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Predisposición de los pacientes a participar en ensayos clínicos en el Hospital Dr. César Milstein: un estudio de corte transversal
Patients’ Predisposition to Participate in Clinical Trials at Hospital: A Cross-Sectional Study
Li Sz Wei, María Pia Izaguirre Germain, Diego Caruso
Autor para correspondencia
diecaruso@hotmail.com

Autor para correspondencia.
Departamento de Medicina Interna, Hospital Dr. Cesar Milstein, Buenos Aires, Argentina
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El ensayo cl&#237;nico &#40;EC&#41; es una herramienta fundamental en la medicina basada en evidencia&#44; consta de procedimientos terap&#233;uticos y diagn&#243;sticos novedosos a trav&#233;s de los cuales se promueve el avance de conocimiento cient&#237;fico y la atenci&#243;n m&#233;dica&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El reclutamiento de participantes es un factor muy importante en la ejecuci&#243;n de un EC&#46; La baja participaci&#243;n en un estudio resulta en un tama&#241;o muestral insuficiente&#46; Esto puede afectar al poder estad&#237;stico&#44; aumentar la probabilidad de cometer errores tipo II y traducirse en resultados err&#243;neos&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Las personas mayores consumen una gran cantidad y diversidad de medicamentos&#44; por lo que su representatividad en EC es esencial&#46; Ellas conforman una minor&#237;a en los EC debido a que suelen tener varias comorbilidades y mayor fragilidad por lo que son excluidas&#44; aun cuando podr&#237;an beneficiarse de la intervenci&#243;n<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La predisposici&#243;n para participar en EC es variable seg&#250;n el tipo de ensayo&#46; Por un lado&#44; en estudios oncol&#243;gicos la participaci&#243;n de las personas mayores suele ser baja&#44; aproximadamente un 2-3&#37;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a>&#46; Por otro lado&#44; los EC relacionados con el SARS-CoV-2&#44; mostraron una mayor predisposici&#243;n a participar&#44; como se vio en el estudio de Abdelhafiz et al&#46;&#44; que reportaron una actitud positiva en un 57&#37; de los participantes mayores de 60 a&#241;os<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Seg&#250;n registros de la Administraci&#243;n de Alimentos y Medicamentos de los EE&#46; UU&#46; &#40;FDA&#41;&#44; la tasa de participaci&#243;n de personas mayores de 70 a&#241;os entre 2005 a 2015 en EC para inscripci&#243;n de drogas neopl&#225;sicas es solo del 24&#37;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Distintos factores implicados en el EC influyen en el grado de participaci&#243;n y permanencia de las personas mayores durante el proceso de estudio&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">El incentivo financiero&#44; la confianza en los m&#233;dicos tratantes&#44; el altruismo y el potencial beneficio personal fueron facilitadores para la participaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">5&#8211;7</span></a>&#59; mientras que la falta de inter&#233;s&#44; problemas con el transporte y rechazo de los familiares fueron algunos de los motivos de negativa a participar&#44; seg&#250;n lo reportado en estudios<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">8&#44;9</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Nuestro objetivo es determinar la voluntad de las personas mayores de participar en los EC e identificar cu&#225;les son los principales factores que podr&#237;an influir en la actitud positiva o negativa a dicha participaci&#243;n&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">M&#233;todos</span><p id="par0045" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio de corte transversal en consultorios ambulatorios adheridos al Hospital Dr&#46; C&#233;sar Milstein&#44; hospital universitario ubicado en la Ciudad de Buenos Aires&#44; Argentina&#44; que es administrado por el Instituto Nacional de Servicios Sociales para Jubilados y Pensionados &#40;INSSJP&#47;PAMI&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">El estudio fue aprobado por el Comit&#233; de &#201;tica en Investigaci&#243;n del hospital&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Durante el mes de enero de 2023&#44; se invit&#243; a participar a personas mayores de 60 a&#241;os&#44; afiliados a PAMI&#44; que concurrieran a centros ambulatorios adheridos al Hospital Dr&#46; C&#233;sar Milstein&#46; Fueron excluidos aquellos pacientes que se negaran a participar&#44; que tuvieran barreras del lenguaje o deterioro cognitivo&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Instrumentos de medici&#243;n y recolecci&#243;n de datos</span><p id="par0060" class="elsevierStylePara elsevierViewall">Entrevistadores entrenados realizaron las encuestas donde se recolectaron datos sociodemogr&#225;ficos que incluyeron edad&#44; sexo&#44; a&#241;os de educaci&#243;n &#40;variable categorizada en estratos seg&#250;n su m&#225;ximo nivel de instrucci&#243;n alcanzado&#58; primario-secundario-terciario y universitario&#41;&#44; estatus laboral y convivencia con otras personas&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Se consult&#243; la presencia de comorbilidades incluyendo el antecedente de enfermedad oncol&#243;gica&#44; el grado de funcionalidad y desempe&#241;o de actividades diarias mediante la escala de Karnofsky<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Por medio del &#237;ndice de Religiosidad de la Universidad de Duke &#40;DUREL&#41;&#44; se midi&#243; el grado de religiosidad de los pacientes encuestados<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">El &#237;ndice DUREL se utiliz&#243; para evaluar la religiosidad en tres dominios