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Frecuencia de depresión y calidad de vida en pacientes con diabetes mellitus en establecimientos de salud pública de Lima Metropolitana
Frequency of depression and quality of life in patients with diabetes mellitus in public health facilities in metropolitan Lima
Roberto A. Accinellia,b,c,e,
Autor para correspondencia
roberto.accinelli@upch.pe

Autor para correspondencia. Dirección: Av. Honorio Delgado 430, SMP, Lima, Peru 15102. Teléfono:+51-931997343.
, Kevin Brian Ariasb,c,f, Juan Alonso Leon-Abarcab,c,g, Lidia M. Lópezb,h, Javier E. Saavedrac,d,i
a Hospital Cayetano Heredia, Lima, Perú
b Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima, Perú
c Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Perú
d Instituto Nacional de Salud Mental «Honorio Delgado – Hideyo Noguchi», Lima, Perú
e Médico Neumólogo, Magister en Salud Pública
f Médico Cirujano
g Estudiante de Medicina
h Médico Cirujano
i Médico Psiquiatra, Doctor en Medicina
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Asimismo&#44; el riesgo de mortalidad y morbilidad se incrementa al estar asociado con otras patolog&#237;as&#44; siendo la depresi&#243;n una de ellas <a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">3</span></a>&#44; afectando la adherencia&#44; el funcionamiento y los costos del tratamiento <a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">4</span></a>&#46; La relaci&#243;n entre depresi&#243;n y las enfermedades cr&#243;nicas&#44; incluida la diabetes&#44; se ha establecido en una relaci&#243;n bidireccional donde factores psicosociales asociados con la depresi&#243;n afectan las condiciones m&#233;dicas y a su vez el impacto de las enfermedades cr&#243;nicas puede predisponer a la depresi&#243;n&#46; La depresi&#243;n es una de las enfermedades con mayor carga de morbilidad en el mundo y un problema prioritario de salud p&#250;blica&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Diversos estudios en pa&#237;ses desarrollados han demostrado que los pacientes con diabetes tienen dos veces m&#225;s riesgo de desarrollar depresi&#243;n en comparaci&#243;n con grupos no diab&#233;ticos <a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">5</span></a>&#46; Asimismo&#44; el curso de la depresi&#243;n es m&#225;s prolongado en aquellas personas con diabetes mellitus que en la poblaci&#243;n general <a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">6</span></a>&#46; El 64&#37; de las personas con diabetes tienen depresi&#243;n con un curso recurrente-remitente&#44; 15&#37; nunca se recupera de su depresi&#243;n y s&#243;lo alrededor del 20&#37; se recupera completamente <a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">7&#44;8</span></a>&#46; El Estudio de Evoluciones M&#233;dicas demostr&#243; que la coexistencia de enfermedades cr&#243;nicas con la depresi&#243;n tiene un impacto agregado en el funcionamiento de la persona que lo sufre <a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">9</span></a>&#46; Son escasos los estudios de frecuencia y prevalencia de depresi&#243;n en pacientes con diabetes en pa&#237;ses en v&#237;as de desarrollo&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">M&#233;todos</span><p id="par0015" class="elsevierStylePara elsevierViewall">Estudio transversal a partir del an&#225;lisis secundario de la base de datos del &#171;Estudio de Salud Integral en Hospitales Generales y Centros de Salud de Lima Metropolitana y el Callao-2015&#187; realizado por el Instituto Nacional de Salud Mental Honorio Delgado-Hideyo Noguchi &#40;INSM&#41;&#46; Esta investigaci&#243;n original fue aprobada por el Comit&#233; de &#201;tica del INSM y la presente investigaci&#243;n por el Comit&#233; de &#201;tica de la Universidad Peruana Cayetano Heredia&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Data</span><p id="par0020" class="elsevierStylePara elsevierViewall">La recolecci&#243;n de la informaci&#243;n se realiz&#243; en 24 establecimientos p&#250;blicos de salud de la ciudad de Lima y el Callao&#44; dependientes del Ministerio de Salud del Per&#250;&#46; Estos inclu&#237;an ocho hospitales generales con gran afluencia de pacientes y sus respectivos centros de salud primarios&#44; dos por cada hospital&#46; La muestra del estudio original realizado entre julio y noviembre del 2015&#44; fue de 10&#44;885 personas adultas de 18 a&#241;os o m&#225;s&#46; Los sujetos fueron seleccionados de las distintas especialidades entre las personas que esperaban a ser atendidas&#46; Para el presente estudio se consider&#243; solo a aquellos pacientes con diagn&#243;stico de diabetes mellitus tipo 1 &#243; 2 y que contaran con informaci&#243;n completa&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Mediciones</span><p id="par0025" class="elsevierStylePara elsevierViewall">Se determin&#243; la presencia de episodio depresivo actual &#40;en las dos &#250;ltimas semanas&#41;&#44; en los &#250;ltimos doce meses y en alg&#250;n momento de la vida&#46; Para ello se emple&#243; el m&#243;dulo