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Summary of the main tips for elderly travelers and the basic coverage that the health insurance should cover&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0030"
        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at5"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Chronic problems&nbsp;\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">Precautions and recommendations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Extreme temperatures and inadequate hydration can lead to the onset of syncope&#44; dizziness&#44; renal failure and electrolyte disturbances&#46;<br><span class="elsevierStyleItalic">Recommendations</span>&#58; Rehydration and reducing the dosage or stop taking the medication for a while&#46;<br><span class="elsevierStyleItalic">Recommendations</span>&#58; Be careful with antihypertension medication during a trip&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Syncope&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Boosting drug-induced hypotension&#44; dehydration&#44; pulmonary thromboembolism&#44; time changes caused by jet lag&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dehydration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Greater susceptibility due to perspiration from the heat&#44; the taking of diuretics and traveler&#39;s diarrhea&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Cardiopulmonary disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Should be assessed before starting a trip and should remain stable and free of disease for at least 3 weeks&#46; The blood pressure changes during flight can decompensate the underlying disease&#46;<br><span class="elsevierStyleItalic">Recommendations</span>&#58; request supplemental oxygen&#46;<br><span class="elsevierStyleItalic">Recommendations</span>&#58; hand hygiene or the use of a facemask in crowded locations to avoid respiratory superinfections&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Deep vein thrombosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Greater susceptibility due to an insufficient venous system&#44; dehydration&#44; changes in cabin pressure&#44; the same position for long periods&#44; obesity&#44; congestive heart failure and cancer&#46;<br><span class="elsevierStyleItalic">Recommendations</span>&#58; change positions&#44; appropriate hydration&#44; exercise the legs&#44; walk on the airplane or rest every 2<span class="elsevierStyleHsp" style=""></span>h during car trips or use compression stockings&#46;<br><span class="elsevierStyleItalic">Recommendations</span>&#58; In case of risk factors&#44; use low-molecular-weight heparins before the flight&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diabetes mellitus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Recommendations</span>&#58; Take care with the type of food&#44; physical activity during the trip and the time changes&#44; which especially affect travelers who use insulin&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Osteoarticular disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Falls and blows are very common during trips&#46; Physiological aging and loss of reflexes increases the likelihood of falls&#46;<br><span class="elsevierStyleItalic">Recommendations</span>&#58; Be careful with falls and blows&#46;<br><span class="elsevierStyleItalic">Recommendations</span>&#58; Be careful with excessive physical activity during the trip&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dementia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">The stress of a trip&#44; the change in routine&#44; the need to sleep in hotels and jet lag can result in a confusional state for frail elderly travelers&#46;<br><span class="elsevierStyleItalic">Recommendations</span>&#58; Travelers with dementia should travel with a companion&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Constipation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">This is a problem for all ages but increases with age&#44; dehydration and prolonged immobility during the trip&#46;<br><span class="elsevierStyleItalic">Recommendations</span>&#58; dietary and pharmacological measures&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1883041.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Chronic problems in the elderly that can worsen during trips&#46;</p>"
        ]
      ]
      5 => array:5 [
        "identificador" => "tbl0005"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "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" style="border-bottom: 2px solid black">&nbsp;\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">Link&nbsp;\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  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Websites</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Centers for disease Control and Prevention&#44; Senior Citizens&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><a class="elsevierStyleInterRef" target="_blank" id="intr0015" href="https://wwwnc.cdc.gov/travel/page/senior-citizens">https&#58;&#47;&#47;wwwnc&#46;cdc&#46;gov&#47;travel&#47;page&#47;senior-citizens</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Government of Canada&#46; Older Traveler&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><a class="elsevierStyleInterRef" target="_blank" id="intr0020" href="https://travel.gc.ca/travelling/health-safety/older-travellers">https&#58;&#47;&#47;travel&#46;gc&#46;ca&#47;travelling&#47;health-safety&#47;older-travellers</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Travel Health Pro&#46; Older travelers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><a class="elsevierStyleInterRef" target="_blank" id="intr0025" href="https://travelhealthpro.org.uk/factsheet/70/older-travellers">https&#58;&#47;&#47;travelhealthpro&#46;org&#46;uk&#47;factsheet&#47;70&#47;older-travellers</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>U&#46;S&#46; Passports and International Travel&#46; Considerations for Older Travelers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><a class="elsevierStyleInterRef" target="_blank" id="intr0030" href="https://travel.state.gov/content/passports/en/go/older-traveler.html">https&#58;&#47;&#47;travel&#46;state&#46;gov&#47;content&#47;passports&#47;en&#47;go&#47;older-traveler&#46;html</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Australia Government&#46; Department of Foreign Affairs and trade&#46; Smarttraveller&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><a class="elsevierStyleInterRef" target="_blank" id="intr0035" href="http://smartraveller.gov.au/Pages/default.aspx">http&#58;&#47;&#47;smartraveller&#46;gov&#46;au&#47;Pages&#47;default&#46;aspx</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Vaccines