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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Curvas de supervivencia que eval&#250;an la mortalidad en funci&#243;n del estado nutricional en pacientes con insuficiencia card&#237;aca avanzada&#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 insuficiencia card&#237;aca &#40;IC&#41; representa la etapa final de varias enfermedades card&#237;acas<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a>&#46; La incidencia de la IC aumenta dr&#225;sticamente con la edad y&#44; debido al envejecimiento de la poblaci&#243;n as&#237; como a los avances en la supervivencia&#44; la prevalencia de la IC est&#225; aumentando&#44; lo que se asocia con una carga significativa para los pacientes y los costos y recursos de atenci&#243;n m&#233;dica<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; La IC avanzada se asocia frecuentemente con la atrofia muscular&#44; la caquexia card&#237;aca y la desnutrici&#243;n debido a la ingesta deficiente de nutrientes y a circunstancias cl&#237;nicas relacionadas con la enfermedad<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">4</span></a>&#46; La desnutrici&#243;n en la poblaci&#243;n mayor es el resultado de problemas de salud multifactoriales<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">5</span></a>&#44; y es particularmente frecuente en pacientes con IC<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">6</span></a>&#46; Se ha valorado que el estado nutricional deficiente en dichas poblaciones se asocia con peores resultados de salud<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Adem&#225;s de los par&#225;metros biol&#243;gicos y cl&#237;nicos&#44; el uso de medidas para ver resultados informados por el paciente &#40;PROM&#41; se reconoce cada vez m&#225;s como una forma importante de evaluar el estado de salud de una persona&#46; Las PROM son herramientas de medici&#243;n mediante las cuales los pacientes brindan informaci&#243;n sobre aspectos de su estado de salud&#44; incluidos s&#237;ntomas&#44; calidad de vida&#44; funcionalidad y salud f&#237;sica y mental<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">8</span></a>&#46; Entre las diversas escalas empleadas para determinar la desnutrici&#243;n en pacientes con IC<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">9-11</span></a>&#44; la <span class="elsevierStyleItalic">Mini Nutritional Assessment Short Form</span> &#40;MNA-SF&#41; ha demostrado ser una herramienta confiable y sencilla para detectar el estado nutricional anormal<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a> y es un fuerte predictor de mortalidad por IC<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A pesar de contar con varias herramientas para evaluar el estado nutricional en la IC&#44; la informaci&#243;n sobre un enfoque hol&#237;stico basado en el estado de salud y el comportamiento frente a la enfermedad autoinformado por el paciente es escasa&#44; especialmente en etapas avanzadas&#46; Por tanto&#44; el objetivo de este estudio ha sido evaluar el impacto del estado nutricional en la calidad de vida&#44; las capacidades de autocuidado y las actividades de la vida diaria en pacientes mayores con IC avanzada&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dise&#241;o del estudio y pacientes</span><p id="par0020" class="elsevierStylePara elsevierViewall">El estudio HADES &#40;insuficiencia card&#237;aca en estadios avanzados&#41; es un estudio de cohorte prospectivo y multic&#233;ntrico&#46; Incluy&#243; pacientes con IC &#8805;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>a&#241;os con estado funcional IV de la <span class="elsevierStyleItalic">New York Heart Association</span> &#40;NYHA&#41;&#44; o aquellos que requirieron hospitalizaci&#243;n al menos dos veces en los seis meses anteriores&#46; Para los fines de este estudio nos centramos en pacientes de &#8805;<span class="elsevierStyleHsp" style=""></span>65<span class="elsevierStyleHsp" style=""></span>a&#241;os para hacer la muestra m&#225;s homog&#233;nea y evitar sesgos relacionados con la edad&#46; Todos los pacientes estaban cl&#237;nicamente estables en el momento de la inclusi&#243;n&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Los pacientes fueron seleccionados a partir de historias cl&#237;nicas electr&#243;nicas de atenci&#243;n primaria y de informes de alta hospitalaria&#46; En el estudio participaron un total de 22 centros de atenci&#243;n primaria&#44; tres hospitales universitarios&#44; un hospital con &#225;rea de agudos y una unidad de rehabilitaci&#243;n geri&#225;trica de Barcelona &#40;Espa&#241;a&#41; entre junio de 2017 y diciembre de 2019&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El protocolo del estudio fue aprobado por el Comit&#233; de &#201;tica del Instituto de Investigaci&#243;n en Atenci&#243;n Primaria de Atenci&#243;n Primaria IDIAP Jordi Gol &#40;referencia P17&#47;086&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Evaluaciones cl&#237;nicas y PROM</span><p id="par0035" class="elsevierStylePara elsevierViewall">Dado que muchos pacientes no pod&#237;an acudir al centro de atenci&#243;n primaria&#44; 27 enfermeros del equipo de investigaci&#243;n acudieron al domicilio del paciente para cumplimentar los cuestionarios y realizar los ex&#225;menes cl&#237;nicos&#46; Se evalu&#243; una muestra de pacientes en una unidad de cuidados intermedios donde se recuperaban tras el alta hospitalaria&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Para evaluar inicialmente el estado nutricional y detectar desnutrici&#243;n&#44; el personal administr&#243; el cuestionario de siete &#237;tems MNA-SF&#46; El MNA-SF ha demostrado buena sensibilidad y especificidad para detectar la desnutrici&#243;n y las personas en riesgo de desnutrici&#243;n entre los adultos mayores que viven en comunidades<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">14</span></a>&#46; Cuando las puntuaciones de detecci&#243;n eran inferiores a once puntos &#40;que se considera el umbral de riesgo de desnutrici&#243;n&#41;&#44; se utiliz&#243; un conjunto de &#237;tems adicionales para clasificar a los pacientes en dos categor&#237;as&#58; riesgo o desnutrici&#243;n establecida&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">La calidad de vida se evalu&#243; mediante el instrumento EQ-5D-3L&#44; y los resultados de los pacientes se obtuvieron a partir de entrevistas personales realizadas por los trabajadores&#46; Este instrumento proporciona un perfil descriptivo simple y un valor de &#237;ndice resumido &#250;nico para el estado de salud&#46; El instrumento explora la movilidad&#44; el autocuidado&#44; la realizaci&#243;n de actividades habituales&#44; el dolor o malestar y la presencia de ansiedad o depresi&#243;n en los pacientes&#46; Tambi&#233;n se incluye una puntuaci&#243;n visual anal&#243;gica &#40;EVA&#41;&#44; que proporciona un &#237;ndice num&#233;rico entre 0 &#40;peor&#41; y 100 &#40;la mejor salud que el paciente puede imaginar&#41;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a>&#46; La conducta de autocuidado se evalu&#243; con la escala europea de conducta de autocuidado en IC<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a> y se utiliz&#243; el &#237;ndice de Barthel para determinar el impacto en las actividades de la vida diaria<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a>&#46; Ambas PROM recibieron una puntuaci&#243;n de 0 &#40;la peor&#41; a 100 &#40;la mejor&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Aunque el &#237;ndice de masa corporal &#40;IMC&#41; se evalu&#243; como parte del MNA-SF&#44; se incluy&#243; adem&#225;s en los modelos multivariados para determinar su asociaci&#243;n independiente con un mayor riesgo de desnutrici&#243;n&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Las variables cl&#237;nicas se recogieron de los registros m&#233;dicos y del examen cl&#237;nico&#44; la ecocardiograf&#237;a y las pruebas de laboratorio&#44; incluida la hemoglobina&#44; la funci&#243;n renal&#44; los iones y los biomarcadores card&#237;acos&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">An&#225;lisis estad&#237;stico</span><p id="par0060" class="elsevierStylePara elsevierViewall">Se utilizaron estad&#237;sticas descriptivas para resumir los datos demogr&#225;ficos y cl&#237;nicos&#44; con las variables continuas presentadas como media y desviaci&#243;n est&#225;ndar &#40;DE&#41; o mediana y rango intercuart&#237;lico &#40;RIQ&#41;&#44; y las variables categ&#243;ricas como frecuencias y porcentajes&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Se utilizaron pruebas t-independientes y no param&#233;tricas para comparar las medianas entre grupos para variables con distribuci&#243;n normal y no normal&#44; respectivamente&#46; Se utiliz&#243; la prueba de chi-cuadrado para comparar proporciones entre grupos&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Dado que el an&#225;lisis descriptivo se realiz&#243; respecto de una variable con m&#225;s de dos categor&#237;as &#40;sin riesgo&#44; riesgo y desnutrici&#243;n&#41;&#44; se realiz&#243; an&#225;lisis de varianza &#40;ANOVA&#41; para variables continuas que siguen una distribuci&#243;n normal&#44; mientras que para variables continuas que no siguen una distribuci&#243;n normal se utiliz&#243; la prueba de Kruskal-Wallis&#46; En el caso de variables categ&#243;ricas se realiz&#243; la prueba de chi-cuadrado&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Los datos del tiempo transcurrido hasta el evento se presentan gr&#225;ficamente utilizando curvas de Kaplan-Meier para analizar el efecto de la desnutrici&#243;n en la mortalidad&#44; y se utilizaron pruebas de rango logar&#237;tmico para comparar la supervivencia entre grupos&#46; Las variables asociadas a la probabilidad de presentar riesgo de desnutrici&#243;n en el an&#225;lisis bivariado &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; se incluyeron en un modelo de regresi&#243;n log&#237;stica siguiendo un procedimiento por pasos&#46; El an&#225;lisis estad&#237;stico se realiz&#243; utilizando el software R para Windows versi&#243;n 3&#46;6&#46;1&#44; Viena&#44; Austria&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><p id="par0080" class="elsevierStylePara elsevierViewall">De los 271 participantes incluidos inicialmente en el estudio&#44; 265 eran mayores de 64<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; y se administr&#243; el MNA-SF a 260 &#40;98&#44;05&#37;&#41; de estos pacientes&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Entre los participantes &#62;<span class="elsevierStyleHsp" style=""></span>64<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; 158 &#40;60&#44;8&#37;&#41; eran mujeres y la edad media fue de 84&#44;8 &#40;DE&#58; 7&#44;5&#41; a&#241;os&#46; Los pacientes &#8805;<span class="elsevierStyleHsp" style=""></span>75<span class="elsevierStyleHsp" style=""></span>a&#241;os representaron el 89&#44;2&#37;&#46; La mediana de seguimiento fue de 14&#44;9<span class="elsevierStyleHsp" style=""></span>meses &#40;RIQ&#58; 25-75&#59; 4&#44;9-26&#44;9&#41;&#46; Utilizando el MNA-SF&#44; se identific&#243; que 126 &#40;48&#44;5&#37;&#41; pacientes estaban en riesgo de desnutrici&#243;n y 33 &#40;12&#44;7&#37;&#41; pacientes ten&#237;an desnutrici&#243;n confirmada&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Durante el seguimiento fallecieron 133 &#40;51&#44;2&#37;&#41; pacientes&#46; La mortalidad fue del 78&#44;8&#37; entre 26 pacientes con desnutrici&#243;n confirmada&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">El deterioro del estado nutricional &#40;es decir&#44; estado nutricional normal frente a desnutrici&#243;n en riesgo frente a desnutrici&#243;n confirmada&#41; se asoci&#243; con una edad cada vez mayor &#40;media &#91;DE&#93;&#58; 83&#44;5 &#91;7&#44;4&#93; frente a 85&#44;0 &#91;7&#44;4&#93; frente a 88&#44;0 &#91;7&#44;4&#93;&#41;&#44; un IMC m&#225;s bajo &#40;29&#44;1 &#91;5&#44;5&#93; vs 27&#44;6 &#91;5&#44;4&#93; vs 25&#44;3 &#91;5&#44;0&#93;&#41;&#44; niveles m&#225;s bajos de hemoglobina &#40;11&#44;7 &#91;1&#44;6&#93; vs 11&#44;4 &#91;1&#44;8&#93; vs 10&#44;6 &#91;1&#44;4&#93;&#41;&#44; una mayor dependencia para las actividades diarias &#40;puntuaciones del &#237;ndice de Barthel&#58; 69&#44;8 &#91;18&#44;6&#93; vs 59&#44;7 &#91;25&#44;0&#93; vs 31&#44;4 &#91;21&#44;3&#93;&#41;&#44; peor calidad de vida percibida &#40;puntuaciones EQ-5D-5L&#58; 57&#44;0 &#91;16&#44;4&#93; vs 52&#44;0 &#91;16&#44;8&#93; vs 40&#44;9 &#91;19&#44;9&#93;&#41; y peor autocuidado &#40;<span class="elsevierStyleItalic">European Heart Failure Self-care</span> puntuaciones de comportamiento&#58; 24&#44;6 &#91;6&#44;7&#93; frente a 26&#44;3 &#91;7&#44;1&#93; frente a 31&#44;2 &#91;9&#44;5&#93;&#41;&#46; Ni la comorbilidad ni los medicamentos utilizados para controlar la IC se asociaron con el riesgo de desnutrici&#243;n o con la mortalidad &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Un mejor &#237;ndice de Barthel y las puntuaciones de calidad de vida se relacionaron inversamente con el riesgo de desnutrici&#243;n &#40;odds ratio &#91;OR&#93;&#58; 0&#44;97 &#91;intervalo de confianza del 95&#37;&#58; 0&#44;96-0&#44;98&#93; y OR&#58; 0&#44;98 &#91;intervalo de confianza