que eval&#250;a el episodio depresivo seg&#250;n el CIE-10 del instrumento MINI&#58; Entrevista Neuropsiqui&#225;trica Internacional versi&#243;n espa&#241;ol CIE-10 <a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">10</span></a>&#44; modificada para obtener frecuencia anual y de vida&#44; y adaptado ling&#252;&#237;sticamente en estudios anteriores del INSM&#46; El an&#225;lisis psicom&#233;trico de los s&#237;ntomas depresivos alcanz&#243; un coeficiente alpha de Chronbach de 0&#44;665 <a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">La calidad de vida fue medida empleando el &#205;ndice de Calidad de Vida de Mezzich &#40;versi&#243;n espa&#241;ola&#41; <a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">12</span></a>&#46; Este consiste en 10 &#237;tems que incluyen bienestar f&#237;sico&#44; bienestar psicol&#243;gico o emocional&#44; auto-cuidado y funcionamiento independiente&#44; funcionamiento ocupacional&#44; funcionamiento interpersonal&#44; apoyo social-emocional&#44; apoyo comunitario y de servicios&#44; plenitud personal&#44; satisfacci&#243;n espiritual y calidad de vida global&#46; Cada &#237;tem es valorado por el sujeto en una escala ordinal de 1 a 10 puntos&#46; Este instrumento fue adaptado ling&#252;&#237;sticamente y validado para la poblaci&#243;n peruana&#44; con un coeficiente alpha de Chronbach de 0&#44;867 <a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">13</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El diagn&#243;stico de diabetes mellitus fue obtenido del reporte estad&#237;stico diario de atenciones consignado por el m&#233;dico tratante&#44; sin importar que esta fuera tipo 1 o tipo 2&#46; Las covariables incluyen grupo etario en a&#241;os &#40;18-30&#44; 30-45&#44; 45-60 y mayores de 60&#41;&#44; sexo&#44; grado de instrucci&#243;n &#40;primaria&#44; secundaria&#44; superior no universitario&#44; universitario&#41; y estado civil &#40;soltero&#44; casado&#44; conviviente y se agrupo a los que eran separado&#44; divorciado o viudo&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">An&#225;lisis estad&#237;stico</span><p id="par0040" class="elsevierStylePara elsevierViewall">La base de datos fue analizada con el software estad&#237;stico Stata 14 &#40;Stata Corporation&#44; College Station&#44; Texas&#44; USA&#41;&#46; Se consider&#243; un nivel de significancia de 0&#44;05 en todas las pruebas estad&#237;sticas&#46; Se realiz&#243; un an&#225;lisis exploratorio de las variables que podr&#237;an estar asociadas con depresi&#243;n&#44; para ello primero se realiz&#243; la prueba de Chi cuadrado y solo aquellas variables con un p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 &#40;sexo&#44; edad&#44; grado de instrucci&#243;n y estado civil&#41; se incluyeron en los modelos de regresi&#243;n log&#237;stica&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">El an&#225;lisis de la calidad de vida se realiz&#243; en cada uno de las 10 &#225;reas que tiene el &#237;ndice de calidad de vida de Mezzich y para ello se emple&#243; la prueba T&#46; Los resultados se muestran como media y desviaci&#243;n est&#225;ndar&#46; Para obtener la diferencia m&#237;nima cl&#237;nicamente importante &#40;DMCI&#41; se determin&#243; el valor de media desviaci&#243;n est&#225;ndar de la variable calidad de vida <a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">14&#44;15</span></a>&#44; que equivale a 0&#46;74&#46; Luego se determin&#243; si la diferencia de cada &#225;rea entre los pacientes con DM y depresi&#243;n con aqu&#233;llos con DM y sin depresi&#243;n el &#225;rea de calidad de vida es mayor que 0&#46;74&#46; En las &#225;rea en que esto ocurri&#243; se estableci&#243; una DMCI&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Resultados</span><p id="par0050" class="elsevierStylePara elsevierViewall">De 471 pacientes con diabetes mellitus registrados en la base de datos&#44; se incluy&#243; para el estudio a 468&#46; El promedio de edad de estos pacientes fue 55<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleUnderline">&#43;</span><span class="elsevierStyleHsp" style=""></span>12&#46;2 a&#241;os&#46; La frecuencia actual de depresi&#243;n fue 5&#44;9&#37;&#44; la anual 8&#44;6&#37; y la de vida 31&#44;8&#37;&#46; La mayor&#237;a de participantes era del sexo femenino y se encontraban con estado civil de casado o conviviente&#46; De acuerdo al nivel educativo&#44; la mayor&#237;a hab&#237;a alcanzado como m&#237;nimo el nivel secundario &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#44; se observa que las mujeres presentan mayor frecuencia de depresi&#243;n&#44; ya sea esta actual&#44; a los doce meses o en alg&#250;n momento de su vida &#40;8&#44;44&#37;&#44; 11&#44;69&#37;&#44; 37&#44;01&#37; respectivamente&#44; p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46; Con respecto a la edad&#44; no se encuentran diferencias de depresi&#243;n entre grupos en la categor&#237;a actual&#44; anual y de vida&#44; excepto por la mayor frecuencia de depresi&#243;n en adultos de 45-60 