and Travel&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><a class="elsevierStyleInterRef" target="_blank" id="intr0040" href="http://www.vacunasyviajes.es/vacunasyviajes/Viajeros_especiales_enfermos.html">http&#58;&#47;&#47;www&#46;vacunasyviajes&#46;es&#47;vacunasyviajes&#47;Viajeros&#95;especiales&#95;enfermos&#46;html</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Fundacion io&#46; Elderly travelers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><a class="elsevierStyleInterRef" target="_blank" id="intr0045" href="http://fundacionio.org/viajar/otros/viajeros%20mayores.html">http&#58;&#47;&#47;fundacionio&#46;org&#47;viajar&#47;otros&#47;viajeros&#37;20mayores&#46;html</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Travel blogs for elderly travelers</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>TravelBlog&#46; The Old Age Travelers&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><a class="elsevierStyleInterRef" target="_blank" id="intr0050" href="https://www.travelblog.org/Bloggers/The-Old-Age-Travellers">https&#58;&#47;&#47;www&#46;travelblog&#46;org&#47;Bloggers&#47;The-Old-Age-Travellers</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lonely planet Thorn Tree forum&#46; Older Traveler&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><a class="elsevierStyleInterRef" target="_blank" id="intr0055" href="https://www.lonelyplanet.com/thorntree/forums/older-travellers">https&#58;&#47;&#47;www&#46;lonelyplanet&#46;com&#47;thorntree&#47;forums&#47;older-travellers</a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1883040.png"
              ]
            ]
          ]
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:28 [
            0 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "Available at&#58; <a class="elsevierStyleInterRef" target="_blank" id="intr0060" href="http://www2.unwto.org/es">http&#58;&#47;&#47;www2&#46;unwto&#46;org&#47;es</a> &#91;accessed 14&#46;12&#46;17&#93;"
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "World Tourism Organization &#40;UNWTO&#41;"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2017"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "Available at&#58; <a class="elsevierStyleInterRef" target="_blank" id="intr0065" href="http://estadisticas.tourspain.es/es-es/estadisticas/familitur/informesdinamicos/paginas/default.aspx">http&#58;&#47;&#47;estadisticas&#46;tourspain&#46;es&#47;es-es&#47;estadisticas&#47;familitur&#47;informesdinamicos&#47;paginas&#47;default&#46;aspx</a> &#91;accessed 14&#46;12&#46;17&#93;"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Subdelegaci&#243;n General de Conocimiento y Estudios Tur&#237;sticos&#46; FAMILITUR"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Ministerio de Energ&#237;a&#44; Turismo y Agencia Digital&#44; Secretaria de Estado de Turismo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2017"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The older traveller&#58; a guide for the health professional"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46; Baker"
                            1 => "G&#46;K&#46; Brink"
                            2 => "S&#46; Lipschitz"
                            3 => "T&#46; Marcolongo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "edicion" => "1st ed&#46;"
                        "fecha" => "2016"
                        "editorial" => "South African Society of Travel Medicine"
                        "editorialLocalizacion" => "Green Stone&#44; South Africa"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The elderly travellers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46;C&#46; Cooper"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.tmaid.2005.06.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Travel Med Infect Dis"
                        "fecha" => "2006"
                        "volumen" => "4"
                        "paginaInicial" => "218"
                        "paginaFinal" => "222"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16887743"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Australian senior adventure travellers to Peru&#58; maximising older tourists&#8217; travel health experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "I&#46; Bauer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.tmaid.2012.03.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Travel Med Infect Dis"
                        "fecha" => "2012"
                        "volumen" => "10"
                        "paginaInicial" => "59"
                        "paginaFinal" => "68"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22459635"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Elderly travellers&#58; review and advices"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46; Eperon"
                            1 => "F&#46; Chappuis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Med Suisse"
                        "fecha" => "2015"
                        "volumen" => "11"
                        "paginaInicial" => "1028"
                        "paginaFinal" => "1032"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26103767"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The elderly travellers"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Forest"
                            1 => "M&#46; Brihier"
                            2 => "M&#46; Verny"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.lpm.2012.05.032"
                      "Revista" => array:6 [
                        "tituloSerie" => "Presse Med"
                        "fecha" => "2013"
                        "volumen" => "42"
                        "paginaInicial" => "209"
                        "paginaFinal" => "216"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23305909"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Health advice for older people travelling overseas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;C&#46; Wong"
                            1 => "H&#46; Simons"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.7748/nop2012.11.24.9.14.c9365"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nurs Older People"
                        "fecha" => "2012"
                        "volumen" => "24"
                        "paginaInicial" => "14"
                        "paginaFinal" => "19"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23311276"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines for the prevention of travel-associated illness in older adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "T&#46;K&#46; Lee"
                            1 => "J&#46;N&#46; Hutter"