del 95&#37;&#58; 0&#44;96-0&#44;99&#93;&#41;&#44; respectivamente&#46; Las puntuaciones m&#225;s altas en la escala europea de conducta de autocuidado de la IC&#44; que implica un peor autocuidado&#44; se relacionaron con un mayor riesgo de desnutrici&#243;n &#40;OR&#58; 1&#44;05 &#91;intervalo de confianza del 95&#37;&#58; 1&#44;02-1&#44;09&#93;&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En cuanto a la calidad de vida&#44; los pacientes con IC y desnutrici&#243;n informaron peores resultados relacionados con la movilidad&#44; el cuidado personal&#44; las actividades habituales y la ansiedad o depresi&#243;n en comparaci&#243;n con los pacientes con IC con un estado nutricional normal &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; De manera similar&#44; los pacientes con desnutrici&#243;n reportaron peores puntuaciones en la mayor&#237;a de los &#237;tems de conducta de autocuidado &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">El an&#225;lisis de la curva de Kaplan Meier mostr&#243; que el grupo desnutrido ten&#237;a un riesgo de mortalidad significativamente mayor &#40;p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">El modelo multivariado ajustado encontr&#243; que niveles m&#225;s bajos de IMC y hemoglobina&#44; y peores puntuaciones en calidad de vida y actividades de la vida diaria&#44; eran predictivos de desnutrici&#243;n &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discusi&#243;n</span><p id="par0120" class="elsevierStylePara elsevierViewall">En nuestra cohorte encontramos que la desnutrici&#243;n en pacientes con IC avanzada se asoci&#243; significativamente con niveles bajos de hemoglobina&#44; mala calidad de vida autoinformada&#44; impactos adversos en las actividades diarias y el autocuidado&#44; y una mayor mortalidad&#46; Al combinar tanto el riesgo de desnutrici&#243;n como la desnutrici&#243;n establecida en nuestra cohorte&#44; observamos que la prevalencia fue similar a estudios previos de una revisi&#243;n sistem&#225;tica reciente que describe la prevalencia de desnutrici&#243;n en pacientes con IC&#44; que result&#243; en un 46&#37;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">En una poblaci&#243;n anciana&#44; cr&#243;nicamente enferma y con una comorbilidad importante&#44; como la analizada en nuestro estudio&#44; la relaci&#243;n entre todos los factores que contribuyen a la fragilidad y el pron&#243;stico es compleja&#46; Varios factores pueden contribuir a la desnutrici&#243;n&#44; incluida la p&#233;rdida de apetito&#44; la polifarmacia y la fragilidad y&#44; en particular&#44; la presencia de enfermedades cr&#243;nicas<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a>&#46; La edad&#44; el tiempo transcurrido desde el diagn&#243;stico de IC&#44; las hospitalizaciones previas&#44; el apoyo social y familiar&#44; as&#237; como otras caracter&#237;sticas cl&#237;nicas y sociales tambi&#233;n pueden influir en el estado nutricional y contribuir al empeoramiento de la calidad de vida&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Varios pacientes de nuestra cohorte ten&#237;an comorbilidades concomitantes&#44; como c&#225;ncer&#44; depresi&#243;n&#44; insuficiencia renal y enfermedad pulmonar obstructiva cr&#243;nica&#44; todas las cuales podr&#237;an afectar el estado nutricional e influir en el pron&#243;stico<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">20-23</span></a>&#46; Sin embargo&#44; no encontramos que ninguna de estas comorbilidades estuviera asociada significativamente con la desnutrici&#243;n&#46; Como se inform&#243; en otros estudios&#44; encontramos niveles m&#225;s bajos de hemoglobina en pacientes con desnutrici&#243;n<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">24</span></a>&#46; Sin embargo&#44; el diagn&#243;stico de anemia&#44; que se define por un punto de corte &#60;<span class="elsevierStyleHsp" style=""></span>12 o &#60;<span class="elsevierStyleHsp" style=""></span>13<span class="elsevierStyleHsp" style=""></span>g&#47;dl de hemoglobina en mujeres y hombres&#44; respectivamente&#44; no se asoci&#243; con desnutrici&#243;n en nuestros pacientes&#44; probablemente debido a los bajos niveles basales en el conjunto&#46; Se ha informado que m&#225;s de la mitad de los pacientes mayores con IC tienen un nivel de hemoglobina inferior a 12<span class="elsevierStyleHsp" style=""></span>g&#47;dl y&#44; entre ellos&#44; el 79&#44;1&#37; se encontraba en clase<span class="elsevierStyleHsp" style=""></span>IV de la NYHA<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">25</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">En la poblaci&#243;n de mayor edad&#44; la anemia es causada por deficiencias nutricionales&#44; inflamaci&#243;n cr&#243;nica&#44; enfermedades renales cr&#243;nicas o anemia inexplicable en aproximadamente un tercio cada una<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a>&#46; En pacientes con IC la patog&#233;nesis de la anemia es multifactorial&#44; influyendo la inflamaci&#243;n asociada&#44; el sistema renina-angiotensina y la hemodiluci&#243;n<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">27</span></a>&#46; Un estudio de Opasich et al&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">28</span></a> encontr&#243; una causa espec&#237;fica de anemia en solo el 43&#37; de los pacientes con IC estable&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Tambi&#233;n se ha descrito que algunos medicamentos pueden afectar negativamente el estado nutricional al modificar la percepci&#243;n sensorial del gusto o la absorci&#243;n intestinal&#44; particularmente en los adultos mayores<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">29</span></a>&#46; Adem&#225;s&#44; los efectos secundarios&#44; como n&#225;useas y v&#243;mitos&#44; diarrea&#44; p&#233;rdida de apetito y fatiga&#44; tambi&#233;n pueden influir en la ingesta nutricional&#46; Sin embargo&#44; en nuestra cohorte no encontramos relaci&#243;n con ninguno de los medicamentos enumerados en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> y el estado nutricional&#44; probablemente porque estos medicamentos se toleran bien&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">La asociaci&#243;n entre el IMC&#44; la nutrici&#243;n y la caquexia card&#237;aca sigue sin estar clara&#46; En los pacientes con IC es posible encontrar masa muscular reducida junto con un IMC normal debido a la presencia de edema o acumulaci&#243;n de masa libre de grasa<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a>&#46; Se ha informado que hasta el 50&#37; de los pacientes con IC clasificados como obesos estaban desnutridos o en riesgo de desnutrici&#243;n<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">31</span></a>&#46; Dado que est&#225; bien establecido que un IMC bajo se relaciona con un peor pron&#243;stico en pacientes mayores y con IC&#44; se ha argumentado que se debe aplicar una modificaci&#243;n en los puntos de corte del IMC en esta poblaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">32&#44;33</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">El mal estado nutricional se ha asociado con impactos adversos en la calidad de vida de pacientes mayores con enfermedades cr&#243;nicas<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">34</span></a>&#46; En un estudio reciente&#44; los pacientes con IC con una ingesta cal&#243;rica insuficiente ten&#237;an peor calidad de vida y un mayor riesgo de reingreso hospitalario en comparaci&#243;n con los pacientes con IC con una ingesta cal&#243;rica suficiente<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">35</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">El autocuidado es crucial en el manejo de la IC&#44; e incluye la adherencia al tratamiento&#44; cambios en el estilo de vida&#44; seguimiento de los s&#237;ntomas y actitud y respuesta adecuadas a los indicadores de deterioro&#46; Recomendaciones recientes de la Asociaci&#243;n de Insuficiencia Card&#237;aca de la Sociedad Europea de Cardiolog&#237;a resaltaron la importancia del autocuidado en el tratamiento de la IC&#44; incluido el mantenimiento de un estado nutricional &#243;ptimo&#46; Es necesario considerar la reducci&#243;n de peso cuando el IMC es superior a 35<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; buscar atenci&#243;n m&#233;dica cuando aparece una p&#233;rdida de peso involuntaria y limitar la ingesta de sal y de alcohol<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">36</span></a>&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">En nuestra poblaci&#243;n encontramos que la desnutrici&#243;n se asoci&#243; con un peor autocuidado&#46; Un estudio realizado en una sala de rehabilitaci&#243;n geri&#225;trica de un hospital inform&#243; que los pacientes mayores con riesgo de desnutrici&#243;n ten&#237;an una menor capacidad de autocuidado&#44; probablemente debido a una menor capacidad para utilizar estrategias cognitivas&#44; afectivas y conductuales<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">37</span></a>&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">La dependencia funcional &#40;es decir&#44; la necesidad de asistencia para las actividades de la vida diaria&#41; est&#225; estrechamente relacionada con un estado nutricional deficiente<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">38</span></a>&#46; Se ha descrito una relaci&#243;n rec&#237;proca entre la desnutrici&#243;n y la discapacidad en la poblaci&#243;n de mayor edad&#44; seg&#250;n la cual la desnutrici&#243;n puede exacerbar la discapacidad y la discapacidad puede exacerbar la desnutrici&#243;n&#46; El envejecimiento&#44; la presencia de enfermedades cr&#243;nicas y la polifarmacia se asocian tanto con la dependencia funcional como con un mal estado nutricional<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">39</span></a>&#46; Tambi&#233;n se ha demostrado que una reducci&#243;n en la ingesta de prote&#237;nas&#44; como consecuencia de un estado nutricional deficiente&#44; produce una reducci&#243;n de la masa muscular y una disminuci&#243;n de la movilidad&#44; lo que lleva a una menor independencia en las actividades de la vida diaria<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">40</span></a>&#46;</p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Fortalezas y limitaciones</span><p id="par0170" class="elsevierStylePara elsevierViewall">Este es el primer estudio&#44; hasta donde sabemos&#44; que vincula el autocuidado con el riesgo de desnutrici&#243;n en pacientes con IC avanzada&#46; Sin embargo&#44; el estudio tambi&#233;n presenta algunas limitaciones&#46; Dado que nuestro estudio se centra en el estado avanzado de IC&#44; el tama&#241;o de la muestra puede no ser suficiente para proporcionar una validaci&#243;n externa s&#243;lida&#46; Sin embargo&#44; es uno de los pocos estudios que analiza la asociaci&#243;n entre el estado nutricional y las medidas de resultado informadas por los pacientes&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Hubiera sido relevante recolectar datos sobre disfagia&#44; trastornos orofar&#237;ngeos y la administraci&#243;n de suplementos nutricionales&#44; que pueden contribuir a la desnutrici&#243;n&#44; pero lamentablemente no tuvimos acceso a esta informaci&#243;n&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusiones</span><p id="par0180" class="elsevierStylePara elsevierViewall">En pacientes mayores con IC avanzada la desnutrici&#243;n se asoci&#243; con peores medidas de resultados informadas por los pacientes relacionadas con una mala calidad de vida y efectos adversos en el autocuidado y las actividades diarias&#46; El mal estado nutricional tambi&#233;n se asoci&#243; con mayores tasas de mortalidad&#46; El estado nutricional debe ser abordado sistem&#225;ticamente por enfermeros de atenci&#243;n primaria y m&#233;dicos de familia para mejorar las tasas de supervivencia de estos pacientes&#46; Ser&#237;a de gran ayuda la incorporaci&#243;n de profesionales expertos en nutrici&#243;n en los centros de atenci&#243;n primaria de salud&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Financiaci&#243;n</span><p id="par0185" class="elsevierStylePara elsevierViewall">Este proyecto se ha llevado a cabo con el apoyo del Departamento de Salud de la Generalitat de Catalunya&#44; en la convocatoria correspondiente al a&#241;o 2016 de concesi&#243;n de ayudas del Plan Estrat&#233;gico de Investigaci&#243;n e Innovaci&#243;n en Salud &#40;PERIS&#41; 2016-2020&#44; modalidad Proyectos de investigaci&#243;n orientados a atenci&#243;n primaria&#44; con c&#243;digo de expediente SLT002&#47;16&#47;00073&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicto de intereses</span><p id="par0190" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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    "fechaRecibido" => "2023-11-20"
    "fechaAceptado" => "2024-01-07"
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            0 => "Older patients"