a&#241;os &#40;36&#44;57&#37;&#41; en comparaci&#243;n con adultos mayores de 60 a&#241;os &#40;26&#44;99&#37;&#41;&#46; En el caso del estado civil&#44; se encontr&#243; que los diab&#233;ticos convivientes presentaron mayor frecuencia de depresi&#243;n que los solteros &#40;8&#44;77&#37; vs 0&#37;&#44; p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Adem&#225;s&#44; en la frecuencia de vida los casados presentaron menor depresi&#243;n que los separados&#44; viudos o divorciados &#40;28&#44;66&#37; vs 40&#44;91&#37;&#44; p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Por grado de educaci&#243;n no se encontraron diferencias de depresi&#243;n actual&#44; anual o en alg&#250;n momento de la vida&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Al hacer la regresi&#243;n log&#237;stica se hall&#243; que el sexo era el &#250;nico factor asociado a depresi&#243;n&#44; tanto en la frecuencia actual&#44; anual y en la de vida&#46; Asimismo&#44; la frecuencia anual del episodio depresivo se asoci&#243; con tener un nivel educativo superior no universitario &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">La calidad de vida en los pacientes diab&#233;ticos fue menor cuando tuvieron depresi&#243;n actual &#40;6&#44;7 vs&#46; 7&#44;6 p &#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46; Cuando se analiz&#243; las diferencias en cada uno de los par&#225;metros&#44; que componen esta escala de Mezzich&#44; se observ&#243; la misma diferencia con excepci&#243;n de las &#225;reas de bienestar psicol&#243;gico o emocional y en la de apoyo comunitario y de servicios &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;0&#46;05&#41;&#46; Al comparar lo mismo&#44; pero usando la diferencia m&#237;nima cl&#237;nicamente importante &#40;DMCI&#41;&#44; se hall&#243; que tanto bienestar f&#237;sico como apoyo comunitario y de servicios no ten&#237;an una diferencia cl&#237;nicamente importante&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discusi&#243;n</span><p id="par0070" class="elsevierStylePara elsevierViewall">Nuestros resultados indican que los pacientes con DM de Lima Metropolitana atendidos en centros de salud p&#250;blica presentan m&#225;s depresi&#243;n que la poblaci&#243;n general&#46; En el presente estudio la frecuencia actual de depresi&#243;n en pacientes diab&#233;ticos fue de 5&#44;77&#37;&#44; la anual fue de 8&#44;55&#37; y la de vida fue 31&#44;84&#37;&#44; mientras que en la poblaci&#243;n general de Lima Metropolitana se hall&#243; una prevalencia de depresi&#243;n actual de 2&#44;8&#37;&#44; la anual fue de 6&#44;2&#37; y la de vida fue de 17&#44;2&#37; <a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">16</span></a>&#46; En 1993 se encontr&#243; que las personas con DM ten&#237;an una prevalencia de depresi&#243;n tres veces m&#225;s elevada que la poblaci&#243;n general <a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">17</span></a>&#46; En otro meta-an&#225;lisis en que se incluy&#243; a 20&#44;218 pacientes con DM&#44; de 42 estudios&#44; se encontr&#243; que la depresi&#243;n es dos veces m&#225;s com&#250;n en personas con DM en comparaci&#243;n a la poblaci&#243;n general <a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">18</span></a>&#46; Ali en un meta-an&#225;lisis de 10 estudios controlados obtuvo entre los DM tipo 2 una frecuencia de depresi&#243;n casi dos veces mayor <a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">19</span></a>&#46; Creemos que es importante examinar la evoluci&#243;n de la depresi&#243;n en pacientes con diagn&#243;stico de diabetes de larga data&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Se ha planteado que los s&#237;ntomas depresivos podr&#237;an ser una consecuencia de la carga de la DM&#46; El n&#250;mero de enfermedades cr&#243;nicas parece explicar parte de la asociaci&#243;n entre la DM y los s&#237;ntomas depresivos <a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">20</span></a>&#46; La depresi&#243;n en DM ser&#237;a un fen&#243;meno multideterminado resultante de las interacciones entre factores biol&#243;gicos y psicosociales <a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">21</span></a>&#46; Pero la mayor incidencia de depresi&#243;n en pacientes con diabetes puede ser una consecuencia de la resistencia central a la insulina&#46; La resistencia a la insulina en el cerebro puede provocar alteraciones en la funci&#243;n mitocondrial&#44; aumento de los niveles de monoamino oxidasas y aumento del aclaramiento de la dopamina <a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">22</span></a>&#46; Se ha planteado que la disfunci&#243;n mitocondrial puede contribuir a la depresi&#243;n <a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">23</span></a>&#46; La resistencia a la insulina guarda una relaci&#243;n directa con la gravedad de los s&#237;ntomas de depresi&#243;n en individuos sin DM <a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">24</span></a>&#46; Pero es uno de los varios mecanismos asociados a depresi&#243;n