                            2 => "J&#46; Masel"
                            3 => "C&#46; Joya"
                            4 => "T&#46;J&#46; Whitman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s40794-017-0054-0"
                      "Revista" => array:5 [
                        "tituloSerie" => "Trop Dis Travel Med Vaccines"
                        "fecha" => "2017"
                        "volumen" => "3"
                        "paginaInicial" => "10"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28883980"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Health and well-being factors associated with international business travel"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;D&#46; Burkholder"
                            1 => "R&#46; Joines"
                            2 => "M&#46; Cunningham-Hill"
                            3 => "B&#46; Xu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1708-8305.2010.00441.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Travel Med"
                        "fecha" => "2010"
                        "volumen" => "17"
                        "paginaInicial" => "329"
                        "paginaFinal" => "333"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20920054"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Immunosenescence&#58; a product of the environment&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;M&#46; Su"
                            1 => "D&#46; Aw"
                            2 => "D&#46;B&#46; Palmer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.coi.2013.05.018"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Immunol"
                        "fecha" => "2013"
                        "volumen" => "25"
                        "paginaInicial" => "498"
                        "paginaFinal" => "550"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23809359"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Updated recommendations for use of tetanus toxoid&#44; reduced diphtheria toxoid&#44; and acellular pertussis &#40;TDAP&#41; vaccine in adults aged 65 years and older &#8212; Advisory Committee on Immunization Practices &#40;ACIP&#41;&#44; 2012"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "Centers for Disease Control and Prevention &#40;CDC&#41;"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Morb Mortal Wkly Rep"
                        "fecha" => "2012"
                        "volumen" => "29"
                        "paginaInicial" => "468"
                        "paginaFinal" => "470"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Inmunidad a la difteria en una poblaci&#243;n anciana"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Velarde-Mayol"
                            1 => "J&#46;&#193;&#46; G&#243;mez de Caso"
                            2 => "&#193;&#46; Gil de Miguel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;"
                        "fecha" => "2005"
                        "volumen" => "125"
                        "paginaInicial" => "409"
                        "paginaFinal" => "411"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Elderly subjects have a delayed antibody response and prolonged viraemia following yellow fever vaccination&#58; a prospective controlled cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;H&#46; Roukens"
                            1 => "D&#46; Soonawala"
                            2 => "S&#46;A&#46; Joosten"
                            3 => "A&#46;W&#46; de Visser"
                            4 => "X&#46; Jiang"
                            5 => "K&#46; Dirksen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "PLoS ONE"
                        "fecha" => "2011"
                        "volumen" => "6"
                        "paginaInicial" => "1"
                        "paginaFinal" => "6"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Centers for Disease Control and Prevention &#40;CDC&#41;&#44; Yellow Fever Vaccine Booster Doses&#58; Recommendations of the Advisory Committee on Immunization Practices&#44; 2015"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;E&#46; Staples"
                            1 => "J&#46;A&#46; Bocchini Jr&#46;"
                            2 => "L&#46; Rubin"
                            3 => "M&#46; Fischer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Morb Mortal Wkly Rep"
                        "fecha" => "2015"
                        "volumen" => "64"
                        "paginaInicial" => "647"
                        "paginaFinal" => "650"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Malaria in the returning older traveler"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "N&#46; Allen"
                            1 => "C&#46; Bergin"
                            2 => "S&#46;P&#46; Kennelly"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s40794-016-0018-9"
                      "Revista" => array:5 [
                        "tituloSerie" => "Trop Dis Travel Med Vaccines"
                        "fecha" => "2016"
                        "volumen" => "2"
                        "paginaInicial" => "2"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28883946"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The older traveller"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;L&#46; Giles"
                            1 => "T&#46;A&#46; Ruff"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Aust J Hosp Pharm"
                        "fecha" => "1999"
                        "volumen" => "29"
                        "paginaInicial" => "222"
                        "paginaFinal" => "226"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Travel vaccines and eldery person&#58; review of vaccines available in the Unites States"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "K&#46; Leder"
                            1 => "P&#46;F&#46; Wellwer"
                            2 => "M&#46;E&#46; Wilson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/322968"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2001"
                        "volumen" => "33"
                        "paginaInicial" => "1553"
                        "paginaFinal" => "1566"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11588700"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chronic illnesses in travelers to developing countries"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Stienlauf"
                            1 => "B&#46; Streltsin"
                            2 => "E&#46; Meltzer"
                            3 => "E&#46; Kopel"
                            4 => "E&#46; Leshem"