clave&#58; participaci&#243;n organizacional religiosa&#44; participaci&#243;n no organizacional religiosa y religiosidad intr&#237;nseca&#46; Este &#237;ndice consta de cinco preguntas que miden la frecuencia de asistencia a servicios religiosos&#44; la participaci&#243;n en actividades religiosas privadas y la integraci&#243;n de las creencias religiosas en la vida diaria&#46; Cada &#237;tem se califica con una escala de Likert entre 1 y 5 o 6&#46; Los puntajes se suman para obtener una medida global de religiosidad entre 5 y 27 puntos&#46; Los puntajes m&#225;s altos indican niveles mayores de religiosidad&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Se consult&#243; sobre su deseo de participaci&#243;n voluntaria en EC&#46; Adem&#225;s&#44; se les realiz&#243; la encuesta validada &#171;Encuesta Nacional de Tendencias sobre Informaci&#243;n en Salud &#40;HINTS 5&#44; ciclo 4&#41;&#187;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> sobre el conocimiento&#44; raz&#243;n de participaci&#243;n&#44; participaci&#243;n previa en EC y percepci&#243;n del estado de la propia salud&#46; Esta encuesta tambi&#233;n indaga acerca de qu&#233; escenarios y factores influencian o incentivan a la participaci&#243;n en EC&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">El resultado primario fue la tasa de predisposici&#243;n a participar en EC y&#44; con prop&#243;sitos del an&#225;lisis&#44; se colaps&#243; la variable originalmente obtenida como ordinal &#171;participar&#237;a en un EC&#187; con los siguientes estratos&#58; &#171;definitivamente no&#187;&#44; &#171;probablemente no&#187;&#44; &#171;no estoy seguro&#187;&#44; &#171;probablemente s&#237;&#187;&#44; &#171;definitivamente s&#237;&#187; a una dicot&#243;mica&#58; &#171;probablemente s&#237;&#187; y &#171;definitivamente s&#237;&#187; a dos categor&#237;as&#58; &#171;probablemente y definitivamente s&#237;&#187; por un lado&#44; y por otro &#171;no estoy seguro&#44; probablemente no y definitivamente no&#187;&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">An&#225;lisis estad&#237;stico</span><p id="par0090" class="elsevierStylePara elsevierViewall">Se realiz&#243; estad&#237;stica descriptiva&#46; Las variables categ&#243;ricas se expresaron como n&#250;meros absolutos y proporciones&#46; Las diferencias en las variables categ&#243;ricas se compararon usando el test <span class="elsevierStyleItalic">X</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span>&#46; Las variables continuas se describieron acorde a la distribuci&#243;n de los datos&#46; Se utiliz&#243; media&#44; desviaci&#243;n est&#225;ndar o mediana y rangos intercuart&#237;licos&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Posteriormente&#44; se realiz&#243; un an&#225;lisis multivariado mediante regresi&#243;n log&#237;stica ordinal para evaluar la asociaci&#243;n de los factores sociodemogr&#225;ficos con la predisposici&#243;n a participar en EC&#46; Se calcularon los <span class="elsevierStyleItalic">odds ratio</span> &#40;OR&#41; con su intervalo de confianza de 95&#37; &#40;IC 95&#37;&#41;&#46; Se estableci&#243; como significancia estad&#237;stica una p &#61; 0&#44;05&#46; En el mismo se incluyeron variables como edad &#40;categorizada como mayor o menor de 75 a&#241;os&#41;&#44; sexo&#44; nivel educativo&#44; convivencia&#44; estatus laboral y puntaje de Duke&#46;</p><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Tama&#241;o muestral</span><p id="par0100" class="elsevierStylePara elsevierViewall">Estimando una prevalencia de predisposici&#243;n a participar en EC de 20&#37; &#40;&#177; 5&#41; con un nivel de confianza de 95&#37;&#44; se estim&#243; un tama&#241;o muestral de 246 participantes&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><p id="par0105" class="elsevierStylePara elsevierViewall">Durante el mes de enero de 2023 se invitaron a participar a 278 pacientes de los cuales 251 dieron su consentimiento para responder la encuesta&#46;</p><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Caracter&#237;sticas basales de los participantes &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;</span><p id="par0110" class="elsevierStylePara elsevierViewall">La edad promedio fue de 72&#44;9 a&#241;os y 154 &#40;61&#44;4&#37;&#41; de los pacientes entrevistados eran mujeres&#46; Ten&#237;an estudios primarios o secundarios 195 &#40;77&#37;&#41; y 56 &#40;22&#37;&#41; cursaron estudios universitarios&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Respecto a la capacidad para valerse por s&#237; mismos&#44; 230 &#40;91&#44;6&#37;&#41; eran capaces de realizar las actividades diarias y trabajo sin cuidados especiales&#46; Un total de 194 &#40;77&#37;&#41; conviv&#237;an con alguien m&#225;s y 196 &#40;78&#37;&#41; no se encontraban laboralmente activos&#46; El &#237;ndice mediano de religiosidad fue de 14 puntos&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">De los participantes&#44; 156 &#40;62&#37;&#41; no ten&#237;an comorbilidades&#44; 44 &#40;17&#44;5&#37;&#41; ten&#237;an baja y 51&#40;20&#37;&#41; alta carga com&#243;rbida&#46; Dentro de las comorbilidades consultadas&#44; 158 &#40;16&#44;7&#37;&#41; ten&#237;an antecedente de enfermedad oncol&#243;gica&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Respecto a la percepci&#243;n de la calidad del sistema de salud&#44; 133 &#40;53&#37;&#41; participantes lo consideraron entre bueno y excelente y 118 &#40;47&#37;&#41; lo calificaron entre malo y aceptable&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Participaci&#243;n y conocimiento sobre ensayos cl&#237;nicos</span><p id="par0130" class="elsevierStylePara elsevierViewall">De los 251 adultos que fueron consultados sobre si alguna vez participaron en alg&#250;n