como neurotransmisi&#243;n dopamin&#233;rgica disminuida <a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">25</span></a>&#46; Estas alteraciones tambi&#233;n pueden interactuar con otros factores&#44; que pueden contribuir a la depresi&#243;n y la ansiedad&#44; incluida la susceptibilidad gen&#233;tica&#44; alteraciones en los ritmos circadianos o cambios en el contenido de monoaminas como serotonina&#44; norepinefrina y dopamina <a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">26</span></a>&#46; Las personas reci&#233;n diagnosticadas de DM tienen menos s&#237;ntomas de depresi&#243;n que los ya diagnosticados <a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">27</span></a>&#46; Los ratones KO del receptor de insulina del cerebro con el envejecimiento presentan signos equivalentes a depresi&#243;n<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">24</span></a>&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Estas variaciones bioqu&#237;micas explicar&#237;an los hallazgos en personas con DM de anormalidades en las im&#225;genes cerebrales&#44; que incluyen actividad cerebral alterada y conectividad mediante resonancia magn&#233;tica funcional <a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">28</span></a>&#44; microestructura alterada mediante im&#225;genes de tensor de difusi&#243;n <a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">29</span></a> y circuitos neuronales alterados en el cuerpo estriado <a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">30</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">En otros estudios realizados en el Per&#250; en pacientes con DM se ha encontr&#243; altas prevalencias de depresi&#243;n&#44; en Lima Metropolitana la prevalencia actual de depresi&#243;n fue 73&#44;3&#37; <a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">31</span></a>&#44; en Chiclayo 57&#44;78&#37; <a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">32</span></a> y en Trujillo 38&#44;21&#37; <a class="elsevierStyleCrossRef" href="#bib0405"><span class="elsevierStyleSup">33</span></a>&#46; Esta disimilitud en los resultados puede atribuirse a diferencias metodol&#243;gicas&#44; en el caso de nuestro estudio se utiliz&#243; un instrumento de diagn&#243;stico categ&#243;rico&#44; es decir sobre presencia o no de episodio depresivo seg&#250;n los criterios operacionales del CIE-10&#44; y en los otros estudios se utiliz&#243; instrumentos dimensionales como el Inventario de Depresi&#243;n de Beck&#59; tambi&#233;n es posible que factores etno-culturales pudieron inducir a sesgos de medici&#243;n <a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">34</span></a>&#44; o por haber hecho el estudio entre pacientes hospitalizados o en m&#225;s graves&#44; quienes tendr&#225;n porcentajes m&#225;s elevados de depresi&#243;n&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Las mujeres tuvieron mayor frecuencia de depresi&#243;n&#46; Es lo hallado en estudios semejantes<a class="elsevierStyleCrossRefs" href="#bib0295"><span class="elsevierStyleSup">11&#44;35</span></a><span class="elsevierStyleSup">&#93;</span>&#46; En la poblaci&#243;n general ser mujer est&#225; asociado con tasas m&#225;s elevadas de depresi&#243;n <a class="elsevierStyleCrossRef" href="#bib0420"><span class="elsevierStyleSup">36</span></a>&#46; Las razones para explicar est&#225; mayor frecuencia en personas de sexo femenino podr&#237;an ser las mujeres realizan menor actividad f&#237;sica&#44; que es un factor protector de depresi&#243;n&#44; que los hombres&#44; lo cual las predispondr&#237;a a tener depresi&#243;n <a class="elsevierStyleCrossRef" href="#bib0425"><span class="elsevierStyleSup">37</span></a>&#46; Khuwaja et al&#46; refieren que el rol social que tiene las mujeres &#40;pasividad&#44; dependencia&#44; expresi&#243;n emocional&#41; les permite expresar mejor sus emociones y as&#237; identificar cuando se sientan deprimidas<a class="elsevierStyleCrossRef" href="#bib0410"><span class="elsevierStyleSup">34</span></a>&#46; Pero consideramos que la principal raz&#243;n sea que las mujeres presentan una mayor resistencia a la insulina que los varones <a class="elsevierStyleCrossRef" href="#bib0430"><span class="elsevierStyleSup">38</span></a>&#44; la que explicar&#237;a que tengan en un porcentaje mayor depresi&#243;n<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">30</span></a>&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Por otro lado&#44; no encontramos que la edad&#44; el estado civil y el grado de instrucci&#243;n se relacionaran con depresi&#243;n&#46; Pero en el an&#225;lisis hallamos que los convivientes presentaron mayor porcentaje de depresi&#243;n frente a los solteros&#44; y que en los casados el porcentaje de depresi&#243;n fue menor que en los separados&#47;divorciados&#47;viudos&#46; Chew tambi&#233;n encontr&#243; un porcentaje m&#225;s alto de depresi&#243;n entre los separados&#47;divorciados <a class="elsevierStyleCrossRef" href="#bib0435"><span