Research letter
The extended family and the poor asthma control in children. A look at family functioning, authority and hierarchies
A.R. Rodríguez-Orozcoa,b,
, E.G. Kanán-Cedeñob,c, C.E. Barbosa-Sánchezc, R.G. Tejeda-Cárdenasc, M.E. Vázquez-Romeroc, A. León-Gutiérrezc
Corresponding author
a División de Posgrado. Facultad de Medicina «Dr. Ignacio Chávez», Universidad Michoacana de San Nicolás de Hidalgo, Morelia, Mexico
b Instituto de Investigación Científica en Temas de Familia, Alergia e Inmunología, Morelia, Mexico
c Facultad de Psicología, Universidad Michoacana de San Nicolás de Hidalgo, Morelia, Mexico
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A look at family functioning, authority and hierarchies" "tieneTextoCompleto" => true "saludo" => "To the Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "62" "paginaFinal" => "65" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A.R. Rodríguez-Orozco, E.G. Kanán-Cedeño, C.E. Barbosa-Sánchez, R.G. Tejeda-Cárdenas, M.E. Vázquez-Romero, A. León-Gutiérrez" "autores" => array:6 [ 0 => array:4 [ "nombre" => "A.R." "apellidos" => "Rodríguez-Orozco" "email" => array:1 [ 0 => "arorozco69@yahoo.com.mx" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "E.G." "apellidos" => "Kanán-Cedeño" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 2 => array:3 [ "nombre" => "C.E." "apellidos" => "Barbosa-Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "R.G." "apellidos" => "Tejeda-Cárdenas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "M.E." "apellidos" => "Vázquez-Romero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "A." "apellidos" => "León-Gutiérrez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "División de Posgrado. Facultad de Medicina «Dr. Ignacio Chávez», Universidad Michoacana de San Nicolás de Hidalgo, Morelia, Mexico" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Instituto de Investigación Científica en Temas de Familia, Alergia e Inmunología, Morelia, Mexico" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Facultad de Psicología, Universidad Michoacana de San Nicolás de Hidalgo, Morelia, Mexico" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Despite adequate administration of daily controller medication, the number of children with uncontrolled asthma is considerably high and reduced quality of life is observed in both parents and children with poor control.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Multiple psychosocial problems can contribute to poor asthma control in a similar proportion to poor treatment adherence.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> From previous studies of psychosomatic families, it has been postulated that there are certain stereotypical types of organisation within them such as agglutination, reciprocal overprotection, rigidity and avoidance of conflict.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> These types of family patterns are highly related to the development and maintenance of psychosomatic symptoms which play an important role in the homeostasis of the family.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">From a systemic perspective, the family becomes the protagonist in the symptoms of the indicated patient (scapegoat). The objective of the present study was to identify behavioural patterns within the family unit with respect to the asthmatic patient with uncontrolled asthma and living in extensive families, putting emphasis on authority and hierarchy in such families.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Seven extensive families with a child between the ages of 6 and 11 years old with uncontrolled asthma, confirmed when 19 or less points were reached by children after application of the asthma control test.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Children's data were obtained from the database of the Institute for Scientific Research in Family, Allergy and Immunology in Morelia, Mexico, in May, 2008. Ten extensive families with a child with uncontrolled asthma were initially considered to be included in the study, but only seven of them finally decided to participate in it.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Family functioning was evaluated in nine different areas with Dr. Emma Espejel Acco's Scale of Family Functioning<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">6</span></a> as a reference base. This scale was chosen because it could attain the desired objective and because it was standardised for the Mexican population with a sensibility of 0.91 to discriminate between dysfunctional and functional families. This instrument is also 0.94 accurate when applied by our team of psychologists who are trained in their application and interpretation. Furthermore, a questionnaire was used to study clinical and demographical aspects in the sample population.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In this study, 95% was considered statistically significant using Student's <span class="elsevierStyleItalic">t</span> test and Pearson's correlation was used to analyse the relation between two areas of family function and written informed consent was obtained from participant families. The protocol was approved by the institutional ethics committee.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Reviewing the clinical and demographical data from the population poll it was obtained that in 71.4% of the families the child who was diagnosed with asthma was 9 years old, the rest of the children who suffered from asthma were seven and 12 years old. In 57.1% (four families) of the population polled the child with asthma was male. It was found that 85.7% of the children with asthma were attending primary school between years 1 and 4; 71.4% of the children diagnosed with asthma lived with their parents and grandparents; and 57.1% of the children did not participate in extracurricular activities.