EC&#44; 12 &#40;5&#37;&#41; manifestaron haberlo hecho en alguna ocasi&#243;n&#46; Asimismo&#44; se pregunt&#243; acerca de su conocimiento sobre los EC y 171 &#40;68&#37;&#41; reportaron no tener conocimiento alguno sobre los mismos y 80 &#40;31&#44;87&#37;&#41; declararon tener alg&#250;n conocimiento sobre estos&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Al consultarles sobre su deseo de participaci&#243;n en EC&#44; 88 participantes &#40;35&#37;&#41; reportaron que probable o definitivamente participar&#237;an en un EC&#44; 98 &#40;39&#37;&#41; probable o definitivamente no y 65 &#40;26&#37;&#41; no lo ten&#237;a claro&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Posteriormente&#44; se recab&#243; informaci&#243;n sobre la influencia de diferentes factores individuales y distintos escenarios para la mayor o menor predisposici&#243;n a participar en EC &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">Se observ&#243; que&#44; a mayor edad&#44; menor voluntad de participar en EC &#40;OR&#58; 0&#44;55&#59; IC 95&#37;&#58; 0&#44;34-0&#44;88&#41;&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Asimismo&#44; el sexo masculino se asoci&#243; con un mayor deseo de participaci&#243;n &#40;OR&#58; 1&#44;74&#59; IC 95&#37;&#58; 1&#44;06-2&#44;84&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">Los escenarios que se asociaron a un mayor deseo de participar en EC fueron el saber que al hacerlo se podr&#237;a ayudar a otros &#40;OR&#58; 1&#44;95&#59; IC 95&#37;&#58; 1&#44;36-2&#44;178&#41;&#44; la posibilidad de recibir ayuda por participar &#40;OR&#58; 1&#44;69&#59; IC 95&#37;&#58; 1&#44;26-2&#44;26&#41; y la posibilidad de probar una nueva clase de atenci&#243;n m&#233;dica &#40;OR&#58; 1&#44;71&#59; IC 95&#37;&#58; 1&#44;20-2&#44;42&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">Entre los pacientes oncol&#243;gicos&#44; 16 de 42 &#40;38&#37;&#41; estaban de acuerdo en participar en EC&#44; mientras que&#44; entre los no oncol&#243;gicos&#44; 72 de 209 &#40;34&#37;&#41; estuvieron de acuerdo&#44; p &#61; 0&#44;65&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discusi&#243;n</span><p id="par0165" class="elsevierStylePara elsevierViewall">En este estudio transversal dise&#241;ado para evaluar la predisposici&#243;n de las personas mayores a participar en EC e identificar los factores sociodemogr&#225;ficos que se asocian con una actitud positiva&#44; un 35&#37; manifest&#243; que probable o definitivamente participar&#237;a en un EC&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">A fines de contrastar nuestros hallazgos con los publicados en la literatura&#44; hemos encontrado resultados de tasas de participaci&#243;n en EC&#44; pero en contextos oncol&#243;gicos y de vacunaci&#243;n&#46; Nuestros hallazgos superan las cifras que se disponen de la FDA de EE&#46; UU&#46;&#44; que reportaron tasas de participaci&#243;n en personas mayores con patolog&#237;a oncol&#243;gica del 24&#37;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a>&#46; Otras cohortes norteamericana y australiana de pacientes oncol&#243;gicos consultados por su potencial participaci&#243;n en EC arrojaron valores entre el 28&#37; y 33&#37;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a><a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a>&#46; En otros escenarios como los EC de vacunas&#44; una encuesta realizada en el a&#241;o 2018 en Atlanta a 400 personas mayores mostr&#243; tasas de predisposici&#243;n a participar que alcanzaron un 62&#44;25&#37;&#46; Este grupo declar&#243; una participaci&#243;n previa en EC de 19&#44;75&#37;&#44; lo que sugiere un elevado inter&#233;s en el tema<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">La tasa de participaci&#243;n previa en EC de las personas mayores encuestadas en nuestro estudio result&#243; ser de un 5&#37;&#44; ligeramente superior a otros hallazgos publicados previamente en contextos oncol&#243;gicos que registraron tasas de entre 2-3&#37;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a>&#44; pero inferior a otros estudios sobre vacunas realizados en pacientes mayores que fueron entre 17 y 20&#37;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">15&#44;16</span></a>&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Este estudio se realiz&#243; en la era pospandemia por COVID-19 y presumimos que la tasa elevada de predisposici&#243;n a participar en EC obtenida podr&#237;a estar relacionada con un mayor conocimiento sobre los EC de vacunas y m&#225;s informaci&#243;n difundida a la poblaci&#243;n acerca de estos temas&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Cuando se estudiaron las caracter&#237;sticas sociodemogr&#225;ficas asociadas a un mayor deseo de participar en EC encontramos que la menor edad y el sexo masculino se vincularon con una mayor voluntad de participar&#44; hallazgos tambi&#233;n reportados en un estudio holand&#233;s que analiz&#243; a 262 personas mayores<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a>&#44; y a su vez&#44; concordantes con los hallados en escenarios como sida&#44; c&#225;ncer colorrectal&#44; c&#225;ncer de pulm&#243;n y enfermedad cardiovascular<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">15&#44;18-20</span></a>&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Al consultar sobre los diferentes escenarios que podr&#237;an aumentar el deseo de participar en EC&#44; se mencionaron varios factores&#44; como el deseo de ayudar a otros&#44; la posibilidad de recibir alg&#250;n tipo de ayuda&#44; como la provisi&#243;n de transporte&#44; y la oportunidad de probar un nuevo tipo de atenci&#243;n m&#233;dica&#46; Algunos hallazgos fueron consistentes con los nuestros&#46; En una revisi&#243;n