class="elsevierStyleSup">39</span></a>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Nuestros diab&#233;ticos con depresi&#243;n presentaron menor calidad de vida&#46; En pacientes con diabetes la depresi&#243;n parece ser un factor determinante de una deficiente calidad de vida <a class="elsevierStyleCrossRef" href="#bib0440"><span class="elsevierStyleSup">40</span></a>&#46; Se ha descrito que altos niveles de depresi&#243;n tienen un impacto negativo en la calidad de vida&#46; Eren y colaboradores catalogan a la depresi&#243;n como un mal penetrante y que su impacto en la calidad de vida de los diab&#233;ticos es directamente proporcional a la gravedad de la depresi&#243;n <a class="elsevierStyleCrossRef" href="#bib0445"><span class="elsevierStyleSup">41</span></a>&#46; La presencia simult&#225;nea de DM y depresi&#243;n causa pobre autocuidado <a class="elsevierStyleCrossRef" href="#bib0450"><span class="elsevierStyleSup">42</span></a>&#44; disminuye la adherencia al tratamiento y la calidad de vida&#44; incrementa las complicaciones <a class="elsevierStyleCrossRef" href="#bib0455"><span class="elsevierStyleSup">43</span></a> y la mortalidad <a class="elsevierStyleCrossRef" href="#bib0460"><span class="elsevierStyleSup">44</span></a>&#44; todo lo cual se traduce en un incremento de los costos en salud <a class="elsevierStyleCrossRef" href="#bib0465"><span class="elsevierStyleSup">45</span></a>&#44; que si se presenta cada enfermedad por separado&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Cuando analizamos por separado las diez &#225;reas que componen el cuestionario de calidad de vida que empleamos encontramos que los puntajes fueron menores en los DM con depresi&#243;n en todas salvo en bienestar psicol&#243;gico y emocional y en apoyo comunitario y de servicios&#46; La condici&#243;n f&#237;sica&#44; social y emocional en pacientes diab&#233;ticos est&#225; disminuida <a class="elsevierStyleCrossRef" href="#bib0470"><span class="elsevierStyleSup">46</span></a>&#46; En la DM hay una p&#233;rdida de masa muscular y polineuropat&#237;a&#44; que ocasionar&#237;an una reducci&#243;n de la fuerza muscular&#44; lo que provoca una disminuci&#243;n del bienestar f&#237;sico&#44; que se incrementa cuando hay un &#225;nimo depresivo <a class="elsevierStyleCrossRef" href="#bib0475"><span class="elsevierStyleSup">47</span></a>&#46; La mayor&#237;a de las personas con DM tienen un autocuidado regular&#46; Es que al diagn&#243;stico los DM son adultos&#44; por lo que la ense&#241;anza de las medidas de control es un reto&#46; Este proceso de aprendizaje se entorpecer&#237;a a&#250;n m&#225;s si presentan depresi&#243;n&#44; ya que la depresi&#243;n interviene negativamente en los procesos cognoscitivos del aprendizaje <a class="elsevierStyleCrossRef" href="#bib0480"><span class="elsevierStyleSup">48</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Al ser este un estudio transversal la primera limitaci&#243;n es que s&#243;lo tenemos la observaci&#243;n de un momento en la vida de los pacientes con DM atendidos en establecimientos de salud de Lima&#46; Siendo un estudio s&#243;lo por encuesta no conocemos el verdadero nivel de la DM ni si se lleva en forma adecuada o no su tratamiento&#46; Otra limitaci&#243;n es el sesgo de selecci&#243;n de los participantes&#44; ya que solo han sido elegidos aquellos que acuden a los hospitales del sector p&#250;blico&#44; sin embargo&#44; se tiene en consideraci&#243;n esto al realizar las conclusiones&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusi&#243;n</span><p id="par0115" class="elsevierStylePara elsevierViewall">La frecuencia de depresi&#243;n en pacientes con diabetes que son atendidos en forma ambulatoria en centros de salud p&#250;blicos es mayor a la poblaci&#243;n general y su calidad de vida se ve reducida significativamente&#44; lo que plantea la necesidad de considerar la depresi&#243;n como un factor aditivo a la carga de morbilidad de esta condici&#243;n&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Fuente de financiamiento</span><p id="par0120" class="elsevierStylePara elsevierViewall">Ninguna</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Tesis acad&#233;mica para optar t&#237;tulo de M&#233;dico Cirujano</span><p id="par0125" class="elsevierStylePara elsevierViewall">Prevalencia de depresi&#243;n y sus factores asociados en pacientes con diabetes mellitus que acuden a consulta externa de hospitales generales y centros de salud de Lima Metropolitana y el Callao &#8211;2015&#44; 2018&#44; Universidad Peruana Cayetano Heredia</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicto de intereses</span><p id="par0130" 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">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La diabetes es una de las principales pandemias en los &#250;ltimos a&#241;os&#46; Su asociaci&#243;n con depresi&#243;n incrementa el riesgo de mortalidad y morbilidad&#46; La coexistencia de ambas patolog&#237;as produce un mal manejo de la diabetes&#44; lo que conlleva a una peor calidad de