                            5 => "G&#46; Segal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.tmaid.2014.10.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Travel Med Infect Dis"
                        "fecha" => "2014"
                        "volumen" => "12"
                        "paginaInicial" => "757"
                        "paginaFinal" => "763"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25457305"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Potential drug interactions in travelers with chronic illnesses&#58; a large retrospective cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Stienlauf"
                            1 => "E&#46; Meltzer"
                            2 => "D&#46; Kurnik"
                            3 => "E&#46; Leshem"
                            4 => "E&#46; Kopel"
                            5 => "B&#46; Streltsin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.tmaid.2014.04.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Travel Med Infect Dis"
                        "fecha" => "2014"
                        "volumen" => "12"
                        "paginaInicial" => "499"
                        "paginaFinal" => "504"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24867407"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dosing antiretroviral medication when crossing time zones"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;M&#46; Lewis"
                            1 => "A&#46; Volny-Anne"
                            2 => "C&#46; Waitt"
                            3 => "M&#46; Boffito"
                            4 => "S&#46; Khoo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/QAD.0000000000000920"
                      "Revista" => array:6 [
                        "tituloSerie" => "AIDS"
                        "fecha" => "2016"
                        "volumen" => "30"
                        "paginaInicial" => "267"
                        "paginaFinal" => "271"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26684823"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "Available at&#58; <a class="elsevierStyleInterRef" target="_blank" id="intr0070" href="http://www.incb.org/incb/en/publications/Guidelines.html">www&#46;incb&#46;org&#47;incb&#47;en&#47;publications&#47;Guidelines&#46;html</a> &#91;accessed 14&#46;12&#46;17&#93;"
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "The International Narcotics Control Board &#40;INCB&#41;"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2017"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "Available at&#58; <a class="elsevierStyleInterRef" target="_blank" id="intr0075" href="http://www.aena.com/">www&#46;AENA&#46;com</a> &#91;accessed 14&#46;12&#46;17&#93;"
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "Agencia Espa&#241;ola de Navegaci&#243;n A&#233;rea &#40;AENA&#41;"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2017"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "Available at&#58; <a class="elsevierStyleInterRef" target="_blank" id="intr0080" href="http://www.lufthansa.com/es/es/Consejos-para-pasajeros-de-la-tercera-edad">http&#58;&#47;&#47;www&#46;lufthansa&#46;com&#47;es&#47;es&#47;Consejos-para-pasajeros-de-la-tercera-edad</a> &#91;accessed 14&#46;12&#46;17&#93;"
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "Lufthansa&#44; Consejos para pasajeros de la tercera edad"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2017"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:3 [
                  "comentario" => "Available at&#58; <a class="elsevierStyleInterRef" target="_blank" id="intr0085" href="https://www.finnair.com/se/gb/information-services/before-the-flight/special-services-health/elderly-passengers">https&#58;&#47;&#47;www&#46;finnair&#46;com&#47;se&#47;gb&#47;information-services&#47;before-the-flight&#47;special-services-health&#47;elderly-passengers</a> &#91;accessed 14&#46;12&#46;17&#93;"
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "Finnair&#44; Special services health"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2017"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Travel insurance claims made by travelers from Australia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46;A&#46; Leggat"
                            1 => "F&#46;W&#46; Leggat"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Travel Med"
                        "fecha" => "2002"
                        "volumen" => "9"
                        "paginaInicial" => "59"
                        "paginaFinal" => "65"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12044271"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fitness to travel &#8212; assessment in the elderly and medically impaired"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "P&#46; Fenner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Aust Fam Physician"
                        "fecha" => "2007"
                        "volumen" => "36"
                        "paginaInicial" => "312"
                        "paginaFinal" => "315"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17492063"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Travel-associated illness in older adults &#40;&#62;60 y&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Gautret"
                            1 => "J&#46; Gaudart"
                            2 => "K&#46; Leder"
                            3 => "E&#46; Schwartz"
                            4 => "F&#46; Castelli"
                            5 => "P&#46;L&#46; Lim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1708-8305.2012.00613.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Travel Med"
                        "fecha" => "2012"
                        "volumen" => "19"
                        "paginaInicial" => "169"
                        "paginaFinal" => "177"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22530824"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/22548874/0000021800000008/v1_201810300615/S2254887418300730/v1_201810300615/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "48740"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Reviews"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/22548874/0000021800000008/v1_201810300615/S2254887418300730/v1_201810300615/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887418300730?idApp=WRCEE"
]
Article information
ISSN: 22548874
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2023 March 6 3 9
2021 April 1 0 1
2020 September 0 1 1
2018 May 0 1 1

Follow this link to access the full text of the article

Idiomas
Revista Clínica Española (English Edition)
es en

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

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