sistem&#225;tica sobre estrategias para aumentar el reclutamiento de personas mayores en EC&#44; se mencion&#243; la provisi&#243;n de transporte como un incentivo para participar&#46; Sin embargo&#44; esta misma revisi&#243;n destac&#243; los incentivos econ&#243;micos como un factor importante&#44; a diferencia de nuestro estudio&#44; donde hasta un 85&#37; de los entrevistados indic&#243; que los incentivos econ&#243;micos no influir&#237;an en su deseo de participar<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Este estudio cuenta con algunas limitaciones&#46; En primer lugar&#44; fue realizado en un &#250;nico centro lo que podr&#237;a limitar la generalizaci&#243;n de nuestros hallazgos&#46; En segundo lugar&#44; al ser un estudio de tipo cuantitativo es posible que ciertos dominios emergentes no hayan podido ser explorados&#46; Tercero&#44; el muestreo fue por conveniencia lo que podr&#237;a introducir un sesgo de selecci&#243;n en favor de los pacientes m&#225;s interesados&#46; Finalmente&#44; al ser un tema poco conocido&#44; los participantes podr&#237;an no haber comprendido completamente los enunciados de algunas preguntas&#44; lo que podr&#237;a introducir un sesgo de informaci&#243;n&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Por otro lado&#44; este estudio tiene como fortalezas haber utilizado un cuestionario estructurado y validado previamente y haber entrevistado poblaci&#243;n adulta mayor&#46; Esto permite conocer sus intereses&#44; percepciones y&#44; de esta forma&#44; mejorar su involucramiento y tasa de participaci&#243;n en EC&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Los adultos encuestados fueron consultados por la potencial participaci&#243;n en EC en general&#44; pero sin aclarar una condici&#243;n cl&#237;nica espec&#237;fica&#46; Las respuestas probablemente pueden depender del contexto o la patolog&#237;a puntual planteada&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Este estudio pone de manifiesto que un tercio de las personas mayores presentan inter&#233;s en participar en un EC&#44; pero que la informaci&#243;n que reciben es escasa&#44; lo cual creemos que puede estar relacionado con que nuestros pacientes pertenecen a un centro que no realiza EC&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Probablemente&#44; otros pacientes que se atienden en centros en donde s&#237; se llevan a cabo EC&#44; est&#233;n m&#225;s familiarizados e interiorizados en estos temas&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Ser&#237;a importante difundir m&#225;s informaci&#243;n sobre los EC para mejorar el acceso a las nuevas terapias en este subgrupo de poblaci&#243;n&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Financiaci&#243;n</span><p id="par0225" class="elsevierStylePara elsevierViewall">Este trabajo no ha recibido ning&#250;n tipo de financiaci&#243;n&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicto de intereses</span><p id="par0230" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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    "resumen" => array:2 [
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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">El ensayo cl&#237;nico &#40;EC&#41; es una herramienta fundamental en la medicina basada en evidencia&#46; Las personas mayores conforman una minor&#237;a en los EC&#46; Nuestro objetivo es determinar su voluntad de participar en estos e identificar los factores que podr&#237;an influir en la actitud hacia la participaci&#243;n&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio de corte transversal a personas mayores de 60 a&#241;os&#44; ambulatorias&#46; Se determin&#243; la tasa de deseo de participaci&#243;n voluntaria en EC y&#44; mediante una encuesta validada &#40;Encuesta Nacional de Tendencias sobre Informaci&#243;n en Salud &#91;HINTS 5&#44; ciclo 4&#93;&#41;&#44; se evalu&#243; el conocimiento&#44; la tasa de participaci&#243;n previa en EC y la influencia de distintos factores que podr&#237;an asociarse a una actitud positiva a participar&#46; Estos factores se analizaron mediante regresi&#243;n log&#237;stica ordinal&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se encuestaron 251 personas mayores&#46; De ellas&#44; 171 &#40;68&#37;&#41; reportaron no tener conocimiento alguno sobre EC y 80 &#40;31&#44;87&#37;&#41; declararon tenerlo en alg&#250;n grado&#46; Un total de 12 pacientes &#40;5&#37;&#41; participaron previamente en un EC y 88 &#40;35&#37;&#41; expresaron que probable o definitivamente participar&#237;an en uno&#46; Se observ&#243; que&#44; a mayor edad&#44; menor voluntad de participar en EC &#40;<span class="elsevierStyleItalic">odds ratio</span> &#91;OR&#93;&#58; 0&#44;55&#59; intervalo de confianza &#91;IC&#93; 95&#37;&#58; 0&#44;34-0&#44;88&#41;&#46; Asimismo&#44; el sexo masculino se asoci&#243; con un mayor deseo de participaci&#243;n &#40;OR&#58; 1&#44;74&#59; IC 95&#37;&#58; 1&#44;06-2&#44;84&#41;&#44; respectivamente&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Los escenarios que se relacionaron con un mayor deseo de participar en EC fueron el saber que al hacerlo se podr&#237;a ayudar a otros &#40;OR&#58; 1&#44;95&#59; IC 95&#37;&#58; 1&#44;36-2&#44;178&#41;&#44; la posibilidad de recibir ayuda por participar &#40;OR&#58; 1&#44;69&#59; IC 95&#37;&#58; 1&#44;26-2&#44;26&#41; y la posibilidad de probar una nueva clase de atenci&#243;n m&#233;dica &#40;OR&#58; 1&#44;71&#59; IC 95&#37;&#58; 1&#44;20-2&#44;42&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El grado de conocimiento sobre los EC de las personas mayores es escaso y hasta un tercio de las mismas participar&#237;an como voluntarias en un EC&#46; La difusi&#243;n de informaci&#243;n sobre los EC podr&#237;a incentivar a una mayor tasa de participaci&#243;n&#46;</p></span>"
