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&#40;datos no publicados&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Hasta este momento&#44; la poblaci&#243;n viajera considerada como de mayor riesgo ha sido la de los inmigrantes establecidos en Europa que viajan a sus pa&#237;ses de origen&#59; los llamados &#171;viajeros que visitan amigos y familiares&#187; &#40;VFA&#41;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">3&#8211;6</span></a>&#46; Su mayor riesgo se justifica por la mayor duraci&#243;n de sus viajes y el contacto estrecho con la poblaci&#243;n local&#46; No obstante&#44; algunos autores advierten del aumento de enfermedades importadas&#44; graves&#44; adquiridas por el colectivo de VML<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">7</span></a>&#46; Los motivos aducidos se atribuyen sobre todo a unas estancias que podr&#237;an ser tan largas o m&#225;s que las de los VFA<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">8</span></a>&#44; o a la acumulaci&#243;n de m&#250;ltiples desplazamientos m&#225;s cortos&#44; que no siempre van precedidos de medidas preventivas<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Hasta la fecha no constan estudios similares a este ni en PubMed&#44; EMBASE ni sumarios del &#205;ndice Biom&#233;dico Espa&#241;ol &#40;IME-biomedicina&#41;&#46; El presente estudio debe considerarse en su conjunto como una aproximaci&#243;n al problema de las infecciones del viajero&#44; que pretende aportar algunos datos que permitan generar nuevas hip&#243;tesis y suscitar el debate y la opini&#243;n de los expertos&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Estudio observacional retrospectivo que incluye todos los VML que han sido visitados en la Unidad de referencia de Salud Internacional del &#225;rea de estudio &#40;PROSICS Metropolitana Nord&#44; Santa Coloma de Gramenet&#44; Catalunya&#44; Espa&#241;a&#41;&#46; Esta unidad atiende a 1&#46;400&#46;000 personas de la zona metropolitana norte de Barcelona y pertenece al principal proveedor p&#250;blico de servicios de salud en Catalunya &#40;<span class="elsevierStyleItalic">Institut Catal&#224; de la Salut</span>&#41;&#44; aunque los viajeros deben realizar un copago simb&#243;lico que incluye el Consejo a Viajeros y la vacunaci&#243;n internacional&#46; Los datos fueron obtenidos mediante el an&#225;lisis de los cuestionarios de los viajeros atendidos en visitas previas al viaje en 2007&#44; por ser el a&#241;o anterior a la fecha considerada de inicio de la crisis &#40;2008&#44; quiebra de Lehman Brothers&#41;&#46; Nuevamente se obtuvieron datos 5 a&#241;os despu&#233;s&#44; en 2012&#44; cuando la crisis se consideraba ya establecida&#46; Paralelamente se revisaron los datos recogidos durante el periodo 2007 al 2012 para observar la evoluci&#243;n del porcentaje de VML respecto al n&#250;mero total de viajeros que realizaron consulta previa al viaje en nuestra unidad&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Se defini&#243; como VML aquel viajero cuyo motivo declarado de desplazamiento al extranjero era llevar a cabo actividades relacionadas con los negocios&#44; los servicios t&#233;cnicos o la mano de obra&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Se analizaron las siguientes variables&#58; edad&#44; sexo&#44; destino del viaje dividido en zonas geogr&#225;ficas &#40;&#193;frica subsahariana&#47;Subcontinente indio&#47;Sudeste de Asia&#47;Centroam&#233;rica y Sudam&#233;rica&#41;&#44; duraci&#243;n del viaje &#40;&#60;1 mes&#44; 1-3 meses&#44; 3-6 meses&#44;<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>6 meses&#41;&#44; tipo de VML seg&#250;n su pa&#237;s de origen aut&#243;ctono &#40;nacido en Espa&#241;a&#41; o inmigrante &#40;nacido fuera de Espa&#241;a&#41;&#44; zona en el destino &#40;rural&#47;urbana&#41;&#44; uso del tratamiento preventivo para la malaria &#40;s&#237;&#47;no&#47;autotratamiento&#41;&#44; existencia de comorbilidades &#40;s&#237;&#47;no&#41; y caracter&#237;sticas de las comorbilidades&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">A fin de caracterizar mejor la serie de VML&#44; se tom&#243; como grupo control una muestra seleccionada de forma aleatoria de VFA &#40;1&#58;1&#41; de personas que hubieran viajado durante los mismos periodos de 2007 y 2012&#44; y se compararon las variables de estudio&#46; Los datos se analizaron por medio del programa Stata 10&#44; versi&#243;n de software 10&#46;0 &#40;Stata Corporation&#44; Texas&#41;&#46; Se aplic&#243; la prueba de Chi-cuadrado para comparar variables cualitativas y la t de Student para comparar variables cuantitativas&#46; Se realiz&#243; la regresi&#243;n log&#237;stica bivariante para determinar la asociaci&#243;n de variables y un test de tendencia &#40;IRR&#58; test de riesgo relativo de incidencia&#41; por medio de una regresi&#243;n de Poisson&#46; Se consideraron estad&#237;sticamente significativos aquellos valores de p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0045" class="elsevierStylePara elsevierViewall">Durante los a&#241;os 2007 y 2012 fueron atendidos un total de 9&#46;197 viajeros&#44; de los que declararon desplazarse por motivos laborales 344 &#40;3&#44;74&#37;&#41;&#59; en 2007 fueron 101 &#40;2&#44;8&#37;&#41; y en 2012 fueron 243 &#40;4&#44;5&#37;&#41;&#44; lo que supone un incremento de 142 viajeros &#40;58&#44;7&#37;&#59; p&#60; 0&#44;001&#41;&#46; La evoluci&#243;n del n&#250;mero de VML durante el periodo se muestra en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46; y los datos sociodemogr&#225;ficos relacionados con los viajes en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; El destino m&#225;s frecuente fue el &#193;frica subsahariana &#40;47&#44;6&#37;&#41;&#46; Un 88&#44;9&#37; de los viajeros hab&#237;an nacido en Espa&#241;a y el 63&#44;95&#37; de los viajeros se desplazaban a zonas rurales&#46; El 23&#44;2&#37; de los viajeros declararon tener comorbilidades&#44; siendo las m&#225;s frecuentes depresi&#243;n&#44; cardiopat&#237;a&#44; psoriasis&#44; asma y diabetes&#44; por orden de frecuencia&#46; Recib&#237;an medicaci&#243;n cr&#243;nica inmunosupresora 5 viajeros &#40;6&#44;2&#37;&#41;&#44; y una &#40;1&#44;2&#37;&#41; era una mujer embarazada &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">El aumento en el n&#250;mero de VML durante el periodo de estudio se traduce en la significaci&#243;n del test de tendencia &#40;IRR&#58; 1&#44;62&#59; IC&#58; 1&#44;59-1&#44;66&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Adem&#225;s&#44; hubo un aumento significativo en la proporci&#243;n de varones &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;006&#41;&#44; en la edad &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#44; en la proporci&#243;n de VML con estancias prolongadas &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; en los desplazamientos a zonas rurales &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;009&#41;&#44; y en la presencia de comorbilidades &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;018&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Las caracter&#237;sticas de los VML y VFA se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> y el an&#225;lisis comparativo entre los VFA del 2007 y los del 2012 en la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0055" class="elsevierStylePara elsevierViewall">El presente estudio pretende reflejar los efectos de un periodo de crisis econ&#243;mica en los VML&#44; al menos de aquellos que son atendidos en una Unidad de Salud Internacional&#46; Nuestros resultados muestran un aumento del n&#250;mero de los VML y cabe preguntarse si su perfil es de alto riesgo&#44; como el de los VFA&#44; o bien se asemeja al de los viajeros por motivos tur&#237;sticos&#46; La respuesta a esta cuesti&#243;n tiene importantes implicaciones de salud&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Se ha observado un aumento no significativo en el n&#250;mero absoluto y la proporci&#243;n de viajes al &#193;frica subsahariana &#40;44&#44;5&#37; en 2007&#44; frente a 50&#44;2&#37; en 2012&#41;&#44; junto con un aumento en la media de d&#237;as de estancia&#46; Por lo tanto&#44; teniendo en cuenta que aproximadamente el 90&#37; de los casos importados de malaria en Europa provienen del &#193;frica subsahariana<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">10</span></a>&#44; es muy probable que aumente el riesgo de