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In 85.7% of the families studied, the asthmatic child had at least one brother/sister, and in 57.2% of the families the brother/sister was the eldest of the children. It was found that the amount of years spent in school was higher for the mother than for the father (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05). In 85.8% of the children it was found that they were diagnosed with asthma in a period of 5–10 years before and 42.9% received at least one treatment for asthma. In 71.5% of the families, the treatment for the child was administered by at least one specialist (paediatrician or allergist). 85.7% of the families acquired a physician for their child's treatment, 57.1% of the children suffered an asthmatic crisis every six months, of which these occurred 2.7 times more frequently at night than in the morning or afternoon. A family history of asthma was found in 57.1% of the families with asthmatic children. Of all the children studied, the most important catalyst for the asthmatic crises were environmental factors.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The results obtained via the Scale of Family Functioning are shown in <a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 2</a> where families were characterised considering areas of family functioning and the most important correlations found among them, respectively. The major parts of the evaluated areas were affected: control, supervision, affect, disruptive conduct, communication, negative affect and resources, were fairly to poorly functional mainly, however the 42.9% of the families were functional in the area of support. The most significant positive correlations observed among studied areas were between support and disruptive conduct (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001), between disruptive conduct and negative affect (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.005), between support and negative affect (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.005), between control and support (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.028) and between control and disruptive conduct (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.028).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Clinical and demographical data showed poor control of asthma, unsatisfied demands of medical assistance, frequent familiar history of allergies, and deficient social insertion of the asthmatic children in community, which is in close relation with the recurring behaviour of the psychosomatic system. The fact that the majority of the areas of the Scale of Family Function revealed families with fairly functional or poorly functional behaviour, indicates rigidity in the system. The correlations found among areas of family function indicate that when the efficiency of authority is high the family members provide social support within and outside the family nucleus, and when this support exists the family well manage limits and methods of behavioural control. On the other hand when the control is high the family can modulate the presence of negative feelings and emotions, recognising the existence of potential affective instruments and their capacity to use them is also activated. Authority and control were associates with an efficient management of inappropriate social behaviour and when support was high the families responded to the presence of negative feelings, which was excellent, when verbal and non-verbal expressions functions were not compromised.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Considerable attention causes the existence of coalitions against parents of the children with uncontrolled asthma in three from seven of the studied families, these coalitions were grandfather and grandmother against mother and father (1/7 families); grandmother and his daughter against mother (1/7 families); and grandmother and grandfather against father (1/7 families). With respect to the hierarchies, in 1/7 families the father/grandfather was the chief member, in one family both grandparents wielded the power predominantly and in two families the power was exercised by the father/husband mainly, despite the existence of higher academic levels in mothers than those found in fathers and grandparents. Succession and inheritance factors and poverty status of families living in more than two generations of its members could be linked to this behaviour in our environment, it demands further studies.</p><p id="par0055" class="elsevierStylePara elsevierViewall">On another note, the studied families were resistant to change, presenting themselves contrastingly united and harmonious with only one clear problem; the child's illness. External relationships were scarce and the family clings to preservation of their own homeostasis, debilitating exchange with their social surroundings, said in other words, they avoid all contact or informational feedback becoming a closed system. The rigidity was reflected once the negative behaviour was analysed and affection control management explored via the scale of family functioning. All this leads to unsolved conflicts that become cyclical, being inherited from one generation to another. An area that reflects this characteristic is resource, due to the fact that it is poorly functional, which indicates that the family does not know how to use them, it has the resources, but it is not allowed to use them or the family cannot identify the way to use them.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The children of these families are subject to a type of behavioural alignment in which they are boxed in and obliged to maintain the family dynamics. In a family where one supports the other, moved by the ideal of reciprocal hyper-protection, the patient becomes the one who most needs the care. On the other hand, when tension arises in the family with a possible argument, the subject of the argument becomes secondary as the patient enters the scene and suppresses the subject as all are concerned for his/her health and wellbeing in accordance with Minuchin.