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          0 => array:2 [
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Clinical trials are a fundamental tool in evidence-based medicine&#44; with participant recruitment being a critical factor for their execution&#46; Low participation in a study leads to inadequate sample size&#46; Older adults constitute a minority in clinical trials&#44; and various factors influence their level of participation and retention during the study process&#46; Our objective is to determine the willingness of older adults to participate in clinical trials and identify their main barriers and facilitator&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional study was carried out on outpatient adults over 60 years of age&#46; The rate of desire for voluntary participation in clinical trials was determined and through a validated survey &#8220;National Health Information Trends Survey &#40;HINTS 5&#44; cycle 4&#41;&#8221; the knowledge&#44; rate of prior participation in CE and the influence of different factors that could be associated with a positive attitude to participate&#46; These factors were analyzed using ordinal logistic regression&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">251 older adults were surveyed&#46; Of them&#44; 171 &#40;68&#37;&#41; reported not having any knowledge about clinical trials and 80 &#40;31&#46;87&#37;&#41; reported having it to some degree&#46; 12 patients &#40;5&#37;&#41; previously participated in a CS and up to 88 patients &#40;35&#37;&#41; expressed that they would probably or definitely participate in one&#46; It was observed that&#44; the older the age&#44; the less willingness to participate in CE &#91;OR&#93;&#58; 0&#46;55 &#40;CI 95&#37; 0&#46;34-0&#46;88&#41;&#46; Likewise&#44; male sex was associated with a greater desire to participate &#91;OR&#93;&#58; 1&#46;74 &#40;CI 95&#37; 1&#46;06-2&#46;84&#41;&#44; respectively&#46; The scenarios that were associated with a greater desire to participate in CE were knowing that by participating you could help others &#91;OR&#93;&#58; 1&#46;95 &#40;95&#37; CI 1&#46;36-2&#46;178&#41;&#44; the possibility of receiving help for participating &#91;OR&#93;&#58; 1&#46;69 &#40;95&#37; CI 1&#46;26-2&#46;26&#41; and the possibility of trying a new type of medical care &#91;OR&#93;&#58; 1&#46;71 &#40;95&#37; CI 1&#46;20-2&#46;42&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">The level of knowledge about CE among older adults is low and up to a third of them would participate as volunteers in a CE&#46; The dissemination of information about ECs could encourage a higher participation rate&#46;</p></span>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Edad&#44; media &#40;DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#44;9 &#40;6&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo femenino&#44; no &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">154 &#40;61&#44;4&#41;&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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Nivel educativo&#44; no &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Primario&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">92 &#40;36&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Secundario&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">103 &#40;41&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Terciario-universitario&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 &#40;22&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Convivencia&#44; no &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">194 &#40;77&#44;3&#41;&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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Estatus laboral&#44; no &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">196 &#40;78&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Puntaje Duke&#44; mediana &#40;IQR&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#44;0 &#40;14&#44;0&#59; 20&#44;0&#41;&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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">&#205;ndice Charlson categorizado&#44; no &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Ausencia de comorbilidad&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">156 &#40;62&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Baja&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">44 &#40;17&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Alta&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51 &#40;20&#44;3&#41;&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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">&#205;ndice de Karnofsky categorizado&#44; no &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Incapaz de trabajar&#44; ayuda variable para autocuidado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;8&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Capaz de realizar actividades normales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">230 &#40;91&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Historia de enfermedad oncol&#243;gica&#44; no &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">209 &#40;83&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas basales de los pacientes</p>"
        ]
      ]
      1 => array:8 [