paludismo&#44; incluso grave en relaci&#243;n a la mayor edad de los VML&#46; En consecuencia deber&#237;a replantearse a qui&#233;n y por cu&#225;nto tiempo deber&#237;a mantenerse el tratamiento preventivo antipal&#250;dico&#44; as&#237; como el papel del autotratamiento en el contexto de viajes de larga duraci&#243;n<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Aunque la duraci&#243;n de los viajes y el tiempo de estancia en zonas rurales del conjunto de los VML podr&#237;an ser similares a los de los VFA&#44; no se tiene conocimiento de que la percepci&#243;n del riesgo sea diferente entre ambos grupos&#44; lo cual puede repercutir en la actitud frente a la adopci&#243;n de medidas preventivas por parte de los viajeros&#46; En nuestro estudio&#44; los VFA tambi&#233;n muestran un aumento del n&#250;mero de desplazamientos aunque sin otras modificaciones esenciales que supongan una alteraci&#243;n de su perfil de riesgo respecto a periodos previos&#46; Existe evidencia acerca de la menor percepci&#243;n del riesgo de enfermedad de los VFA durante su estancia en el extranjero&#44; as&#237; como una menor adherencia a la quimioprofilaxis antipal&#250;dica en viajeros por motivos tur&#237;sticos<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">12</span></a>&#46; La percepci&#243;n habitual entre los profesionales de salud internacional tiende a contemplar a los VML como una poblaci&#243;n bien informada de las enfermedades transmitidas por los mosquitos&#44; por v&#237;a sexual&#44; por agua o alimentos y de los riesgos no infecciosos&#46; No obstante&#44; podr&#237;a no ser as&#237;&#46; De hecho&#44; algunos expertos coinciden con nuestros resultados e incluyen a los VML en un perfil de riesgo similar a los VFA<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">13</span></a>&#44; aunque como se coment&#243;&#44; no existen estudios extensos que lo respalden&#46; Existen evidencias aisladas acerca de un pobre cumplimiento&#44; tanto de la prevenci&#243;n antimosquitos&#44; como de la quimioprofilaxis antipal&#250;dica&#44; de los VML en comparaci&#243;n con los turistas<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">14&#8211;16</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">En el presente estudio tambi&#233;n se encuentra un aumento en la edad de los VML y la presencia de comorbilidades que los hacen m&#225;s susceptibles a sufrir ciertas enfermedades o riesgos asociados con los viajes<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">17</span></a>&#46; La enfermedad identificada con mayor frecuencia fue la depresi&#243;n&#46; La depresi&#243;n puede estar relacionada con la adaptaci&#243;n y&#44; por lo tanto&#44; podr&#237;a agravarse cuando se viaja a otro pa&#237;s&#44; lejos de la familia y en un contexto social y ambiental desconocidos&#46; En un estudio en el que se compararon 2&#46;962 viajeros internacionales&#44; los VML presentaron significativamente un mayor consumo de alcohol&#44; problemas de insomnio&#44; disminuci&#243;n en la confianza para mantenerse al d&#237;a en el trabajo&#44; ansiedad&#44; sensaci&#243;n de choque cultural y problemas de adaptaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">18&#44;19</span></a>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">En un estudio multic&#233;ntrico de la organizaci&#243;n GeoSentinel realizado durante 5 a&#241;os &#40;2007-2011&#41; se analizaron datos de 42&#46;173 viajeros con enfermedades importadas&#46; Entre ellos&#44; 7 de las 28 &#40;25&#37;&#41; muertes registradas correspond&#237;an a VML&#44; tres por malaria grave<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">20</span></a>&#46; En consecuencia&#44; parece razonable incidir en los conocimientos&#44; actitudes y pr&#225;cticas preventivas de los VML&#44; con especial hincapi&#233; en la prevenci&#243;n de la malaria<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">21</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Espa&#241;a ha sufrido los efectos de una crisis econ&#243;mica que ha elevado las tasas de paro por encima del 20&#37;&#46; M&#225;s de 82&#46;000 espa&#241;oles emigraron en busca de una oportunidad laboral en el 2012&#44; lo que signific&#243; un incremento de un 5&#44;5&#37; con respecto al 2011<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">22</span></a>&#46; Por primera vez en m&#225;s de 20 a&#241;os&#44; la tendencia migratoria en el 2013<span class="elsevierStyleHsp" style=""></span>ha sido negativa&#46; Si este flujo se mantiene a medio plazo&#44; Espa&#241;a podr&#237;a asemejarse a pa&#237;ses como los Estados Unidos u otros pa&#237;ses europeos en los que el n&#250;mero de VML es similar al de los VFA<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">23</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">En resumen&#44; en Espa&#241;a el perfil de riesgo de los VML podr&#237;a considerarse alto&#44; m&#225;s cercano al de los VFA&#44; entre los que la incidencia de enfermedades importadas es m&#225;s elevada que entre los que viajan como turistas&#46; Nuestro estudio es pionero en Espa&#241;a y en Europa&#44; por lo que son necesarios nuevos estudios para contrastar los datos obtenidos y determinar si realmente el aumento del riesgo en los viajes se acompa&#241;a de un aumento de las enfermedades importadas&#46; Los profesionales de la salud deben ser conscientes de esta realidad e identificar factores de riesgo de los VML&#44; especialmente los sujetos de m&#225;s edad o con problemas m&#233;dicos subyacentes&#46; Sobre ellos deben centrarse las actividades preventivas&#44; para proporcionar una informaci&#243;n comprensible&#44; realista y aplicable&#46; Igualmente deben tenerse en cuenta los nuevos perfiles de riesgo de los viajeros para la toma de decisiones con relaci&#243;n a las vacunas y a la quimioprofilaxis contra el paludismo&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Los VML representan un nuevo perfil de viajeros de alto riesgo y conviene tenerlo presente tanto en las Unidades de Salud Internacional&#44; donde se pueden minimizar algunos riesgos a trav&#233;s de los consejos previos al viaje&#44; las recomendaciones sobre vacunas y la quimioprofilaxis antipal&#250;dica&#59; como en el resto de estructuras sanitarias&#44; donde se debe considerar atentamente el antecedente de un viaje internacional a zonas de riesgo&#44; especialmente entre los sujetos m&#225;s predispuestos&#44; ante la sospecha de cualquier infecci&#243;n importada<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">24</span></a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicto de intereses</span><p id="par0095" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La crisis econ&#243;mica mundial condiciona la migraci&#243;n de trabajadores europeos hacia pa&#237;ses en v&#237;as de desarrollo con alta incidencia de enfermedades infecciosas&#46; El objetivo de este estudio es valorar si este contexto produce un aumento de los riesgos de los viajeros internacionales que se desplazan por motivos laborales &#40;VML&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional retrospectivo&#46; La poblaci&#243;n de estudio fueron los VML atendidos antes de su viaje en una Unidad de Salud Internacional durante los a&#241;os 2007 &#40;a&#241;o anterior al inicio de la crisis europea&#41; y 2012 &#40;con la crisis estructural establecida&#41;&#46; Se realiz&#243; un an&#225;lisis comparativo sociodemogr&#225;fico y de los factores de riesgo presentes entre ambos grupos&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">En 2007 y 2012 se atendieron un total de 9&#46;197 viajeros&#46; Los VML fueron 344 &#40;3&#44;4&#37;&#41;&#59; en 2007&#44; 101 &#40;2&#44;8&#37;&#41; y en 2012&#44; 243 &#40;4&#44;5&#37;&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; La edad media de los viajeros fue de 38&#44;1 &#40;DE&#58; 10&#44;57&#41; a&#241;os&#46; El destino m&#225;s frecuente fue &#193;frica subsahariana con 164 &#40;47&#44;6&#37;&#41; casos&#46; Se prescribi&#243; quimioprofilaxis antipal&#250;dica a 152 &#40;44&#37;&#41; y presentaban comorbilidades 80 &#40;23&#44;25&#37;&#41;&#46; Los VML del 2012 presentaron significativamente mayor edad &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#44; m&#225;s comorbilidades &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;018&#41;&#44; y mayor proporci&#243;n de estancias en zonas rurales &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;009&#41; durante