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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">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio fue evaluar la prevalencia de malnutrici&#243;n&#44; las caracter&#237;sticas cl&#237;nicas asociadas con la misma y el impacto del estado nutricional en la mortalidad&#44; la calidad de vida y las habilidades relacionadas con el autocuidado y las actividades de la vida diaria en pacientes ancianos con insuficiencia card&#237;aca avanzada&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Entre junio de 2017 y diciembre de 2019 se llev&#243; a cabo un estudio prospectivo multic&#233;ntrico de cohortes que incluy&#243; a 260 pacientes ancianos con insuficiencia card&#237;aca avanzada que viv&#237;an en la comunidad&#46; El estudio se llev&#243; a cabo en 22 centros de atenci&#243;n primaria&#44; tres hospitales universitarios&#44; un hospital de agudos y una unidad de rehabilitaci&#243;n geri&#225;trica de la ciudad de Barcelona &#40;Espa&#241;a&#41;&#46; El estado nutricional se evalu&#243; al inicio del estudio mediante el cuestionario <span class="elsevierStyleItalic">Mini Nutritional Assessment</span> &#40;MNA&#41; Las medidas de resultado informadas por los pacientes incluyeron calidad de vida &#40;EQ-5D-3L&#41;&#44; conducta de autocuidado &#40;Escala europea de conducta de autocuidado en insuficiencia card&#237;aca&#41; e impacto en las actividades de la vida diaria &#40;&#237;ndice de Barthel&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Utilizando el MNA-SF&#44; se identific&#243; que 126 &#40;48&#44;5&#37;&#41; pacientes estaban en riesgo de malnutrici&#243;n y 33 &#40;12&#44;7&#37;&#41; pacientes ten&#237;an malnutrici&#243;n confirmada&#46; En comparaci&#243;n con aquellos con un estado nutricional normal&#44; los pacientes con malnutrici&#243;n confirmada eran significativamente mayores&#44; con un IMC m&#225;s bajo y con niveles reducidos de hemoglobina&#46; Durante el seguimiento &#40;mediana de 14&#44;9 meses&#44; intervalo intercuartil&#58; 4&#44;9-26&#44;9&#41;&#44; 133 &#40;51&#44;2&#37;&#41; de los participantes incluidos murieron&#46; La mortalidad fue significativamente mayor entre los pacientes con malnutrici&#243;n &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Un mayor &#237;ndice de Barthel y mejores puntuaciones de calidad de vida se relacionaron inversamente con el riesgo de desnutrici&#243;n &#40;odds ratio &#91;OR&#93; 0&#44;97 &#91;intervalo de confianza del 95&#37;&#58; 0&#44;96-0&#44;98&#93; y OR 0&#44;98 &#91;intervalo de confianza del 95&#37;&#58; 0&#44;96-0&#44;99&#93;&#41;&#44; respectivamente&#46; Las puntuaciones m&#225;s altas en la Escala Europea&#44; que implican un peor autocuidado&#44; se relacionaron con un mayor riesgo de desnutrici&#243;n &#40;OR 1&#44;05 &#91;intervalo de confianza del 95&#37;&#58; 1&#44;02-1&#44;09&#93;&#41;&#46; El modelo log&#237;stico multivariado ajustado encontr&#243; que la malnutrici&#243;n se asociaba significativamente con una mala calidad de vida y peores puntuaciones en las escalas de independencia en actividades de la vida diaria y el autocuidado&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En pacientes ancianos con insuficiencia card&#237;aca avanzada la malnutrici&#243;n se asoci&#243; con peores resultados en calidad de vida&#44; en el autocuidado de su enfermedad y mayor limitaci&#243;n en las actividades de la vida diaria&#46; El estado nutricional debe ser abordado sistem&#225;ticamente por los enfermeros y m&#233;dicos de atenci&#243;n primaria para mejorar la supervivencia de estos pacientes&#46; Ser&#237;a de gran ayuda la incorporaci&#243;n de profesionales expertos en nutrici&#243;n en los centros de atenci&#243;n primaria de salud&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to assess the prevalence of malnutrition&#44; the clinical characteristics associated with malnutrition and the impact of nutritional status on mortality&#44; quality of life&#44; self-care abilities&#44; and activities of daily living in the older patients with advanced heart failure&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A prospective multicentre cohort study including 260 community-dwelling elderly patients with advanced heart failure was conducted between June 2017 and December 2019&#46; The study was carried out in 22 primary healthcare centres&#44; three university hospitals&#44; one acute-care hospital&#44; and one geriatric rehabilitation unit in the city of Barcelona &#40;Spain&#41;&#46; Nutritional status was assessed at baseline using the Mini Nutritional Assessment &#40;MNA&#41; questionnaire&#46; Patient-reported outcome measures included quality of life &#40;EQ-5D-3L&#41;&#44; self-care behaviour &#40;European Heart Failure Self-care Behaviour Scale&#41; and impact on activities of daily living &#40;Barthel index&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Using the MNA-SF&#44; 126 &#40;48&#46;5&#37;&#41; patients were identified as being at risk of malnutrition and 33 &#40;12&#46;7&#37;&#41; patients as having confirmed malnutrition&#46; Compared to heart failure patients with normal nutritional status&#44; patients with confirmed malnutrition were significantly older&#44; with a lower BMI&#44; and with reduced haemoglobin levels&#46; During follow-up &#40;median 14&#46;9 months&#44; interquartile range&#58; 4&#46;9-26&#46;9&#41;&#44; 133 &#40;51&#46;2&#37;&#41; of the included participants died&#44; and mortality was significantly higher among patients identified as having malnutrition &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; Better Barthel index and quality of life scores were inversely related to the risk of malnutrition &#40;Odds Ratio &#91;OR&#93; 0&#46;97 &#91;95&#37; confidence interval&#58; 0&#46;96 to 0&#46;98&#93; and OR 0&#46;98 &#91;95&#37; confidence interval&#58; 0&#46;96 to 0&#46;99&#93;&#41;&#44; respectively&#46; Higher scores in the European Heart Failure Self-care Behaviour Scale&#44; which implies worse self care&#44; were related to higher malnutrition risk &#40;OR 1&#46;05 &#91;95&#37; confidence interval&#58; 1&#46;02 to 1&#46;09&#93;&#41;&#46; Adjusted multivariate logistic model found that malnutrition was significantly associated with poor quality of life&#44; and adverse impacts on daily activities and self-care&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">In community-dwelling older patients with advanced heart failure&#44; malnutrition was associated with worse patient reported outcome measures related to poor quality of life&#44; and adverse impacts on self-care and daily activities&#46; Nutritional status must be systematically addressed by primary care nurses and family doctors to improve survival rates in these patients&#46; It would be helpful the incorporation of expert professionals in nutrition in the primary health care centres&#46;</p></span>"
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                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Todos&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>260&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sin riesgo&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>101&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Riesgo&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>126&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Desnutrici&#243;n&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Mortalidad &#40;n&#44; &#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">133 &#40;51&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46 &#40;45&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61 &#40;48&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;78&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Sexo &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Mujeres</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">158 &#40;60&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63 &#40;62&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">77 &#40;61&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;54&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;722&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hombres</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">102 &#40;39&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;37&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49 &#40;38&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;45&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Edad &#40;a&#241;os&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">84&#44;8 &#40;7&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">83&#44;5 &#40;7&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#44;0 &#40;7&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&#44;0 &#40;7&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Grupos de edad</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">65-74 a&#241;os</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28 &#40;10&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;9&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;11&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;12&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">75-84 a&#241;os</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88 &#40;33&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48 &#40;47&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">38 &#40;30&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;6&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#62;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">84 a&#241;os</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">144 &#40;55&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43 &#40;42&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74 &#40;58&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;81&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Nivel educativo&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;607&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Escuela primaria</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Secundaria o estudios universitarios</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Entorno&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Cl&#237;nica de rehabilitaci&#243;n</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Variables cl&#237;nicas</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#205;ndice de masa corporal &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Presi&#243;n arterial sist&#243;lica &#40;mm&#47;Hg&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Presi&#243;n arterial diast&#243;lica&#40;mm7Hg&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Frecuencia card&#237;aca &#40;beats&#47;min&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Creatinina&#40;mg&#47;dl&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Filtraci&#243;n glomerular &#40;ml&#47;min&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&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-with-role" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hemoglobina &#40;g&#47;dl&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Prop&#233;ptido natriur&#233;tico cerebral N-terminal &#40;pg&#47;ml&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">6753 &#40;8567&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7099 &#40;9997&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6546&#40;7622&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6442&#40;7191&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;881&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Fracci&#243;n de eyecci&#243;n&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;258&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#60; 50&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">67 &#40;29&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24 &#40;25&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">37 &#40;34&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;23&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8805; 50&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">159 &#40;70&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">70 &#40;74&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">69 &#40;65&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20 &#40;76&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#205;ndice de Barthel</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">60&#44;0 &#40;25&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">31&#44;4 &#40;21&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Calidad de vida &#40;EurolQol-5D-3L&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">52&#44;6 &#40;17&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">57&#44;0 &#40;16&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">40&#44;9 &#40;19&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Escala europea de conductas de autocuidado en insuficiencia card&#237;aca</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">31&#44;2 &#40;9&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Comorbilidades &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Anemia</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Depresi&#243;n</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">51 &#40;50&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;980&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Enfermedad renal cr&#243;nica</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">106 &#40;40&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Dislipidemia</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Enfermedad de las arterias perif&#233;ricas</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Neoplasia maligna</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hipertensi&#243;n arterial</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Fibrilaci&#243;n auricular</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">130 &#40;50&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">51 &#40;50&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Enfermedad pulmonar cr&#243;nica</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">77 &#40;29&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">33 &#40;32&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;21&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;455&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Diabetes</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">93 &#40;35&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">32 &#40;31&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">50 &#40;39&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;33&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;436&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8 &#40;7&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;7&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Algunos problemas para caminar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">220 &#40;85&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86 &#40;85&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">113 &#40;80&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;67&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>En cama&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;7&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;6&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;32&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Cuidados personales&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No tiene problemas con el autocuidado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42 &#40;16&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;25&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;12&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Algunos problemas para lavarse o vestirse&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">143 &#40;55&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61 &#40;60&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72 &#40;57&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;31&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No puede lavarse&#47;vestirse&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73 &#40;28&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;13&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;29&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;68&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Actividades habituales&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No tiene problemas para realizar actividades habituales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;7&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;12&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;5&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Algunos problemas para actividades habituales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">151 &#40;585&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61 &#40;60&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81 &#40;64&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;28&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No puede hacer actividades habituales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87 &#40;33&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;26&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;29&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;71&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Dolor&#47;malestar&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;424&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sin dolor ni molestias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68 &#40;26&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;23&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;28&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;28&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dolor o malestar moderado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">151 &#40;58&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59 &#40;58&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76 &#40;60&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;50&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dolor o malestar extremo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87 &#40;33&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;17&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;11&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;21&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Ansiedad&#47;depresi&#243;n&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sin ansiedad o depresi&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52 &#40;20&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 820&#44;29&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;23&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;9&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ansiedad o depresi&#243;n moderada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94 &#40;36&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48 &#40;48&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;32&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;18&#44;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ansiedad o depresi&#243;n extrema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">110 &#40;43&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;31&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 &#40;44&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;71&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#205;tem&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sin riesgo&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>100&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46; Me peso todos los d&#237;as&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;9 &#40;1&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;6 &#40;1&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46; Si me falta el aire&#44; me lo tomo con calma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;4 &#40;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;6 &#40;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;0 &#40;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46; Si mi dificultad para respirar aumenta&#44; me comunico con mi m&#233;dico o enfermero&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;0 &#40;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;0 &#40;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;3 &#40;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;494&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46; Si mis pies&#47;piernas se hinchan m&#225;s de lo habitual&#44; me comunico con mi m&#233;dico o enfermero&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;2 &#40;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;1 &#40;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;2 &#40;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;6 &#40;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;092&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46; Si gano 2 kg en una semana&#44; me comunico con mi m&#233;dico o enfermero&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;8 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;6 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;7 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;2 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;061&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46; Limito la cantidad de l&#237;quido que bebo &#40;no m&#225;s de 1&#44;5-2 l&#47;d&#237;a&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;2 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;0 &#40;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;2 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;8 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46; Me todo un descanso durante el d&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;5 &#40;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;3 &#40;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;6 &#40;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;7 &#40;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;030&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46; Si siento un aumento de la fatiga&#44; me comunico con mi m&#233;dico o enfermero&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;0 &#40;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;1 &#40;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9 &#40;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;3 &#40;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;117&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46; Sigo una dieta baja en sal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;8 &#40;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;8 &#40;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;7 &#40;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;1 &#40;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;174&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46; Tomo mi medicaci&#243;n seg&#250;n lo prescrito&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;4 &#40;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;3 &#40;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;4 &#40;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;8 &#40;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;027&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46; Recibo la vacuna contra la gripe todos los a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;8 &#40;1&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;6 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;9 &#40;1&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;2 &#40;1&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;049&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46; Hago ejercicio regularmente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;5 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;2 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;4 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;3 &#40;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3457720.png"
              ]
            ]
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          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Media &#40;desviaci&#243;n est&#225;ndar&#41;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Asociaci&#243;n entre conductas de autocuidado <span class="elsevierStyleItalic">&#40;European Heart Failure Self-care Behavior Scale&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a> y desnutrici&#243;n&#44; en pacientes con insuficiencia card&#237;aca avanzada</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:40 [
            0 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "End-stage heart disease in the elderly"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Spanish Society of Cardiology Section on Geriatric Cardiology &#171;End stage heart disease in the elderly&#187; working group"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Mart&#237;nez-Sell&#233;s"
                            1 => "M&#46;T&#46; Vid&#225;n"
                            2 => "R&#46; L&#243;pez-Palop"
                            3 => "L&#46; Rexach"
                            4 => "E&#46; S&#225;nchez"
                            5 => "T&#46; Datino"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/s1885-5857(09)71668-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Cardiol&#46;"
                        "fecha" => "2009"
                        "volumen" => "62"
                        "paginaInicial" => "409"
                        "paginaFinal" => "421"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19401126"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Burden of heart failure in primary healthcare"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "F&#46;E&#46; Gonzalez-Loyola"
                            1 => "M&#46;A&#46; Mu&#241;oz"
                            2 => "E&#46; Navas"
                            3 => "J&#46; Real"
                            4 => "E&#46; Vinyoles"
                            5 => "J&#46;M&#46; Verd&#250;-Rotellar"
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Original
Impacto de la malnutrición en la calidad de vida de los pacientes ancianos con insuficiencia cardíaca avanzada
Impact of malnutrition on the quality of life in older patients with advanced heart failure: a cohort study
J.-M. Verdu-Rotellara,b,c, E. Calerod, J. Durane, E. Navasc, S. Alonsoa, N. Argemía, M. Casademunta, P. Furióa, E. Casajuanaa, E. Vinyolesa,c,f, M.A. Muñoza,b,c,
Autor para correspondencia
mamunoz.bcn.ics@gencat.cat

Autor para correspondencia.