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        "etiqueta" => "Tabla 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">EC&#58; ensayo cl&#237;nico&#46;</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"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>251&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" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Mi participaci&#243;n ayudar&#237;a a otras personas&#44; no &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Absolutamente nada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55 &#40;21&#44;91&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Un poco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;12&#44;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Algo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">147 &#40;58&#44;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mucho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18 &#40;7&#44;17&#41;&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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Me pagar&#237;an por participar&#44; no &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Absolutamente nada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">214 &#40;85&#44;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Un poco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;3&#44;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Algo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;11&#44;55&#41;&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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Recibir&#237;a apoyo por participar&#44; como transporte&#44; cuidado infantil&#44; no &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Absolutamente nada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">126 &#40;50&#44;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Un poco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;9&#44;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Algo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">101 &#40;40&#44;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mucho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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 &#40;0&#44;40&#41;&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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Si mi m&#233;dico me recomendara participar&#44; no &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Absolutamente nada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77 &#40;30&#44;68&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Un poco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;11&#44;55&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Algo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">137 &#40;54&#44;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mucho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;3&#44;19&#41;&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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Me gustar&#237;a recuperarme&#44; no &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Absolutamente nada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;6&#44;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Un poco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;3&#44;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Algo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">95 &#40;37&#44;85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mucho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">131 &#40;52&#44;19&#41;&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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tendr&#237;a la oportunidad de probar una nueva clase de atenci&#243;n&#44; no &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Absolutamente nada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59 &#40;23&#44;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Un poco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;15&#44;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Algo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">144 &#40;57&#44;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mucho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;3&#44;19&#41;&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  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Si la atenci&#243;n habitual no estuviera cubierta por mi seguro&#44; no &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Absolutamente nada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85 &#40;33&#44;86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Un poco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;9&#44;56&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Algo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">135 &#40;53&#44;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mucho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;2&#44;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3684437.png"
              ]
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        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Influencia de diferentes escenarios en la predisposici&#243;n a participar en EC</p>"
        ]
      ]
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        "etiqueta" => "Tabla 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">EC&#58; ensayo cl&#237;nico&#59; IC&#58; intervalo de confianza&#59; OR&#58; <span class="elsevierStyleItalic">odds ratio</span>&#59; ref&#46;&#58; referencia&#46;</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"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&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  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">An&#225;lisis crudo</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">An&#225;lisis ajustado</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IC 95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><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">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">IC 95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Edad mayor de 75 a&#241;os</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;37-0&#44;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;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