periodos m&#225;s largos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A 5 a&#241;os del inicio de la crisis econ&#243;mica&#44; existe una variaci&#243;n en el perfil del VML&#46; Su n&#250;mero ha aumentado significativamente&#44; as&#237; como la proporci&#243;n de los que presentan factores de riesgo para contraer enfermedades importadas&#46; Las Unidades de Salud Internacional deber&#237;an adaptarse a las nuevas circunstancias y adoptar medidas preventivas en dicho colectivo&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The economic world crisis has led to the migration of European workers to developing countries with a high incidence of infectious diseases&#46; The objective of this study was to assess whether this context has produced an increase in the risks to international travellers for work reasons &#40;TWR&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Observational&#44; retrospective study&#46; The study population included TWR who were attended before travelling at an International Health Unit in the year 2007 &#40;the year before the initiation of the European crisis&#41; and in the year 2012 &#40;when the structural crisis was established&#41;&#46; A comparative socioeconomic analysis was performed as well as an analysis of the risk factors present in both groups&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">In 2007 and 2012 a total of 9&#44;197 travellers were attended&#46; Of these&#44; there were 344 TWR &#40;3&#46;4&#37;&#41;&#59; 101 TWR &#40;2&#46;8&#37;&#41; in 2007 and 243 TWR &#40;4&#46;5&#37;&#41; in 2012 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; The average age of the travellers was 38&#46;1 years &#40;SD&#58; 10&#46;57&#41;&#46; The most common destination was Sub-Saharan Africa&#44; in 164 &#40;47&#46;6&#37;&#41; of the cases&#46; Malaria chemoprophylaxis was prescribed to 152 travellers &#40;44&#37;&#41; and 80 presented comorbidity &#40;23&#46;25&#37;&#41;&#46; The TWR from 2012 presented a significantly greater age &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; more comorbidity &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;018&#41; and a greater proportion of stays in rural areas &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0009&#41; for longer time periods &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">At 5 years from the start of the economic crisis&#44; there was a change in the profile of TWR&#46; Their number has increased significantly&#44; as has the proportion who present risk factors for contracting imported diseases&#46; The International Health Units should adapt to these new circumstances and adopt preventive measures for this population&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introduction"
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            "identificador" => "abst0030"
            "titulo" => "Methods"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusions"
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        "descripcion" => array:1 [
          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Porcentaje de viajeros por motivo laboral atendidos en la Unidad de Salud Internacional Metropolitana Norte del 2007 al 2012 &#40;test de tendencia 2007-2012 &#40;IRR&#41;&#58; 1&#46;62&#59; IC&#58; 1&#44;59-1&#44;66&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&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">N&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">&#37;&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">2007&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">2012&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">P<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><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="" 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">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>101&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">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>243&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><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></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Sexo</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hombre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">262&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">76&#44;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">67 &#40;66&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">195 &#40;80&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Edad&#40;mediana&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&#44;1&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">36&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;05&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="6" 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="6" align="left" valign="top"><span class="elsevierStyleItalic">Regi&#243;n de destino</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#193;frica subsahariana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">164&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47&#44;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45 &#40;44&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">122 &#40;50&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Subcontinente indio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7&#44;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;8&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 &#40;8&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sudam&#233;rica y Centroam&#233;rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#44;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28 &#40;27&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65 &#40;26&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sudeste asi&#225;tico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;18&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 &#40;13&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;42&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="6" 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="6" align="left" valign="top"><span class="elsevierStyleItalic">Duraci&#243;n del viaje</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804; 1 mes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">185&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74 &#40;73&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">111 &#40;45&#44;6&#37;&#41;&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" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1-<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>3 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#44;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;15&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71 &#40;29&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3-<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>6meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#44;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;7&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;9&#44;8&#37;&#41;&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" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;6 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#44;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;2&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36 &#40;14&#44;8&#37;&#41;&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" title="table-entry  " colspan="6" 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="6" align="left" valign="top"><span class="elsevierStyleItalic">&#193;rea visitada</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Rural&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">220&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63&#44;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54 &#40;53&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">166 &#40;68&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Urbana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">124&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47 &#40;46&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77 &#40;31&#44;6&#37;&#41;&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" title="table-entry  " colspan="6" 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="6" align="left" valign="top"><span class="elsevierStyleItalic">Tipo de