, en representación del estudio HADES
a Gerència Territorial de Barcelona (Atenció Primària), Institut Català de la Salut, Barcelona, España
b Departament de Ciències Experimentals i de la Salut, Facultat de Medicina, Universitat Pompeu Fabra, Barcelona, España
c Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España
d Hospital Universitari de Bellvitge, Institut Català de la Salut, Hospitalet de Llobregat, Barcelona, España
e Clínica Sant Antoni (Institut Mèdic i de Rehabilitació), Barcelona, España
f Departament de Medicina, Facultat de Medicina, Universitat de Barcelona, Barcelona, España
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Curvas de supervivencia que eval&#250;an la mortalidad en funci&#243;n del estado nutricional en pacientes con insuficiencia card&#237;aca avanzada&#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 insuficiencia card&#237;aca &#40;IC&#41; representa la etapa final de varias enfermedades card&#237;acas<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a>&#46; La incidencia de la IC aumenta dr&#225;sticamente con la edad y&#44; debido al envejecimiento de la poblaci&#243;n as&#237; como a los avances en la supervivencia&#44; la prevalencia de la IC est&#225; aumentando&#44; lo que se asocia con una carga significativa para los pacientes y los costos y recursos de atenci&#243;n m&#233;dica<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">2&#44;3</span></a>&#46; La IC avanzada se asocia frecuentemente con la atrofia muscular&#44; la caquexia card&#237;aca y la desnutrici&#243;n debido a la ingesta deficiente de nutrientes y a circunstancias cl&#237;nicas relacionadas con la enfermedad<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">4</span></a>&#46; La desnutrici&#243;n en la poblaci&#243;n mayor es el resultado de problemas de salud multifactoriales<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">5</span></a>&#44; y es particularmente frecuente en pacientes con IC<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">6</span></a>&#46; Se ha valorado que el estado nutricional deficiente en dichas poblaciones se asocia con peores resultados de salud<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Adem&#225;s de los par&#225;metros biol&#243;gicos y cl&#237;nicos&#44; el uso de medidas para ver resultados informados por el paciente &#40;PROM&#41; se reconoce cada vez m&#225;s como una forma importante de evaluar el estado de salud de una persona&#46; Las PROM son herramientas de medici&#243;n mediante las cuales los pacientes brindan informaci&#243;n sobre aspectos de su estado de salud&#44; incluidos s&#237;ntomas&#44; calidad de vida&#44; funcionalidad y salud f&#237;sica y mental<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">8</span></a>&#46; Entre las diversas escalas empleadas para determinar la desnutrici&#243;n en pacientes con IC<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">9-11</span></a>&#44; la <span class="elsevierStyleItalic">Mini Nutritional Assessment Short Form</span> &#40;MNA-SF&#41; ha demostrado ser una herramienta confiable y sencilla para detectar el estado nutricional anormal<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a> y es un fuerte predictor de mortalidad por IC<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A pesar de contar con varias herramientas para evaluar el estado nutricional en la IC&#44; la informaci&#243;n sobre un enfoque hol&#237;stico basado en el estado de salud y el comportamiento frente a la enfermedad autoinformado por el paciente es escasa&#44; especialmente en etapas avanzadas&#46; Por tanto&#44; el objetivo de este estudio ha sido evaluar el impacto del estado nutricional en la calidad de vida&#44; las capacidades de autocuidado y las actividades de la vida diaria en pacientes mayores con IC avanzada&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Dise&#241;o del estudio y pacientes</span><p id="par0020" class="elsevierStylePara elsevierViewall">El estudio HADES &#40;insuficiencia card&#237;aca en estadios avanzados&#41; es un estudio de cohorte prospectivo y multic&#233;ntrico&#46; Incluy&#243; pacientes con IC &#8805;<span class="elsevierStyleHsp" style=""></span>40<span class="elsevierStyleHsp" style=""></span>a&#241;os con estado funcional IV de la <span class="elsevierStyleItalic">New York Heart Association</span> &#40;NYHA&#41;&#44; o aquellos que requirieron hospitalizaci&#243;n al menos dos veces en los seis meses anteriores&#46; Para los fines de este estudio nos centramos en pacientes de &#8805;<span class="elsevierStyleHsp" style=""></span>65<span class="elsevierStyleHsp" style=""></span>a&#241;os para hacer la muestra m&#225;s homog&#233;nea y evitar sesgos relacionados con la edad&#46; Todos los pacientes estaban cl&#237;nicamente estables en el momento de la inclusi&#243;n&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Los pacientes fueron seleccionados a partir de historias cl&#237;nicas electr&#243;nicas de atenci&#243;n primaria y de informes de alta hospitalaria&#46; En el estudio participaron un total de 22 centros de atenci&#243;n primaria&#44; tres hospitales universitarios&#44; un hospital con &#225;rea de agudos y una unidad de rehabilitaci&#243;n geri&#225;trica de Barcelona &#40;Espa&#241;a&#41; entre junio de 2017 y diciembre de 2019&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El protocolo del estudio fue aprobado por el Comit&#233; de &#201;tica del Instituto de Investigaci&#243;n en Atenci&#243;n Primaria de Atenci&#243;n Primaria IDIAP Jordi Gol &#40;referencia P17&#47;086&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Evaluaciones cl&#237;nicas y PROM</span><p id="par0035" class="elsevierStylePara elsevierViewall">Dado que muchos pacientes no pod&#237;an acudir al centro de atenci&#243;n primaria&#44; 27 enfermeros del equipo de investigaci&#243;n acudieron al domicilio del paciente para cumplimentar los cuestionarios y realizar los ex&#225;menes cl&#237;nicos&#46; Se evalu&#243; una muestra de pacientes en una unidad de cuidados intermedios donde se recuperaban tras el alta hospitalaria&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Para evaluar inicialmente el estado nutricional y detectar desnutrici&#243;n&#44; el personal administr&#243; el cuestionario de siete &#237;tems MNA-SF&#46; El MNA-SF ha demostrado buena sensibilidad y especificidad para detectar la desnutrici&#243;n y las personas en riesgo de desnutrici&#243;n entre los adultos mayores que viven en comunidades<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">14</span></a>&#46; Cuando las puntuaciones de detecci&#243;n eran inferiores a once puntos &#40;que se considera el umbral de riesgo de desnutrici&#243;n&#41;&#44; se utiliz&#243; un conjunto de &#237;tems adicionales para clasificar a los pacientes en dos categor&#237;as&#58; riesgo o desnutrici&#243;n establecida&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">La calidad de vida se evalu&#243; mediante el instrumento EQ-5D-3L&#44; y los resultados de los pacientes se obtuvieron a partir de entrevistas personales realizadas por los trabajadores&#46; Este instrumento proporciona un perfil descriptivo simple y un valor de &#237;ndice resumido &#250;nico para el estado de salud&#46; El instrumento explora la movilidad&#44; el autocuidado&#44; la realizaci&#243;n de actividades habituales&#44; el dolor o malestar y la presencia de ansiedad o depresi&#243;n en los pacientes&#46; Tambi&#233;n se incluye una puntuaci&#243;n visual anal&#243;gica &#40;EVA&#41;&#44; que proporciona un &#237;ndice num&#233;rico entre 0 &#40;peor&#41; y 100 &#40;la mejor salud que el paciente puede imaginar&#41;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a>&#46; La conducta de autocuidado se evalu&#243; con la escala europea de conducta de autocuidado en IC<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a> y se utiliz&#243; el &#237;ndice de Barthel para determinar el impacto en las actividades de la vida diaria<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">17</span></a>&#46; Ambas PROM recibieron una puntuaci&#243;n de 0 &#40;la peor&#41; a 100 &#40;la mejor&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Aunque el &#237;ndice de masa corporal &#40;IMC&#41; se evalu&#243; como parte del MNA-SF&#44; se incluy&#243; adem&#225;s en los modelos multivariados para determinar su asociaci&#243;n independiente con un mayor riesgo de desnutrici&#243;n&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Las variables cl&#237;nicas se recogieron de los registros m&#233;dicos y del examen cl&#237;nico&#44; la ecocardiograf&#237;a y las pruebas de laboratorio&#44; incluida la hemoglobina&#44; la funci&#243;n renal&#44; los iones y los biomarcadores card&#237;acos&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">An&#225;lisis estad&#237;stico</span><p id="par0060" class="elsevierStylePara elsevierViewall">Se utilizaron estad&#237;sticas descriptivas para resumir los datos demogr&#225;ficos y cl&#237;nicos&#44; con las variables continuas presentadas como media y desviaci&#243;n est&#225;ndar &#40;DE&#41; o mediana y rango intercuart&#237;lico &#40;RIQ&#41;&#44; y las variables categ&#243;ricas como frecuencias y porcentajes&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Se utilizaron pruebas t-independientes y no param&#233;tricas para comparar las medianas entre grupos para variables con distribuci&#243;n normal y no normal&#44; respectivamente&#46; Se utiliz&#243; la prueba de chi-cuadrado para comparar proporciones entre grupos&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Dado que el an&#225;lisis descriptivo se realiz&#243; respecto de una variable con m&#225;s de dos categor&#237;as &#40;sin riesgo&#44; riesgo y desnutrici&#243;n&#41;&#44; se realiz&#243; an&#225;lisis de varianza &#40;ANOVA&#41; para variables continuas que siguen una distribuci&#243;n normal&#44; mientras que para variables continuas que no siguen una distribuci&#243;n normal se utiliz&#243; la prueba de Kruskal-Wallis&#46; En el caso de variables categ&#243;ricas se realiz&#243; la prueba de chi-cuadrado&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Los datos del tiempo transcurrido hasta el evento se presentan gr&#225;ficamente utilizando curvas de Kaplan-Meier para analizar el efecto de la desnutrici&#243;n en la mortalidad&#44; y se utilizaron pruebas de rango logar&#237;tmico para comparar la supervivencia entre grupos&#46; Las variables asociadas a la probabilidad de presentar riesgo de desnutrici&#243;n en el an&#225;lisis bivariado &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;01&#41; se incluyeron en un modelo de regresi&#243;n log&#237;stica siguiendo un procedimiento por pasos&#46; El an&#225;lisis estad&#237;stico se realiz&#243; utilizando el software R para Windows versi&#243;n 3&#46;6&#46;1&#44; Viena&#44; Austria&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><p id="par0080" class="elsevierStylePara elsevierViewall">De los 271 participantes incluidos inicialmente en el estudio&#44; 265 eran mayores de 64<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; y se administr&#243; el MNA-SF a 260 &#40;98&#44;05&#37;&#41; de estos pacientes&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Entre los participantes &#62;<span class="elsevierStyleHsp" style=""></span>64<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; 158 &#40;60&#44;8&#37;&#41; eran mujeres y la edad media fue de 84&#44;8 &#40;DE&#58; 7&#44;5&#41; a&#241;os&#46; Los pacientes &#8805;<span class="elsevierStyleHsp" style=""></span>75<span class="elsevierStyleHsp" style=""></span>a&#241;os representaron el 89&#44;2&#37;&#46; La mediana de seguimiento fue de 14&#44;9<span class="elsevierStyleHsp" style=""></span>meses &#40;RIQ&#58; 25-75&#59; 4&#44;9-26&#44;9&#41;&#46; Utilizando el MNA-SF&#44; se identific&#243; que 126 &#40;48&#44;5&#37;&#41; pacientes estaban en riesgo de desnutrici&#243;n y 33 &#40;12&#44;7&#37;&#41; pacientes ten&#237;an desnutrici&#243;n confirmada&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Durante el seguimiento fallecieron 133 &#40;51&#44;2&#37;&#41; pacientes&#46; La mortalidad fue del 78&#44;8&#37; entre 26 pacientes con desnutrici&#243;n confirmada&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">El deterioro del estado nutricional &#40;es decir&#44; estado nutricional normal frente a desnutrici&#243;n en riesgo frente a desnutrici&#243;n confirmada&#41; se asoci&#243; con una edad cada vez mayor &#40;media &#91;DE&#93;&#58; 83&#44;5 &#91;7&#44;4&#93; frente a 85&#44;0 &#91;7&#44;4&#93; frente a 88&#44;0 &#91;7&#44;4&#93;&#41;&#44; un IMC m&#225;s bajo &#40;29&#44;1 &#91;5&#44;5&#93; vs 27&#44;6 &#91;5&#44;4&#93; vs 25&#44;3 &#91;5&#44;0&#93;&#41;&#44; niveles m&#225;s bajos de hemoglobina &#40;11&#44;7 &#91;1&#44;6&#93; vs 11&#44;4 &#91;1&#44;8&#93; vs 10&#44;6 &#91;1&#44;4&#93;&#41;&#44; una mayor dependencia para las actividades diarias &#40;puntuaciones del &#237;ndice de Barthel&#58; 69&#44;8 &#91;18&#44;6&#93; vs 59&#44;7 &#91;25&#44;0&#93; vs 31&#44;4 &#91;21&#44;3&#93;&#41;&#44; peor calidad de vida percibida &#40;puntuaciones EQ-5D-5L&#58; 57&#44;0 &#91;16&#44;4&#93; vs 52&#44;0 &#91;16&#44;8&#93; vs 40&#44;9 &#91;19&#44;9&#93;&#41; y peor autocuidado &#40;<span class="elsevierStyleItalic">European Heart Failure Self-care</span> puntuaciones de comportamiento&#58; 24&#44;6 &#91;6&#44;7&#93; frente a 26&#44;3 &#91;7&#44;1&#93; frente a 31&#44;2 &#91;9&#44;5&#93;&#41;&#46; Ni la comorbilidad ni los medicamentos utilizados para controlar la IC se asociaron con el riesgo de desnutrici&#243;n o con la mortalidad &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Un mejor &#237;ndice de Barthel y las puntuaciones de calidad de vida se relacionaron inversamente con el riesgo de desnutrici&#243;n &#40;odds ratio &#91;OR&#93;&#58; 0&#44;97 &#91;intervalo de confianza del 95&#37;&#58; 0&#44;96-0&#44;98&#93; y OR&#58; 0&#44;98 &#91;intervalo de confianza del 95&#37;&#58; 0&#44;96-0&#44;99&#93;&#41;&#44; respectivamente&#46; Las puntuaciones m&#225;s altas en la escala europea de conducta de autocuidado de la IC&#44; que implica un peor autocuidado&#44; se relacionaron con un mayor riesgo de desnutrici&#243;n &#40;OR&#58; 1&#44;05 &#91;intervalo de confianza del 95&#37;&#58; 1&#44;02-1&#44;09&#93;&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En cuanto a la calidad de vida&#44; los pacientes con IC y desnutrici&#243;n informaron peores resultados relacionados con la movilidad&#44; el cuidado personal&#44; las actividades habituales y la ansiedad o depresi&#243;n en comparaci&#243;n con los pacientes con IC con un estado nutricional normal &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; De manera similar&#44; los pacientes con desnutrici&#243;n reportaron peores puntuaciones en la mayor&#237;a de los &#237;tems de conducta de autocuidado &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">El an&#225;lisis de la curva de Kaplan Meier mostr&#243; que el grupo desnutrido ten&#237;a un riesgo de mortalidad significativamente mayor &#40;p<span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">El modelo multivariado ajustado encontr&#243; que niveles m&#225;s bajos de IMC y hemoglobina&#44; y peores puntuaciones en calidad de vida y actividades de la vida diaria&#44; eran predictivos de desnutrici&#243;n &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discusi&#243;n</span><p id="par0120" class="elsevierStylePara elsevierViewall">En nuestra cohorte encontramos que la desnutrici&#243;n en pacientes con IC avanzada se asoci&#243; significativamente con niveles bajos de hemoglobina&#44; mala calidad de vida autoinformada&#44; impactos adversos en las actividades diarias y el autocuidado&#44; y una mayor mortalidad&#46; Al combinar tanto el riesgo de desnutrici&#243;n como la desnutrici&#243;n establecida en nuestra cohorte&#44; observamos que la prevalencia fue similar a estudios previos de una revisi&#243;n sistem&#225;tica reciente que describe la prevalencia de desnutrici&#243;n en pacientes con IC&#44; que result&#243; en un 46&#37;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">En una poblaci&#243;n anciana&#44; cr&#243;nicamente enferma y con una comorbilidad importante&#44; como la analizada en nuestro estudio&#44; la relaci&#243;n entre todos los factores que contribuyen a la fragilidad y el pron&#243;stico es compleja&#46; Varios factores pueden contribuir a la desnutrici&#243;n&#44; incluida la p&#233;rdida de apetito&#44; la polifarmacia y la fragilidad y&#44; en particular&#44; la presencia de enfermedades cr&#243;nicas<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a>&#46; La edad&#44; el tiempo transcurrido desde el diagn&#243;stico de IC&#44; las hospitalizaciones previas&#44; el apoyo social y familiar&#44; as&#237; como otras caracter&#237;sticas cl&#237;nicas y sociales tambi&#233;n pueden influir en el estado nutricional y contribuir al empeoramiento de la calidad de vida&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Varios pacientes de nuestra cohorte ten&#237;an comorbilidades concomitantes&#44; como c&#225;ncer&#44; depresi&#243;n&#44; insuficiencia renal y enfermedad pulmonar obstructiva cr&#243;nica&#44; todas las cuales podr&#237;an afectar el estado nutricional e influir en el pron&#243;stico<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">20-23</span></a>&#46; Sin embargo&#44; no encontramos que ninguna de estas comorbilidades estuviera asociada significativamente con la desnutrici&#243;n&#46; Como se inform&#243; en otros estudios&#44; encontramos niveles m&#225;s bajos de hemoglobina en pacientes con desnutrici&#243;n<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">24</span></a>&#46; Sin embargo&#44; el diagn&#243;stico de anemia&#44; que se define por un punto de corte &#60;<span class="elsevierStyleHsp" style=""></span>12 o &#60;<span class="elsevierStyleHsp" style=""></span>13<span class="elsevierStyleHsp" style=""></span>g&#47;dl de hemoglobina en mujeres y hombres&#44; respectivamente&#44; no se asoci&#243; con desnutrici&#243;n en nuestros pacientes&#44; probablemente debido a los bajos niveles basales en el conjunto&#46; Se ha informado que m&#225;s de la mitad de los pacientes mayores con IC tienen un nivel de hemoglobina inferior a 12<span class="elsevierStyleHsp" style=""></span>g&#47;dl y&#44; entre ellos&#44; el 79&#44;1&#37; se encontraba en clase<span class="elsevierStyleHsp" style=""></span>IV de la NYHA<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">25</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">En la poblaci&#243;n de mayor edad&#44; la anemia es causada por deficiencias nutricionales&#44; inflamaci&#243;n cr&#243;nica&#44; enfermedades renales cr&#243;nicas o anemia inexplicable en aproximadamente un tercio cada una<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a>&#46; En pacientes con IC la patog&#233;nesis de la anemia es multifactorial&#44; influyendo la inflamaci&#243;n asociada&#44; el sistema renina-angiotensina y la hemodiluci&#243;n<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">27</span></a>&#46; Un estudio de Opasich et al&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">28</span></a> encontr&#243; una causa espec&#237;fica de anemia en solo el 43&#37; de los pacientes con IC estable&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Tambi&#233;n se ha descrito que algunos medicamentos pueden afectar negativamente el estado nutricional al modificar la percepci&#243;n sensorial del gusto o la absorci&#243;n intestinal&#44; particularmente en los adultos mayores<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">29</span></a>&#46; Adem&#225;s&#44; los efectos secundarios&#44; como n&#225;useas y v&#243;mitos&#44; diarrea&#44; p&#233;rdida de apetito y fatiga&#44; tambi&#233;n pueden influir en la ingesta nutricional&#46; Sin embargo&#44; en nuestra cohorte no encontramos relaci&#243;n con ninguno de los medicamentos enumerados en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> y el estado nutricional&#44; probablemente porque estos medicamentos se toleran bien&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">La asociaci&#243;n entre el IMC&#44; la nutrici&#243;n y la caquexia card&#237;aca sigue sin estar clara&#46; En los pacientes con IC es posible encontrar masa muscular reducida junto con un IMC normal debido a la presencia de edema o acumulaci&#243;n de masa libre de grasa<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a>&#46; Se ha informado que hasta el 50&#37; de los pacientes con IC clasificados como obesos estaban desnutridos o en riesgo de desnutrici&#243;n<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">31</span></a>&#46; Dado que est&#225; bien establecido que un IMC bajo se relaciona con un peor pron&#243;stico en pacientes mayores y con IC&#44; se ha argumentado que se debe aplicar una modificaci&#243;n en los puntos de corte del IMC en esta poblaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">32&#44;33</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">El mal estado nutricional se ha asociado con impactos adversos en la calidad de vida de pacientes mayores con enfermedades cr&#243;nicas<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">34</span></a>&#46; En un estudio reciente&#44; los pacientes con IC con una ingesta cal&#243;rica insuficiente ten&#237;an peor calidad de vida y un mayor riesgo de reingreso hospitalario en comparaci&#243;n con los pacientes con IC con una ingesta cal&#243;rica suficiente<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">35</span></a>&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">El autocuidado es crucial en el manejo de la IC&#44; e incluye la adherencia al tratamiento&#44; cambios en el estilo de vida&#44; seguimiento de los s&#237;ntomas y actitud y respuesta adecuadas a los indicadores de deterioro&#46; Recomendaciones recientes de la Asociaci&#243;n de Insuficiencia Card&#237;aca de la Sociedad Europea de Cardiolog&#237;a resaltaron la importancia del autocuidado en el tratamiento de la IC&#44; incluido el mantenimiento de un estado nutricional &#243;ptimo&#46; Es necesario considerar la reducci&#243;n de peso cuando el IMC es superior a 35<span class="elsevierStyleHsp" style=""></span>kg&#47;m<span class="elsevierStyleSup">2</span>&#44; buscar atenci&#243;n m&#233;dica cuando aparece una p&#233;rdida de peso involuntaria y limitar la ingesta de sal y de alcohol<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">36</span></a>&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">En nuestra poblaci&#243;n encontramos que la desnutrici&#243;n se asoci&#243; con un peor autocuidado&#46; Un estudio realizado en una sala de rehabilitaci&#243;n geri&#225;trica de un hospital inform&#243; que los pacientes mayores con riesgo de desnutrici&#243;n ten&#237;an una menor capacidad de autocuidado&#44; probablemente debido a una menor capacidad para utilizar estrategias cognitivas&#44; afectivas y conductuales<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">37</span></a>&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">La dependencia funcional &#40;es decir&#44; la necesidad de asistencia para las actividades de la vida diaria&#41; est&#225; estrechamente relacionada con un estado nutricional deficiente<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">38</span></a>&#46; Se ha descrito una relaci&#243;n rec&#237;proca entre la desnutrici&#243;n y la discapacidad en la poblaci&#243;n de mayor edad&#44; seg&#250;n la cual la desnutrici&#243;n puede exacerbar la discapacidad y la discapacidad puede exacerbar la desnutrici&#243;n&#46; El envejecimiento&#44; la presencia de enfermedades cr&#243;nicas y la polifarmacia se asocian tanto con la dependencia funcional como con un mal estado