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;34-0&#44;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo masculino</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;95-2&#44;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;082&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;06-2&#44;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;027&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="7" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Nivel educativo</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">Me pagar&#237;an por participar&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Si mi m&#233;dico me recomendara participar&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Si mi familia y mis amigos me alentaran a participar&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">0&#44;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\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">Me gustar&#237;a recuperarme&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;92-1&#44;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;13&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">Tendr&#237;a la oportunidad de probar una nuevaclase de atenci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;20-2&#44;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;00&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">Si la atenci&#243;n habitual no estuviera cubiertapor mi seguro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;97-1&#44;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\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;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3684435.png"
              ]
            ]
            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\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">Tasa de deseo de participaci&#243;n voluntaria en EC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>251 &#40;&#37;&#41;&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">Probablemente o definitivamente s&#237;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88 &#40;35&#41;&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">No claro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65 &#40;26&#41;&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">Probablemente o definitivamente no&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98 &#40;39&#41;&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">Tasa de participaci&#243;n previa en EC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;5&#41;&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">Falta de conocimiento sobre EC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">171 &#40;68&#41;&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">Acuerdo en participar de EC entre los pacientes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oncol&#243;gicos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16 &#40;38&#41;&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">No oncol&#243;gicos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72 &#40;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3684436.png"
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        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Influencia de factores individuales y distintos escenarios para la predisposici&#243;n a participaci&#243;n en EC&#46; Modelo de regresi&#243;n log&#237;stica</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:20 [
            0 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Clinical Trials and Older Adults &#8212; Strategies to Drive Older Adult Participation&#44; 2017 Disponible en&#58; <a target="_blank" href="https://www.geron.org/programs-services/alliances-and-multi-stakeholder-collaborations/clinical-trials-and-older-adults">https&#58;&#47;&#47;www&#46;geron&#46;org&#47;programs-services&#47;alliances-and-multi-stakeholder-collaborations&#47;clinical-trials-and-older-adults</a>"
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Barriers to participation in clinical trials of cancer&#58; a meta-analysis and systematic review of patient-reported factors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46;J&#46; Mills"
                            1 => "D&#46; Seely"
                            2 => "B&#46; Rachlis"
                            3 => "L&#46; Griffith"
                            4 => "P&#46; Wu"
                            5 => "K&#46; Wilson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet Oncol&#46;"
                        "fecha" => "2006"
                        "volumen" => "7"
                        "paginaInicial" => "141"
                        "paginaFinal" => "148"
                        "itemHostRev" => array:3 [
                          "pii" => "S155072891930067X"
                          "estado" => "S300"
                          "issn" => "15507289"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Factors Influencing Participation in COVID-19 Clinical Trials&#58; A Multi-National Study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;S&#46; Abdelhafiz"
                            1 => "S&#46; Abd ElHafeez"
                            2 => "M&#46;A&#46; Khalil"
                            3 => "M&#46; Shahrouri"
                            4 => "B&#46; Alosaim"
                            5 => "R&#46;O&#46; Salem"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Front Med&#46;"