viaje</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Aut&#243;ctonos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">306&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88&#44;9&#37;&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" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Inmigrantes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#37;&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" title="table-entry  " colspan="6" 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="6" 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="6" align="left" valign="top"><span class="elsevierStyleItalic">Prevenci&#243;n malaria</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">152&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53 &#40;52&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">128 &#40;52&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Autotratamiento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;4&#37;&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" title="table-entry  " colspan="6" 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="6" align="left" valign="top"><span class="elsevierStyleItalic">Comorbilidades</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#44;25&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23 &#40;22&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57 &#40;23&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48 &#40;35&#44;3&#41;&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
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">122&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;38&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;27&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;08&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="4" 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="4" align="left" valign="top"><span class="elsevierStyleItalic">Duraci&#243;n del viaje</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804; 1 mes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">111&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1-<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>3 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">107&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3-<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>6meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;6 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;001&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="4" 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="4" align="left" valign="top"><span class="elsevierStyleItalic">&#193;rea visitada</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Rural&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">152&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">162&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" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Urbana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;04&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="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Prevenci&#243;n malaria</span>&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" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">129&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">114&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Autotratamiento</span>&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" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Comorbilidades</span>&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" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis comparativo entre los viajeros por motivo laboral &#40;VML&#41; y una muestra seleccionada de forma aleatoria &#40;1&#58;1&#41; de los viajeros que visitan familiares y amigos &#40;VFA&#41; del 2012</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&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">2007&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">2012&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">P<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&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">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>101&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">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>243&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><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></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Sexo</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hombre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">129&#40;26&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">350 &#40;73&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mujer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73 &#40;34&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">136 &#40;65&#44;1&#41;&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" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Edad&#40;mediana</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;06&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="4" align="left" valign="top"><span class="elsevierStyleItalic">Regi&#243;n de destino</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#193;frica subsahariana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50 &#40;49&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">132 &#40;54&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Subcontinente indio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33 &#40;32&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52 &#40;21&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sudam&#233;rica y Centroam&#233;rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;0&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sudeste asi&#225;tico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;16&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57 &#40;23&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;17&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="4" 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="4" align="left" valign="top"><span class="elsevierStyleItalic">Duraci&#243;n del viaje</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804; 1 mes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29 &#40;28&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88 &#40;36&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1-<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>3 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45 &#40;44&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">107 &#40;44&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3-<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>6meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;26&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42 &#40;17&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;6 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;2&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">&#193;rea visitada</span>&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" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Rural&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71&#40;70&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">152&#40;44&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Urbana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&#40;29&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">91&#40;37&#44;44&#37;&#41;&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" title="table-entry  " colspan="4" 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="4" align="left" valign="top"><span class="elsevierStyleItalic">Prevenci&#243;n malaria</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54&#40;53&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">129 &#40;53&#44;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Autotratamiento</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;2&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 &#40;5&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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ORIGINAL
¿La crisis económica condiciona la aparición de un nuevo perfil de riesgo en viajeros internacionales?
Has the economic crisis led to a new risk profile for international travellers?
S. Rourea,b,c,
Autor para correspondencia
sroura.mn.ics@gencat.cat

Autor para correspondencia.