vida&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Determinar la frecuencia de depresi&#243;n en pacientes con diabetes mellitus y el efecto que tienen ambas patolog&#237;as sobre la calidad de vida en pacientes que acuden de forma ambulatoria a establecimientos de salud p&#250;blicos de Lima y Callao&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">An&#225;lisis secundario de la base de datos del Estudio Epidemiol&#243;gico de Salud Mental de depresi&#243;n en adultos diab&#233;ticos&#46; El instrumento empleado para determinar el episodio depresivo fue el MINI &#40;Entrevista Neuropsiqui&#225;trica Internacional&#41; mientras que la calidad de vida fue medida empleando el &#205;ndice de Calidad de Vida de Mezzich&#46; Se obtuvo informaci&#243;n de diagn&#243;stico de diabetes tipo 1 &#243; 2 del registro m&#233;dico diario &#40;HIS&#41; de atenci&#243;n&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La frecuencia de depresi&#243;n en los 471 pacientes con diabetes fue 5&#44;8&#37; en las &#250;ltimas dos semanas&#46; Mientras que la frecuencia anual fue 8&#44;6&#37; y en alg&#250;n momento de la vida 31&#44;8&#37;&#46; Ser mujer se asoci&#243; con mayor frecuencia de depresi&#243;n&#46; La calidad de vida fue menor en los pacientes con diabetes y depresi&#243;n &#40;p&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La frecuencia de depresi&#243;n en pacientes con diabetes que son atendidos en forma ambulatoria en centros de salud p&#250;blicos es mayor a la poblaci&#243;n general y su calidad de vida se ve reducida significativamente&#44; lo que plantea la necesidad de considerar la depresi&#243;n como un factor aditivo a la carga de morbilidad de esta condici&#243;n&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Diabetes is one of the main pandemics in recent years&#46; Its association with depression increases the risk of mortality and morbidity&#46; The coexistence of both diseases leads to poor management of diabetes&#44; which leads to a worse quality of life&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objective</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To determine the frequency of depression in patients with diabetes mellitus and the effect of both pathologies on the quality of life in patients who attend outpatient appointments at public health facilities in Lima and Callao&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Methodology</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Secondary analysis of the Epidemiological Study of Mental Health of depression in diabetic adults&#46; The instrument used to determine the depressive episode was the MINI &#40;Mini-International Neuropsychiatric Interview&#41; while quality of life was measured using the Mezzich Quality of Life Index&#46; Diagnosis information of type 1 or 2 diabetes was obtained from the daily medical record &#40;HIS&#41; of care&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The frequency of depression in the 471 patients with diabetes was 5&#46;8&#37; in the last two weeks&#46; While the annual frequency was 8&#46;6&#37; and 31&#46;8&#37; at some point in life&#46; Being a woman was associated with a greater frequency of depression&#46; Quality of life was lower in patients with diabetes and depression &#40;p &#60;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41;&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The frequency of depression in patients with diabetes who are treated on an outpatient basis in public health centres is higher than the general population and their quality of life is significantly reduced&#44; which raises the need for considering depression as an additional factor to the burden of morbidity of this condition&#46;</p></span>"
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Superior universitaria&#42;&#42;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;0&#44;05<a class="elsevierStyleCrossRef" href="#tblfn0010">&#42;</a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>30-45&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \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" 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
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                  \t\t\t\t">Secundaria y bachillerato&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Superior no universitaria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;84&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</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\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  " align="left" valign="\n
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                  \t\t\t\t">Universitaria incluida posgrado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#44;79&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">NS&nbsp;\t\t\t\t\t\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">3&#44;22&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