nutricional<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">39</span></a>&#46; Tambi&#233;n se ha demostrado que una reducci&#243;n en la ingesta de prote&#237;nas&#44; como consecuencia de un estado nutricional deficiente&#44; produce una reducci&#243;n de la masa muscular y una disminuci&#243;n de la movilidad&#44; lo que lleva a una menor independencia en las actividades de la vida diaria<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">40</span></a>&#46;</p><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Fortalezas y limitaciones</span><p id="par0170" class="elsevierStylePara elsevierViewall">Este es el primer estudio&#44; hasta donde sabemos&#44; que vincula el autocuidado con el riesgo de desnutrici&#243;n en pacientes con IC avanzada&#46; Sin embargo&#44; el estudio tambi&#233;n presenta algunas limitaciones&#46; Dado que nuestro estudio se centra en el estado avanzado de IC&#44; el tama&#241;o de la muestra puede no ser suficiente para proporcionar una validaci&#243;n externa s&#243;lida&#46; Sin embargo&#44; es uno de los pocos estudios que analiza la asociaci&#243;n entre el estado nutricional y las medidas de resultado informadas por los pacientes&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Hubiera sido relevante recolectar datos sobre disfagia&#44; trastornos orofar&#237;ngeos y la administraci&#243;n de suplementos nutricionales&#44; que pueden contribuir a la desnutrici&#243;n&#44; pero lamentablemente no tuvimos acceso a esta informaci&#243;n&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusiones</span><p id="par0180" class="elsevierStylePara elsevierViewall">En pacientes mayores con IC avanzada la desnutrici&#243;n se asoci&#243; con peores medidas de resultados informadas por los pacientes relacionadas con una mala calidad de vida y efectos adversos en el autocuidado y las actividades diarias&#46; El mal estado nutricional tambi&#233;n se asoci&#243; con mayores tasas de mortalidad&#46; El estado nutricional debe ser abordado sistem&#225;ticamente por enfermeros de atenci&#243;n primaria y m&#233;dicos de familia para mejorar las tasas de supervivencia de estos pacientes&#46; Ser&#237;a de gran ayuda la incorporaci&#243;n de profesionales expertos en nutrici&#243;n en los centros de atenci&#243;n primaria de salud&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Financiaci&#243;n</span><p id="par0185" class="elsevierStylePara elsevierViewall">Este proyecto se ha llevado a cabo con el apoyo del Departamento de Salud de la Generalitat de Catalunya&#44; en la convocatoria correspondiente al a&#241;o 2016 de concesi&#243;n de ayudas del Plan Estrat&#233;gico de Investigaci&#243;n e Innovaci&#243;n en Salud &#40;PERIS&#41; 2016-2020&#44; modalidad Proyectos de investigaci&#243;n orientados a atenci&#243;n primaria&#44; con c&#243;digo de expediente SLT002&#47;16&#47;00073&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicto de intereses</span><p id="par0190" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio fue evaluar la prevalencia de malnutrici&#243;n&#44; las caracter&#237;sticas cl&#237;nicas asociadas con la misma y el impacto del estado nutricional en la mortalidad&#44; la calidad de vida y las habilidades relacionadas con el autocuidado y las actividades de la vida diaria en pacientes ancianos con insuficiencia card&#237;aca avanzada&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Entre junio de 2017 y diciembre de 2019 se llev&#243; a cabo un estudio prospectivo multic&#233;ntrico de cohortes que incluy&#243; a 260 pacientes ancianos con insuficiencia card&#237;aca avanzada que viv&#237;an en la comunidad&#46; El estudio se llev&#243; a cabo en 22 centros de atenci&#243;n primaria&#44; tres hospitales universitarios&#44; un hospital de agudos y una unidad de rehabilitaci&#243;n geri&#225;trica de la ciudad de Barcelona &#40;Espa&#241;a&#41;&#46; El estado nutricional se evalu&#243; al inicio del estudio mediante el cuestionario <span class="elsevierStyleItalic">Mini Nutritional Assessment</span> &#40;MNA&#41; Las medidas de resultado informadas por los pacientes incluyeron calidad de vida &#40;EQ-5D-3L&#41;&#44; conducta de autocuidado &#40;Escala europea de conducta de autocuidado en insuficiencia card&#237;aca&#41; e impacto en las actividades de la vida diaria &#40;&#237;ndice de Barthel&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Utilizando el MNA-SF&#44; se identific&#243; que 126 &#40;48&#44;5&#37;&#41; pacientes estaban en riesgo de malnutrici&#243;n y 33 &#40;12&#44;7&#37;&#41; pacientes ten&#237;an malnutrici&#243;n confirmada&#46; En comparaci&#243;n con aquellos con un estado nutricional normal&#44; los pacientes con malnutrici&#243;n confirmada eran significativamente mayores&#44; con un IMC m&#225;s bajo y con niveles reducidos de hemoglobina&#46; Durante el seguimiento &#40;mediana de 14&#44;9 meses&#44; intervalo intercuartil&#58; 4&#44;9-26&#44;9&#41;&#44; 133 &#40;51&#44;2&#37;&#41; de los participantes incluidos murieron&#46; La mortalidad fue significativamente mayor entre los pacientes con malnutrici&#243;n &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46; Un mayor &#237;ndice de Barthel y mejores puntuaciones de calidad de vida se relacionaron inversamente con el riesgo de desnutrici&#243;n &#40;odds ratio &#91;OR&#93; 0&#44;97 &#91;intervalo de confianza del 95&#37;&#58; 0&#44;96-0&#44;98&#93; y OR 0&#44;98 &#91;intervalo de confianza del 95&#37;&#58; 0&#44;96-0&#44;99&#93;&#41;&#44; respectivamente&#46; Las puntuaciones m&#225;s altas en la Escala Europea&#44; que implican un peor autocuidado&#44; se relacionaron con un mayor riesgo de desnutrici&#243;n &#40;OR 1&#44;05 &#91;intervalo de confianza del 95&#37;&#58; 1&#44;02-1&#44;09&#93;&#41;&#46; El modelo log&#237;stico multivariado ajustado encontr&#243; que la malnutrici&#243;n se asociaba significativamente con una mala calidad de vida y peores puntuaciones en las escalas de independencia en actividades de la vida diaria y el autocuidado&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En pacientes ancianos con insuficiencia card&#237;aca avanzada la malnutrici&#243;n se asoci&#243; con peores resultados en calidad de vida&#44; en el autocuidado de su enfermedad y mayor limitaci&#243;n en las actividades de la vida diaria&#46; El estado nutricional debe ser abordado sistem&#225;ticamente por los enfermeros y m&#233;dicos de atenci&#243;n primaria para mejorar la supervivencia de estos pacientes&#46; Ser&#237;a de gran ayuda la incorporaci&#243;n de profesionales expertos en nutrici&#243;n en los centros de atenci&#243;n primaria de salud&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to assess the prevalence of malnutrition&#44; the clinical characteristics associated with malnutrition and the impact of nutritional status on mortality&#44; quality of life&#44; self-care abilities&#44; and activities of daily living in the older patients with advanced heart failure&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A prospective multicentre cohort study including 260 community-dwelling elderly patients with advanced heart failure was conducted between June 2017 and December 2019&#46; The study was carried out in 22 primary healthcare centres&#44; three university hospitals&#44; one acute-care hospital&#44; and one geriatric rehabilitation unit in the city of Barcelona &#40;Spain&#41;&#46; Nutritional status was assessed at baseline using the Mini Nutritional Assessment &#40;MNA&#41; questionnaire&#46; Patient-reported outcome measures included quality of life &#40;EQ-5D-3L&#41;&#44; self-care behaviour &#40;European Heart Failure Self-care Behaviour Scale&#41; and impact on activities of daily living &#40;Barthel index&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Using the MNA-SF&#44; 126 &#40;48&#46;5&#37;&#41; patients were identified as being at risk of malnutrition and 33 &#40;12&#46;7&#37;&#41; patients as having confirmed malnutrition&#46; Compared to heart failure patients with normal nutritional status&#44; patients with confirmed malnutrition were significantly older&#44; with a lower BMI&#44; and with reduced haemoglobin levels&#46; During follow-up &#40;median 14&#46;9 months&#44; interquartile range&#58; 4&#46;9-26&#46;9&#41;&#44; 133 &#40;51&#46;2&#37;&#41; of the included participants died&#44; and mortality was significantly higher among patients identified as having malnutrition &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; Better Barthel index and quality of life scores were inversely related to the risk of malnutrition &#40;Odds Ratio &#91;OR&#93; 0&#46;97 &#91;95&#37; confidence interval&#58; 0&#46;96 to 0&#46;98&#93; and OR 0&#46;98 &#91;95&#37; confidence interval&#58; 0&#46;96 to 0&#46;99&#93;&#41;&#44; respectively&#46; Higher scores in the European Heart Failure Self-care Behaviour Scale&#44; which implies worse self care&#44; were related to higher malnutrition risk &#40;OR 1&#46;05 &#91;95&#37; confidence interval&#58; 1&#46;02 to 1&#46;09&#93;&#41;&#46; Adjusted multivariate logistic model found that malnutrition was significantly associated with poor quality of life&#44; and adverse impacts on daily activities and self-care&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">In community-dwelling older patients with advanced heart failure&#44; malnutrition was associated with worse patient reported outcome measures related to poor quality of life&#44; and adverse impacts on self-care and daily activities&#46; Nutritional status must be systematically addressed by primary care nurses and family doctors to improve survival rates in these patients&#46; It would be helpful the incorporation of expert professionals in nutrition in the primary health care centres&#46;</p></span>"
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">88 &#40;33&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#205;ndice de masa corporal &#40;kg&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Presi&#243;n arterial sist&#243;lica &#40;mm&#47;Hg&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">122 &#40;19&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Presi&#243;n arterial diast&#243;lica&#40;mm7Hg&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">66&#44;2 &#40;9&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;407&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Frecuencia card&#237;aca &#40;beats&#47;min&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">75&#44;3 &#40;13&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;184&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Creatinina&#40;mg&#47;dl&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;4 &#40;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;4 &#40;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;3 &#40;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;4 &#40;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;844&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Filtraci&#243;n glomerular &#40;ml&#47;min&#47;m</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span><span class="elsevierStyleItalic">&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">47&#44;6 &#40;20&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">45&#44;1 &#40;20&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;294&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Hemoglobina &#40;g&#47;dl&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11&#44;4 &#40;1&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11&#44;7 &#40;1&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11&#44;4 &#40;1&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&#44;6 &#40;1&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Prop&#233;ptido natriur&#233;tico cerebral N-terminal &#40;pg&#47;ml&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6753 &#40;8567&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7099 &#40;9997&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Fracci&#243;n