                        "fecha" => "2021"
                        "volumen" => "8"
                        "paginaInicial" => "608959"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "FDA analysis of enrollment of older adults in clinical trials for cancer drug registration&#58; A 10-year experience by the U&#46;S&#46; Food and Drug Administration"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46; Singh"
                            1 => "B&#46; Kanapuru"
                            2 => "C&#46; Smith"
                            3 => "L&#46;A&#46; Fashoyin-Aje"
                            4 => "A&#46; Myers"
                            5 => "G&#46; Kim"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "J Clin Oncol&#46;"
                        "fecha" => "2017"
                        "volumen" => "35"
                        "paginaInicial" => "10009"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Focus group interviews examining attitudes toward medical research among the Japanese&#58; a qualitative study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46; Asai"
                            1 => "M&#46; Ohnishi"
                            2 => "E&#46; Nishigaki"
                            3 => "M&#46; Sekimoto"
                            4 => "S&#46; Fukuhara"
                            5 => "T&#46; Fukui"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1467-8519.2004.00409.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Bioethics&#46;"
                        "fecha" => "2004"
                        "volumen" => "18"
                        "paginaInicial" => "448"
                        "paginaFinal" => "470"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15462026"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patients&#8217; willingness to participate in clinical trials and their views on aspects of cancer research&#58; results of a prospective patient survey"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;Y&#46; Moorcraft"
                            1 => "C&#46; Marriott"
                            2 => "C&#46; Peckitt"
                            3 => "D&#46; Cunningham"
                            4 => "I&#46; Chau"
                            5 => "N&#46; Starling"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Trials&#46;"
                        "fecha" => "2016"
                        "volumen" => "17"
                        "paginaInicial" => "17"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Perceptions of financial payment for research participation among African-American drug users in HIV studies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Slomka"
                            1 => "S&#46; McCurdy"
                            2 => "E&#46;A&#46; Ratliff"
                            3 => "S&#46; Timpson"
                            4 => "M&#46;L&#46; Williams"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11606-007-0319-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Gen Intern Med&#46;"
                        "fecha" => "2007"
                        "volumen" => "22"
                        "paginaInicial" => "1403"
                        "paginaFinal" => "1409"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17668270"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Barriers and facilitators to participation in clinical trial among lymphoma patients from Sun Yat-sen University Cancer Center in China&#58; An observation study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "Q&#46; Kong"
                            1 => "H&#46; Mei"
                            2 => "Y&#46; Lai"
                            3 => "S&#46; Shi"
                            4 => "Y&#46; Li"
                            5 => "L&#46; He"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Medicine&#46;"
                        "fecha" => "2017"
                        "volumen" => "96"
                        "paginaInicial" => "e8062"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Recruitment and Retention of Older People in Clinical Research&#58; A Systematic Literature Review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "N&#46;D&#46; Forsat"
                            1 => "A&#46; Palmowski"
                            2 => "Y&#46; Palmowski"
                            3 => "M&#46; Boers"
                            4 => "F&#46; Buttgereit"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jgs.16875"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Geriatr Soc&#46;"
                        "fecha" => "2020"
                        "volumen" => "68"
                        "paginaInicial" => "2955"
                        "paginaFinal" => "2963"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33075140"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Validation of the Spanish version of the Palliative Care Outcome Scale"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Grupo Catal&#225;n de Estudio de la Efectividad de los Cuidados Paliativos"
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Serra-Prat"
                            1 => "M&#46; Nabal"
                            2 => "V&#46; Santacruz"
                            3 => "J&#46;M&#46; Picaza"
                            4 => "J&#46; Trelis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Clin&#46;"
                        "fecha" => "2004"
                        "volumen" => "123"
                        "paginaInicial" => "406"
                        "paginaFinal" => "412"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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ISSN: 0211139X
Idioma original: Español
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