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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">Estado civil&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">Conviviente&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\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;74&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\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">0&#44;48&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;48&nbsp;\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="" 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
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Separado &#40;a&#41;&#44; divorciado &#40;a&#41;&#44; viudo &#40;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  " align="left" valign="\n
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                  \t\t\t\t">1&#44;17&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">NS&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;42&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
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                  \t\t\t\t">3&#44;22&nbsp;\t\t\t\t\t\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;27&nbsp;\t\t\t\t\t\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">NS&nbsp;\t\t\t\t\t\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">0&#44;55&nbsp;\t\t\t\t\t\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;96&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
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                  \t\t\t\t">1&#44;61&nbsp;\t\t\t\t\t\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">NS&nbsp;\t\t\t\t\t\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;98&nbsp;\t\t\t\t\t\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;62&nbsp;\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="" 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">Soltero &#40;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
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                  \t\t\t\t">1&#44;00&nbsp;\t\t\t\t\t\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">NS&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
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                  \t\t\t\t">-&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">-&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">NS&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">NS&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;37&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">1&#44;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2764126.png"
              ]
            ]
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        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Regresi&#243;n log&#237;stica&#58; Se muestra la significancia de las variables seleccionadas versus el estado final del paciente depresivo por categor&#237;as</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Tabla 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Tabla "
            "rol" => "short"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">RIQ&#58; Rango intercuartil&#46;</p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">DS&#58; Desviaci&#243;n est&#225;ndar</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
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                0 => """
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>467&#41;</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pacientes Diab&#233;ticos con depresi&#243;n actual&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>27&#41;</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pacientes diab&#233;ticos sin depresi&#243;n&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>440&#41;</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">T test&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><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">&#193;reas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mediana&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">RIQ&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Puntajepromedio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DS&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Puntajepromedio&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="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">DS&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="center" 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">Bienestar f&#237;sico&#44; es decir&#44; sentirse con energ&#237;a&#44; sin dolores&#44; ni problemas f&#237;sicos&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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&#44;1&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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&#44;8&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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">&#62; 0&#44;05&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">Bienestar psicol&#243;gico o emocional&#44; es decir&#44; sentirse bien y satisfecho&#40;a&#41; consigo