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The parent's deficiencies to fulfil the child's needs in each phase of his/her development, could explain certain psycho–physiological disorders in their children. It is observed that the scapegoat, the victim of an attack, is the member that becomes the object of attacks provoked by prejudices, and suffers emotionally which makes him/her susceptible to emotional breakdown at various levels.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">7,8</span></a> Unlike a similar study conducted in nuclear families with children with asthma,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> extended families in this study showed greater commitment in the areas of authority, supervision and disruptive conduct, which are related to the poor allocation of authority between parents and the existence of alliances or coalitions that hinder the development of the family.</p><p id="par0070" class="elsevierStylePara elsevierViewall">The results obtained via the Scale of Family Functioning showed that all evaluated areas of family functioning could be affected in extensive families with a child with uncontrolled asthma, even when the majority of them were in the range of fairly functional to poorly functional. Their evaluation in families in which children remain with uncontrolled asthma despite adhesion to pharmacological treatment and the analysis of correlations among such areas should be used to detect families needing psychotherapeutic assistance to reach a better control of the disease. Recommendations for future research include the validation of the Espejel Acco's Scale of Family Functioning in other cultures and replication of the study with a larger sample of children with uncontrolled asthma comparing their families with those of children with controlled asthma.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Support:</span> refers to the form in which the family members provide social support within and outside of the family nucleus. <span class="elsevierStyleItalic">Authority:</span> efficiency of authority within the family. It is considered as more functional in families where the authority resides in a parental subsystem, which is shared by both parents. <span class="elsevierStyleItalic">Disruptive conduct:</span> this deals with the handling of inappropriate social behaviour such as addictions, problems with authority or other emerging situations. <span class="elsevierStyleItalic">Affect:</span> the way in which the family express the sates of wellbeing or discomfort. <span class="elsevierStyleItalic">Control:</span> how the family manages limits and methods of behavioural control and the families with well established limits that are respected are considered more functional. <span class="elsevierStyleItalic">Negative affect:</span> how the presence of negative feelings and emotions functions within the family. <span class="elsevierStyleItalic">Supervision:</span> put emphasis in rules permitted by the family and their accomplishment. <span class="elsevierStyleItalic">Resources:</span> refers to the existence of potential affective instruments and the family's capacity to utilise and develop them. <span class="elsevierStyleItalic">Communication:</span> evaluates the form in which verbal and non-verbal expression functions within the family.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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" style="border-bottom: 2px solid black">Function family area \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Functional (%) \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Fairly functional (%) \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Poorly dysfunctional (%) \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Dysfunctional (%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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">Authority \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Control \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Supervision \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Affect \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">71.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Support \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Disruptive Conduct \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Communication \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Negative affect \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Resources \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">85.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab165371.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Families according to areas of the Espejel Acco's Scale of Family Functioning.