, O. Pérez-Quíleza, X. Vallèsa, O. Martínez-Cuevasa, M. Sabriàb,c, L. Valerioa,b
a Unidad de Salud Internacional Metropolitana Norte, Institut Català de la Salut, Santa Coloma de Gramenet, Catalunya, España
b Universitat Autònoma de Barcelona, Barcelona, España
c Unidad de Enfermedades Infecciosas, Departamento de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Institut Català de la Salut, Badalona, Catalunya, España
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Porcentaje de viajeros por motivo laboral atendidos en la Unidad de Salud Internacional Metropolitana Norte del 2007 al 2012 &#40;test de tendencia 2007-2012 &#40;IRR&#41;&#58; 1&#46;62&#59; IC&#58; 1&#44;59-1&#44;66&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La vigilancia epidemiol&#243;gica de las enfermedades relacionadas con los viajes es una poderosa herramienta para la detecci&#243;n de enfermedades infecciosas importadas&#44; sobre todo aquellas que tienen repercusi&#243;n en la salud p&#250;blica &#40;como los brotes de dengue y enfermedad de chikungunya que pueden ser transmisibles en Europa&#41;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">1</span></a>&#46; Por tanto&#44; dicha vigilancia espec&#237;fica debe reforzarse cuando el n&#250;mero de viajeros internacionales aumenta por cualquier raz&#243;n&#46; En el marco de la globalizaci&#243;n y en un marcado contexto de crisis econ&#243;mica&#44; cada vez son m&#225;s las personas europeas cualificadas que viajan hacia pa&#237;ses de renta baja&#44; con econom&#237;as emergentes&#44; en busca de nuevas oportunidades de trabajo &#40;p&#46; ej&#46; el crecimiento econ&#243;mico de &#193;frica subsahariana pasar&#225; del 4&#44;7&#37; en 2013 al 5&#44;2&#37; previsto para el 2014<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">2</span></a>&#41;&#46; Estos viajeros&#44; en definitiva&#44; se desplazan a ecosistemas donde existe una alta incidencia de enfermedades infecciosas&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">En un estudio previo realizado en la Unidad de Salut Internacional Metropolitana Norte en 2012 se puso de manifiesto una tendencia al incremento de los viajeros internacionales que se desplazan por motivos laborales &#40;VML&#41; en los &#250;ltimos a&#241;os&#46; Se analizaron 1&#46;227 viajeros &#40;487 del 2008 y 740 del 2011&#41; que en conjunto mostraron un descenso de los viajes por turismo &#40;del 70 al 64&#37;&#41; y un incremento significativo de los viajes por motivo laboral &#40;3&#44;7 al 8&#37;&#41; &#40;datos no publicados&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Hasta este momento&#44; la poblaci&#243;n viajera considerada como de mayor riesgo ha sido la de los inmigrantes establecidos en Europa que viajan a sus pa&#237;ses de origen&#59; los llamados &#171;viajeros que visitan amigos y familiares&#187; &#40;VFA&#41;<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">3&#8211;6</span></a>&#46; Su mayor riesgo se justifica por la mayor duraci&#243;n de sus viajes y el contacto estrecho con la poblaci&#243;n local&#46; No obstante&#44; algunos autores advierten del aumento de enfermedades importadas&#44; graves&#44; adquiridas por el colectivo de VML<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">7</span></a>&#46; Los motivos aducidos se atribuyen sobre todo a unas estancias que podr&#237;an ser tan largas o m&#225;s que las de los VFA<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">8</span></a>&#44; o a la acumulaci&#243;n de m&#250;ltiples desplazamientos m&#225;s cortos&#44; que no siempre van precedidos de medidas preventivas<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Hasta la fecha no constan estudios similares a este ni en PubMed&#44; EMBASE ni sumarios del &#205;ndice Biom&#233;dico Espa&#241;ol &#40;IME-biomedicina&#41;&#46; El presente estudio debe considerarse en su conjunto como una aproximaci&#243;n al problema de las infecciones del viajero&#44; que pretende aportar algunos datos que permitan generar nuevas hip&#243;tesis y suscitar el debate y la opini&#243;n de los expertos&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material y m&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Estudio observacional retrospectivo que incluye todos los VML que han sido visitados en la Unidad de referencia de Salud Internacional del &#225;rea de estudio &#40;PROSICS Metropolitana Nord&#44; Santa Coloma de Gramenet&#44; Catalunya&#44; Espa&#241;a&#41;&#46; Esta unidad atiende a 1&#46;400&#46;000 personas de la zona metropolitana norte de Barcelona y pertenece al principal proveedor p&#250;blico de servicios de salud en Catalunya &#40;<span class="elsevierStyleItalic">Institut Catal&#224; de la Salut</span>&#41;&#44; aunque los viajeros deben realizar un copago simb&#243;lico que incluye el Consejo a Viajeros y la vacunaci&#243;n internacional&#46; Los datos fueron obtenidos mediante el an&#225;lisis de los cuestionarios de los viajeros atendidos en visitas previas al viaje en 2007&#44; por ser el a&#241;o anterior a la fecha considerada de inicio de la crisis &#40;2008&#44; quiebra de Lehman Brothers&#41;&#46; Nuevamente se obtuvieron datos 5 a&#241;os despu&#233;s&#44; en 2012&#44; cuando la crisis se consideraba ya establecida&#46; Paralelamente se revisaron los datos recogidos durante el periodo 2007 al 2012 para observar la evoluci&#243;n del porcentaje de VML respecto al n&#250;mero total de viajeros que realizaron consulta previa al viaje en nuestra unidad&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Se defini&#243; como VML aquel viajero cuyo motivo declarado de desplazamiento al extranjero era llevar a cabo actividades relacionadas con los negocios&#44; los servicios t&#233;cnicos o la mano de obra&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Se analizaron las siguientes variables&#58; edad&#44; sexo&#44; destino del viaje dividido en zonas geogr&#225;ficas &#40;&#193;frica subsahariana&#47;Subcontinente indio&#47;Sudeste de Asia&#47;Centroam&#233;rica y Sudam&#233;rica&#41;&#44; duraci&#243;n del viaje &#40;&#60;1 mes&#44; 1-3 meses&#44; 3-6 meses&#44;<span class="elsevierStyleHsp" style=""></span>&#8805;<span class="elsevierStyleHsp" style=""></span>6 meses&#41;&#44; tipo de VML seg&#250;n su pa&#237;s de origen aut&#243;ctono &#40;nacido en Espa&#241;a&#41; o inmigrante &#40;nacido fuera de Espa&#241;a&#41;&#44; zona en el destino &#40;rural&#47;urbana&#41;&#44; uso del tratamiento preventivo para la malaria &#40;s&#237;&#47;no&#47;autotratamiento&#41;&#44; existencia de comorbilidades &#40;s&#237;&#47;no&#41; y caracter&#237;sticas de las comorbilidades&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">A fin de caracterizar mejor la serie de VML&#44; se tom&#243; como grupo control una muestra seleccionada de forma aleatoria de VFA &#40;1&#58;1&#41; de personas que hubieran viajado durante los mismos periodos de 2007 y 2012&#44; y se compararon las variables de estudio&#46; Los datos se analizaron por medio del programa Stata 10&#44; versi&#243;n de software 10&#46;0 &#40;Stata Corporation&#44; Texas&#41;&#46; Se aplic&#243; la prueba de Chi-cuadrado para comparar variables cualitativas y la t de Student para comparar variables cuantitativas&#46; Se realiz&#243; la regresi&#243;n log&#237;stica bivariante para determinar la asociaci&#243;n de variables y un test de tendencia &#40;IRR&#58; test de riesgo relativo de incidencia&#41; por medio de una regresi&#243;n de Poisson&#46; Se consideraron estad&#237;sticamente significativos aquellos valores de p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Resultados</span><p id="par0045" class="elsevierStylePara elsevierViewall">Durante los a&#241;os 2007 y 2012 fueron atendidos un total de 9&#46;197 viajeros&#44; de los que declararon desplazarse por motivos laborales 344 &#40;3&#44;74&#37;&#41;&#59; en 2007 fueron 101 &#40;2&#44;8&#37;&#41; y en 2012 fueron 243 &#40;4&#44;5&#37;&#41;&#44; lo que supone un incremento de 142 viajeros &#40;58&#44;7&#37;&#59; p&#60; 0&#44;001&#41;&#46; La evoluci&#243;n del n&#250;mero de VML durante el periodo se muestra en la <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46; y los datos sociodemogr&#225;ficos relacionados con los viajes en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; El destino m&#225;s frecuente fue el &#193;frica subsahariana &#40;47&#44;6&#37;&#41;&#46; Un 88&#44;9&#37; de los viajeros hab&#237;an nacido en Espa&#241;a y el 63&#44;95&#37; de los viajeros se desplazaban a zonas rurales&#46; El 23&#44;2&#37; de los viajeros declararon tener comorbilidades&#44; siendo las m&#225;s frecuentes depresi&#243;n&#44; cardiopat&#237;a&#44; psoriasis&#44; asma y diabetes&#44; por orden de frecuencia&#46; Recib&#237;an medicaci&#243;n cr&#243;nica inmunosupresora 5 viajeros &#40;6&#44;2&#37;&#41;&#44; y una &#40;1&#44;2&#37;&#41; era una mujer embarazada &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">El aumento en