de eyecci&#243;n&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&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-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#60; 50&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">67 &#40;29&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24 &#40;25&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">37 &#40;34&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;23&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#8805; 50&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">159 &#40;70&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">70 &#40;74&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">69 &#40;65&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20 &#40;76&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">&#205;ndice de Barthel</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&#44;0 &#40;25&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">69&#44;8 &#40;18&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&#44;7 &#40;25&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#44;4 &#40;21&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Calidad de vida &#40;EurolQol-5D-3L&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Escala europea de conductas de autocuidado en insuficiencia card&#237;aca</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Fibrilaci&#243;n auricular</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Todos&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>258&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sin riesgo&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>101&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Riesgo&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>125&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Desnutrici&#243;n&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>32&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Movilidad&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No tiene problemas para caminar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;6&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;7&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;7&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Algunos problemas para caminar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">220 &#40;85&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">86 &#40;85&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">113 &#40;80&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;67&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>En cama&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;7&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;6&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;32&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Cuidados personales&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No tiene problemas con el autocuidado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42 &#40;16&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;25&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;12&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Algunos problemas para lavarse o vestirse&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">143 &#40;55&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61 &#40;60&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72 &#40;57&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;31&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No puede lavarse&#47;vestirse&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73 &#40;28&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;13&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;29&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22 &#40;68&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Actividades habituales&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No tiene problemas para realizar actividades habituales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;7&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13 &#40;12&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;5&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Algunos problemas para actividades habituales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">151 &#40;585&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">61 &#40;60&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81 &#40;64&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;28&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No puede hacer actividades habituales&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87 &#40;33&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27 &#40;26&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;29&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;71&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Dolor&#47;malestar&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;424&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sin dolor ni molestias&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68 &#40;26&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;23&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;28&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;28&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dolor o malestar moderado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">151 &#40;58&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59 &#40;58&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76 &#40;60&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;50&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Dolor o malestar extremo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87 &#40;33&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;17&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;11&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;21&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Ansiedad&#47;depresi&#243;n&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sin ansiedad o depresi&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">52 &#40;20&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 820&#44;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;23&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;9&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ansiedad o depresi&#243;n moderada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">94 &#40;36&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48 &#40;48&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;32&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;18&#44;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ansiedad o depresi&#243;n extrema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">110 &#40;43&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;31&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 &#40;44&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;71&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#205;tem&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Todos&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>257&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sin riesgo&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>100&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Riesgo&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>124&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46; Me peso todos los d&#237;as&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#44;9 &#40;1&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;6 &#40;1&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;0 &#40;1&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;6 &#40;1&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46; Si me falta el aire&#44; me lo tomo con calma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#44;6 &#40;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;4 &#40;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;0 &#40;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;004&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46; Si mi dificultad para respirar aumenta&#44; me comunico con mi m&#233;dico o enfermero&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">2&#44;1 &#40;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;0 &#40;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;0 &#40;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;3 &#40;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;494&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46; Si mis pies&#47;piernas se hinchan m&#225;s de lo habitual&#44; me comunico con mi m&#233;dico o enfermero&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">2&#44;2 &#40;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;1 &#40;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;092&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46; Si gano 2 kg en una semana&#44; me comunico con mi m&#233;dico o enfermero&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">2&#44;8 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;2 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;061&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46; Limito la cantidad de l&#237;quido que bebo &#40;no m&#225;s de 1&#44;5-2 l&#47;d&#237;a&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">2&#44;2 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;0 &#40;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;2 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;8 &#40;1&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#46; Me todo un descanso durante el d&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;5 &#40;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;3 &#40;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;6 &#40;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;7 &#40;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;030&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&#46; Si siento un aumento de la fatiga&#44; me comunico con mi m&#233;dico o enfermero&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">2&#44;0 &#40;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;1 &#40;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;9 &#40;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;3 &#40;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;117&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46; Sigo una dieta baja en sal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;8 &#40;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;8 &#40;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;7 &#40;1&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;1 &#40;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;174&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46; Tomo mi medicaci&#243;n seg&#250;n lo prescrito&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;4 &#40;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;3 &#40;0&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;4 &#40;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;8 &#40;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;027&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46; Recibo la vacuna contra la gripe todos los a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#44;8 &#40;1&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;9 &#40;1&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;2 &#40;1&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;049&nbsp;\t\t\t\t\t\t\n
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Información del artículo
ISSN: 00142565
Idioma original: Español
DOI:10.1016/j.rce.2024.01.001
Datos actualizados diariamente
año/Mes Html Pdf Total
2024 Agosto 1 1 2
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2024 Febrero 27 20 47

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