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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" style="border-bottom: 2px solid black">Relation between areas of familiar function \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Correlation coefficient \t\t\t\t\t\t\n \t\t\t\t</td><td 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" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><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">Support and authority \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.767 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.044 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Authority and disruptive conduct \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.767 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.044 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Control and support \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.807 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.028 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Control and disruptive conduct \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.807 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.028 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Control and negative affect \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.778 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.039 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Control and resources \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.801 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.031 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Disruptive control and negative affect \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.907 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.005 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Support and disruptive conduct \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Support and negative affect \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.907 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.005 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><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">Communication and negative affect \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.764 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.046 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab165370.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Relation between areas of Family Function.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:9 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Socioeconomic, family and pediatric practice factors that affect level of asthma control" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.R. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 0 | 4 |
| 2024 October | 16 | 2 | 18 |
| 2024 September | 22 | 3 | 25 |
| 2024 August | 14 | 2 | 16 |
| 2024 July | 9 | 4 | 13 |
| 2024 June | 12 | 2 | 14 |
| 2024 May | 9 | 6 | 15 |
| 2024 April | 8 | 6 | 14 |
| 2024 March | 26 | 8 | 34 |
| 2024 February | 14 | 8 | 22 |
| 2024 January | 19 | 9 | 28 |
| 2023 December | 16 | 2 | 18 |
| 2023 November | 21 | 5 | 26 |
| 2023 October | 33 | 7 | 40 |
| 2023 September | 26 | 6 | 32 |
| 2023 August | 24 | 9 | 33 |
| 2023 July | 42 | 6 | 48 |
| 2023 June | 25 | 4 | 29 |
| 2023 May | 30 | 5 | 35 |
| 2023 April | 20 | 1 | 21 |
| 2023 March | 31 | 2 | 33 |
| 2023 February | 22 | 5 | 27 |
| 2023 January | 20 | 2 | 22 |
| 2022 December | 7 | 6 | 13 |
| 2022 November | 13 | 12 | 25 |
| 2022 October | 11 | 11 | 22 |
| 2022 September | 11 | 24 | 35 |
| 2022 August | 13 | 14 | 27 |
| 2022 July | 12 | 8 | 20 |
| 2022 June | 25 | 5 | 30 |
| 2022 May | 30 | 9 | 39 |
| 2022 April | 38 | 7 | 45 |
| 2022 March | 36 | 5 | 41 |
| 2022 February | 16 | 5 | 21 |
| 2022 January | 12 | 6 | 18 |
| 2021 December | 10 | 8 | 18 |
| 2021 November | 11 | 8 | 19 |
| 2021 October | 10 | 8 | 18 |
| 2021 September | 15 | 15 | 30 |
| 2021 August | 4 | 3 | 7 |
| 2021 July | 6 | 8 | 14 |
| 2021 June | 20 | 10 | 30 |
| 2021 May | 17 | 10 | 27 |
| 2021 April | 42 | 13 | 55 |
| 2021 March | 6 | 5 | 11 |
| 2021 February | 10 | 6 | 16 |
| 2021 January | 7 | 10 | 17 |
| 2020 December | 1 | 0 | 1 |
| 2020 November | 0 | 1 | 1 |
| 2020 September | 0 | 1 | 1 |
| 2020 August | 0 | 1 | 1 |
| 2020 July | 0 | 1 | 1 |
| 2020 May | 0 | 1 | 1 |
| 2020 January | 0 | 1 | 1 |
| 2019 December | 0 | 1 | 1 |
| 2019 October | 0 | 4 | 4 |
| 2019 September | 0 | 1 | 1 |
| 2019 July | 0 | 2 | 2 |
| 2019 June | 0 | 24 | 24 |
| 2019 May | 0 | 29 | 29 |
| 2019 April | 0 | 2 | 2 |
| 2019 March | 0 | 3 | 3 |
| 2019 February | 0 | 1 | 1 |
| 2019 January | 0 | 1 | 1 |
| 2018 December | 0 | 1 | 1 |
| 2018 November | 0 | 2 | 2 |
| 2018 October | 0 | 3 | 3 |
| 2018 February | 39 | 1 | 40 |
| 2018 January | 22 | 2 | 24 |
| 2017 December | 35 | 1 | 36 |
| 2017 November | 15 | 1 | 16 |
| 2017 October | 1 | 0 | 1 |
| 2017 September | 6 | 2 | 8 |
| 2017 August | 9 | 6 | 15 |
| 2017 July | 5 | 2 | 7 |
| 2017 June | 12 | 2 | 14 |
| 2017 May | 11 | 2 | 13 |
| 2017 April | 12 | 1 | 13 |
| 2017 March | 9 | 23 | 32 |
| 2017 February | 9 | 9 | 18 |
| 2017 January | 10 | 0 | 10 |
| 2016 December | 11 | 1 | 12 |
| 2016 November | 18 | 1 | 19 |
| 2016 October | 16 | 3 | 19 |
| 2016 September | 7 | 0 | 7 |
| 2016 August | 11 | 1 | 12 |
| 2016 July | 6 | 2 | 8 |
| 2016 June | 14 | 3 | 17 |
| 2016 May | 5 | 14 | 19 |
| 2016 April | 10 | 12 | 22 |
| 2016 March | 11 | 5 | 16 |
| 2016 February | 11 | 5 | 16 |
| 2016 January | 10 | 8 | 18 |
| 2015 December | 8 | 5 | 13 |
| 2015 November | 8 | 2 | 10 |
| 2015 October | 21 | 4 | 25 |
| 2015 September | 15 | 2 | 17 |
| 2015 August | 8 | 4 | 12 |
| 2015 July | 1 | 0 | 1 |
| 2015 June | 1 | 1 | 2 |
| 2015 May | 4 | 0 | 4 |
| 2015 April | 11 | 6 | 17 |
| 2015 March | 4 | 3 | 7 |
| 2015 February | 15 | 6 | 21 |
| 2015 January | 12 | 7 | 19 |
| 2014 December | 10 | 5 | 15 |
| 2014 November | 10 | 1 | 11 |
| 2014 October | 9 | 4 | 13 |
| 2014 September | 14 | 4 | 18 |
| 2014 August | 5 | 1 | 6 |
| 2014 July | 9 | 0 | 9 |
| 2014 June | 4 | 1 | 5 |
| 2014 May | 6 | 1 | 7 |
| 2014 April | 3 | 0 | 3 |
| 2014 March | 26 | 9 | 35 |
| 2014 February | 25 | 5 | 30 |
| 2014 January | 27 | 5 | 32 |
| 2013 December | 30 | 16 | 46 |
| 2013 November | 24 | 9 | 33 |
| 2013 October | 31 | 7 | 38 |
| 2013 September | 32 | 5 | 37 |
| 2013 August | 40 | 9 | 49 |
| 2013 July | 28 | 9 | 37 |
| 2013 June | 7 | 1 | 8 |
| 2013 May | 21 | 11 | 32 |
| 2013 April | 18 | 8 | 26 |
| 2013 March | 15 | 9 | 24 |
| 2013 February | 11 | 8 | 19 |
| 2013 January | 6 | 0 | 6 |
| 2012 December | 6 | 4 | 10 |
| 2012 November | 0 | 2 | 2 |
| 2012 October | 2 | 2 | 4 |
| 2012 January | 262 | 0 | 262 |
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