el n&#250;mero de VML durante el periodo de estudio se traduce en la significaci&#243;n del test de tendencia &#40;IRR&#58; 1&#44;62&#59; IC&#58; 1&#44;59-1&#44;66&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Adem&#225;s&#44; hubo un aumento significativo en la proporci&#243;n de varones &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;006&#41;&#44; en la edad &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#44; en la proporci&#243;n de VML con estancias prolongadas &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; en los desplazamientos a zonas rurales &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;009&#41;&#44; y en la presencia de comorbilidades &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;018&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Las caracter&#237;sticas de los VML y VFA se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a> y el an&#225;lisis comparativo entre los VFA del 2007 y los del 2012 en la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discusi&#243;n</span><p id="par0055" class="elsevierStylePara elsevierViewall">El presente estudio pretende reflejar los efectos de un periodo de crisis econ&#243;mica en los VML&#44; al menos de aquellos que son atendidos en una Unidad de Salud Internacional&#46; Nuestros resultados muestran un aumento del n&#250;mero de los VML y cabe preguntarse si su perfil es de alto riesgo&#44; como el de los VFA&#44; o bien se asemeja al de los viajeros por motivos tur&#237;sticos&#46; La respuesta a esta cuesti&#243;n tiene importantes implicaciones de salud&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Se ha observado un aumento no significativo en el n&#250;mero absoluto y la proporci&#243;n de viajes al &#193;frica subsahariana &#40;44&#44;5&#37; en 2007&#44; frente a 50&#44;2&#37; en 2012&#41;&#44; junto con un aumento en la media de d&#237;as de estancia&#46; Por lo tanto&#44; teniendo en cuenta que aproximadamente el 90&#37; de los casos importados de malaria en Europa provienen del &#193;frica subsahariana<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">10</span></a>&#44; es muy probable que aumente el riesgo de paludismo&#44; incluso grave en relaci&#243;n a la mayor edad de los VML&#46; En consecuencia deber&#237;a replantearse a qui&#233;n y por cu&#225;nto tiempo deber&#237;a mantenerse el tratamiento preventivo antipal&#250;dico&#44; as&#237; como el papel del autotratamiento en el contexto de viajes de larga duraci&#243;n<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Aunque la duraci&#243;n de los viajes y el tiempo de estancia en zonas rurales del conjunto de los VML podr&#237;an ser similares a los de los VFA&#44; no se tiene conocimiento de que la percepci&#243;n del riesgo sea diferente entre ambos grupos&#44; lo cual puede repercutir en la actitud frente a la adopci&#243;n de medidas preventivas por parte de los viajeros&#46; En nuestro estudio&#44; los VFA tambi&#233;n muestran un aumento del n&#250;mero de desplazamientos aunque sin otras modificaciones esenciales que supongan una alteraci&#243;n de su perfil de riesgo respecto a periodos previos&#46; Existe evidencia acerca de la menor percepci&#243;n del riesgo de enfermedad de los VFA durante su estancia en el extranjero&#44; as&#237; como una menor adherencia a la quimioprofilaxis antipal&#250;dica en viajeros por motivos tur&#237;sticos<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">12</span></a>&#46; La percepci&#243;n habitual entre los profesionales de salud internacional tiende a contemplar a los VML como una poblaci&#243;n bien informada de las enfermedades transmitidas por los mosquitos&#44; por v&#237;a sexual&#44; por agua o alimentos y de los riesgos no infecciosos&#46; No obstante&#44; podr&#237;a no ser as&#237;&#46; De hecho&#44; algunos expertos coinciden con nuestros resultados e incluyen a los VML en un perfil de riesgo similar a los VFA<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">13</span></a>&#44; aunque como se coment&#243;&#44; no existen estudios extensos que lo respalden&#46; Existen evidencias aisladas acerca de un pobre cumplimiento&#44; tanto de la prevenci&#243;n antimosquitos&#44; como de la quimioprofilaxis antipal&#250;dica&#44; de los VML en comparaci&#243;n con los turistas<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">14&#8211;16</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">En el presente estudio tambi&#233;n se encuentra un aumento en la edad de los VML y la presencia de comorbilidades que los hacen m&#225;s susceptibles a sufrir ciertas enfermedades o riesgos asociados con los viajes<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">17</span></a>&#46; La enfermedad identificada con mayor frecuencia fue la depresi&#243;n&#46; La depresi&#243;n puede estar relacionada con la adaptaci&#243;n y&#44; por lo tanto&#44; podr&#237;a agravarse cuando se viaja a otro pa&#237;s&#44; lejos de la familia y en un contexto social y ambiental desconocidos&#46; En un estudio en el que se compararon 2&#46;962 viajeros internacionales&#44; los VML presentaron significativamente un mayor consumo de alcohol&#44; problemas de insomnio&#44; disminuci&#243;n en la confianza para mantenerse al d&#237;a en el trabajo&#44; ansiedad&#44; sensaci&#243;n de choque cultural y problemas de adaptaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">18&#44;19</span></a>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">En un estudio multic&#233;ntrico de la organizaci&#243;n GeoSentinel realizado durante 5 a&#241;os &#40;2007-2011&#41; se analizaron datos de 42&#46;173 viajeros con enfermedades importadas&#46; Entre ellos&#44; 7 de las 28 &#40;25&#37;&#41; muertes registradas correspond&#237;an a VML&#44; tres por malaria grave<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">20</span></a>&#46; En consecuencia&#44; parece razonable incidir en los conocimientos&#44; actitudes y pr&#225;cticas preventivas de los VML&#44; con especial hincapi&#233; en la prevenci&#243;n de la malaria<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">21</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Espa&#241;a ha sufrido los efectos de una crisis econ&#243;mica que ha elevado las tasas de paro por encima del 20&#37;&#46; M&#225;s de 82&#46;000 espa&#241;oles emigraron en busca de una oportunidad laboral en el 2012&#44; lo que signific&#243; un incremento de un 5&#44;5&#37; con respecto al 2011<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">22</span></a>&#46; Por primera vez en m&#225;s de 20 a&#241;os&#44; la tendencia migratoria en el 2013<span class="elsevierStyleHsp" style=""></span>ha sido negativa&#46; Si este flujo se mantiene a medio plazo&#44; Espa&#241;a podr&#237;a asemejarse a pa&#237;ses como los Estados Unidos u otros pa&#237;ses europeos en los que el n&#250;mero de VML es similar al de los VFA<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">23</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">En resumen&#44; en Espa&#241;a el perfil de riesgo de los VML podr&#237;a considerarse alto&#44; m&#225;s cercano al de los VFA&#44; entre los que la incidencia de enfermedades importadas es m&#225;s elevada que entre los que viajan como turistas&#46; Nuestro estudio es pionero en Espa&#241;a y en Europa&#44; por lo que son necesarios nuevos estudios para contrastar los datos obtenidos y determinar si realmente el aumento del riesgo en los viajes se acompa&#241;a de un aumento de las enfermedades importadas&#46; Los profesionales de la salud deben ser conscientes de esta realidad e identificar factores de riesgo de los VML&#44; especialmente los sujetos de m&#225;s edad o con problemas m&#233;dicos subyacentes&#46; Sobre ellos deben centrarse las actividades preventivas&#44; para proporcionar una informaci&#243;n comprensible&#44; realista y aplicable&#46; Igualmente deben tenerse en cuenta los nuevos perfiles de riesgo de los viajeros para la toma de decisiones con relaci&#243;n a las vacunas y a la quimioprofilaxis contra el paludismo&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Los VML representan un nuevo perfil de viajeros de alto riesgo y conviene tenerlo presente tanto en las Unidades de Salud Internacional&#44; donde se pueden minimizar algunos riesgos a trav&#233;s de los consejos previos al viaje&#44; las recomendaciones sobre vacunas y la quimioprofilaxis antipal&#250;dica&#59; como en el resto de estructuras sanitarias&#44; donde se debe considerar atentamente el antecedente de un viaje internacional a zonas de riesgo&#44; especialmente entre los sujetos m&#225;s predispuestos&#44; ante la sospecha de cualquier infecci&#243;n importada<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">24</span></a>&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicto de intereses</span><p id="par0095" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "palabras" => array:5 [
            0 => "Viajero internacional"