mismo&#40;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">8&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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&#44;0&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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&#44;6&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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;0001&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">Autocuidado y funcionamiento independiente&#44; es decir&#44; cuidar bien de su persona &#40;por ejemplo&#44; poder alimentarse y asearse solo&#40;a&#41;&#41;&#44; tomar sus propias decisiones&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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&#44;3&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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&#44;2&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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;01&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">Funcionamiento ocupacional&#44; es decir&#44; ser capaz de realizar un trabajo remunerado&#44; actividades de estudio y&#47;o actividades del hogar&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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&#44;9&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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&#44;8&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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;01&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">Funcionamiento interpersonal&#44; es decir&#44; ser capaz de responder y relacionarse bien con su familia&#44; amigos y grupos&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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&#44;7&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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&#44;0&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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;0001&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">Apoyo social - emocional&#44; es decir&#44; tener personas en quienes confiar y que le proporcionen ayuda y apoyo emocional&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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&#44;8&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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&#44;7&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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;01&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">Apoyo comunitario y de servicios&#44; es decir contar con buenos vecinos&#44; disponer de ayuda econ&#243;mica o financiera y de otros servicios como&#44; por ejemplo&#58; ayudarse en situaciones dif&#237;ciles con polladas&#44; colectas&#44; etc&#46;&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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&#44;1&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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&#44;6&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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">p<span class="elsevierStyleHsp" style=""></span>&#62;0&#44;05&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">Plenitud personal&#44; es decir&#44; este cumpliendo con lo que te has propuesto en tu vida&#46; Sentido de realizaci&#243;n personal y de estar cumpliendo con sus metas m&#225;s importantes&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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&#44;6&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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&#44;6&nbsp;\t\t\t\t\t\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&nbsp;\t\t\t\t\t\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">Satisfacci&#243;n espiritual&#44; es decir&#44; haber desarrollado una actitud espiritual hacia la vida m&#225;s all&#237; de lo material y estar en paz interior consigo mismo&#40;a&#41; y con las dem&#225;s personas &#42;&#42;&#42;&#42;439&nbsp;\t\t\t\t\t\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&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">2&nbsp;\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">7&#44;1&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&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">8&#44;2&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">1&#44;4&nbsp;\t\t\t\t\t\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">&#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">Calidad de vida global&#44; es decir&#44; sentirse satisfecho&#40;a&#41;&#44; &#40;contento&#41; y feliz con su vida en general&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Promedio de calidad de vida total&nbsp;\t\t\t\t\t\t\n
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Información del artículo
ISSN: 00347450
Idioma original: Español
DOI:10.1016/j.rcp.2020.01.006
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