            1 => "Salud internacional"
            2 => "Viajero por motivo laboral"
            3 => "Enfermedad importada"
            4 => "Crisis econ&#243;mica"
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            0 => "International traveller"
            1 => "International health"
            2 => "Traveller for work reasons"
            3 => "Imported disease"
            4 => "Economic crisis"
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    "resumen" => array:2 [
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La crisis econ&#243;mica mundial condiciona la migraci&#243;n de trabajadores europeos hacia pa&#237;ses en v&#237;as de desarrollo con alta incidencia de enfermedades infecciosas&#46; El objetivo de este estudio es valorar si este contexto produce un aumento de los riesgos de los viajeros internacionales que se desplazan por motivos laborales &#40;VML&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio observacional retrospectivo&#46; La poblaci&#243;n de estudio fueron los VML atendidos antes de su viaje en una Unidad de Salud Internacional durante los a&#241;os 2007 &#40;a&#241;o anterior al inicio de la crisis europea&#41; y 2012 &#40;con la crisis estructural establecida&#41;&#46; Se realiz&#243; un an&#225;lisis comparativo sociodemogr&#225;fico y de los factores de riesgo presentes entre ambos grupos&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">En 2007 y 2012 se atendieron un total de 9&#46;197 viajeros&#46; Los VML fueron 344 &#40;3&#44;4&#37;&#41;&#59; en 2007&#44; 101 &#40;2&#44;8&#37;&#41; y en 2012&#44; 243 &#40;4&#44;5&#37;&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; La edad media de los viajeros fue de 38&#44;1 &#40;DE&#58; 10&#44;57&#41; a&#241;os&#46; El destino m&#225;s frecuente fue &#193;frica subsahariana con 164 &#40;47&#44;6&#37;&#41; casos&#46; Se prescribi&#243; quimioprofilaxis antipal&#250;dica a 152 &#40;44&#37;&#41; y presentaban comorbilidades 80 &#40;23&#44;25&#37;&#41;&#46; Los VML del 2012 presentaron significativamente mayor edad &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#44; m&#225;s comorbilidades &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;018&#41;&#44; y mayor proporci&#243;n de estancias en zonas rurales &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;009&#41; durante periodos m&#225;s largos &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A 5 a&#241;os del inicio de la crisis econ&#243;mica&#44; existe una variaci&#243;n en el perfil del VML&#46; Su n&#250;mero ha aumentado significativamente&#44; as&#237; como la proporci&#243;n de los que presentan factores de riesgo para contraer enfermedades importadas&#46; Las Unidades de Salud Internacional deber&#237;an adaptarse a las nuevas circunstancias y adoptar medidas preventivas en dicho colectivo&#46;</p></span>"
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            "titulo" => "M&#233;todos"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The economic world crisis has led to the migration of European workers to developing countries with a high incidence of infectious diseases&#46; The objective of this study was to assess whether this context has produced an increase in the risks to international travellers for work reasons &#40;TWR&#41;&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Observational&#44; retrospective study&#46; The study population included TWR who were attended before travelling at an International Health Unit in the year 2007 &#40;the year before the initiation of the European crisis&#41; and in the year 2012 &#40;when the structural crisis was established&#41;&#46; A comparative socioeconomic analysis was performed as well as an analysis of the risk factors present in both groups&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">In 2007 and 2012 a total of 9&#44;197 travellers were attended&#46; Of these&#44; there were 344 TWR &#40;3&#46;4&#37;&#41;&#59; 101 TWR &#40;2&#46;8&#37;&#41; in 2007 and 243 TWR &#40;4&#46;5&#37;&#41; in 2012 &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; The average age of the travellers was 38&#46;1 years &#40;SD&#58; 10&#46;57&#41;&#46; The most common destination was Sub-Saharan Africa&#44; in 164 &#40;47&#46;6&#37;&#41; of the cases&#46; Malaria chemoprophylaxis was prescribed to 152 travellers &#40;44&#37;&#41; and 80 presented comorbidity &#40;23&#46;25&#37;&#41;&#46; The TWR from 2012 presented a significantly greater age &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; more comorbidity &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;018&#41; and a greater proportion of stays in rural areas &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0009&#41; for longer time periods &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">At 5 years from the start of the economic crisis&#44; there was a change in the profile of TWR&#46; Their number has increased significantly&#44; as has the proportion who present risk factors for contracting imported diseases&#46; The International Health Units should adapt to these new circumstances and adopt preventive measures for this population&#46;</p></span>"
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Porcentaje de viajeros por motivo laboral atendidos en la Unidad de Salud Internacional Metropolitana Norte del 2007 al 2012 &#40;test de tendencia 2007-2012 &#40;IRR&#41;&#58; 1&#46;62&#59; IC&#58; 1&#44;59-1&#44;66&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p>"
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" 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="6" align="left" valign="top"><span class="elsevierStyleItalic">Regi&#243;n de destino</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#193;frica subsahariana&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Subcontinente indio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#44;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28 &#40;27&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65 &#40;26&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sudeste asi&#225;tico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14&#44;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19 &#40;18&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32 &#40;13&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;42&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="6" 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="6" align="left" valign="top"><span class="elsevierStyleItalic">Duraci&#243;n del viaje</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804; 1 mes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">185&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53&#44;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74 &#40;73&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">111 &#40;45&#44;6&#37;&#41;&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" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1-<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>3 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#44;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;15&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71 &#40;29&#44;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3-<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>6meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9&#44;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;7&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;9&#44;8&#37;&#41;&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" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;6 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">39&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#44;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;2&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36 &#40;14&#44;8&#37;&#41;&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" title="table-entry  " colspan="6" 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="6" align="left" valign="top"><span class="elsevierStyleItalic">&#193;rea visitada</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Rural&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">220&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">63&#44;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54 &#40;53&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">166 &#40;68&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Urbana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">124&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47 &#40;46&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77 &#40;31&#44;6&#37;&#41;&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" title="table-entry  " colspan="6" 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="6" align="left" valign="top"><span class="elsevierStyleItalic">Tipo de viaje</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Aut&#243;ctonos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">306&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88&#44;9&#37;&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" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Inmigrantes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#37;&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" title="table-entry  " colspan="6" 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="6" 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="6" align="left" valign="top"><span class="elsevierStyleItalic">Prevenci&#243;n malaria</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">152&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">53 &#40;52&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">128 &#40;52&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Autotratamiento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#44;4&#37;&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" title="table-entry  " colspan="6" 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="6" align="left" valign="top"><span class="elsevierStyleItalic">Comorbilidades</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23&#44;25&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23 &#40;22&#44;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57 &#40;23&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;018&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col">2012&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">2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&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">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>243&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">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>243&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><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></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Sexo</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hombre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">155&#40;44&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">195 &#40;55&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mujeres&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88 &#40;64&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48 &#40;35&#44;3&#41;&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" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Edad&#40;mediana&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#44;001&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="4" 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="4" align="left" valign="top"><span class="elsevierStyleItalic">Regi&#243;n de destino</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#193;frica subsahariana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">132&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">122&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Subcontinente indio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sudam&#233;rica y Centroam&#233;rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sudeste asi&#225;tico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;08&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="4" 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="4" align="left" valign="top"><span class="elsevierStyleItalic">Duraci&#243;n del viaje</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804; 1 mes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">111&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1-<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>3 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">107&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#60;0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3-<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>6meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;6 meses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;001&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="4" 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="4" align="left" valign="top"><span class="elsevierStyleItalic">&#193;rea visitada</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Rural&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">152&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">162&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" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Urbana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">91&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;04&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="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Prevenci&#243;n malaria</span>&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" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">129&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">114&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Autotratamiento</span>&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" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Comorbilidades</span>&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" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis comparativo entre los viajeros por motivo laboral &#40;VML&#41; y una muestra seleccionada de forma aleatoria &#40;1&#58;1&#41; de los viajeros que visitan familiares y amigos &#40;VFA&#41; del 2012</p>"
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                  \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">&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">2007&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">2012&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">P<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">&#42;</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&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">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>101&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">N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>243&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><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></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Sexo</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hombre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">129&#40;26&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">350 &#40;73&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mujer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">73 &#40;34&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">136 &#40;65&#44;1&#41;&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" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Edad&#40;mediana</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">36&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;06&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="4" align="left" valign="top"><span class="elsevierStyleItalic">Regi&#243;n de destino</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#193;frica subsahariana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">50 &#40;49&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">132 &#40;54&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Subcontinente indio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33 &#40;32&#44;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52 &#40;21&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sudam&#233;rica y Centroam&#233;rica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0&#44;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;0&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sudeste asi&#225;tico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;16&#44;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">57 &#40;23&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis comparativo de una muestra seleccionada de forma aleatoria de viajeros que visitan familiares y amigos visitados en la Unidad de Salud Internacional Metropolitana Nord&#44; en 2007 y 2012 &#40;N<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>344&#41;</p>"
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                      "titulo" => "Centers for Disease Control and Prevention &#40;CDC&#41; Surveillance for travel-related disease--GeoSentinel Surveillance System&#44; United States&#44; 1997-2011"
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                      "titulo" => "Travel-related infection in European travelers&#44; EuroTravNet 2011"
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                  "referenciaCompleta" => "Instituto Nacional de Estad&#237;stica Censo Electoral de personas espa&#241;olas residentes en el extranjero &#91;consultado 5 Mar 2015&#93;&#46; Disponible en&#58; http&#58;&#47;&#47;www&#46;ine&#46;es&#47;&#46;"
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