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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Several publications<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">1&#8211;4</span></a> have shown that preschool children aged 3&#8211;6 years are able to perform spirometry&#44; thanks to improved spirometric techniques and a test adapted for this age range using computer-animated systems with visual incentives&#44; prompting the European Respiratory Society &#40;ERS&#41; and the American Thoracic Society &#40;ATS&#41;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">5</span></a> to publish standardized procedures for preschoolers in 2007&#46; Reference equations have also been published for this age group in various populations&#44;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">3&#44;6&#8211;11</span></a> including Spain &#40;CANDELA study<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">12</span></a>&#41;&#46; Developing reference equations for preschoolers has been useful for demonstrating the applicability of spirometry in this age group&#44; but one of the problems is the discontinuity of values for children older than 6 years of age&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">13</span></a> This inevitably produces gaps between preschool and school age children which may lead to the misinterpretation of final test results&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">14</span></a> The situation is further complicated by the high number of available reference equations to choose from&#46; Using the wrong equations may lead to both under- and overdiagnosis&#44; so it is essential that data are available to help us assess the adequacy of the equations in our population&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In order to solve these problems&#44; All ages equations for subjects from 3 to 80 years of age were developed&#44;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">15&#44;16</span></a> and in 2010 the Global Lung Function Initiative &#40;GLI&#41; was created to develop the first worldwide continuous reference equations for forced spirometry for all ages &#40;3&#8211;95 years&#41; and different ethnic groups&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">17</span></a> Since then&#44; various authors have validated these equations&#44;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">18&#8211;20</span></a> and assessed the implications of using them instead of the equations currently in use&#46;<a class="elsevierStyleCrossRefs" href="#bib0280"><span class="elsevierStyleSup">21&#8211;23</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The aim of this study was to validate the GLI-2012 reference equations in a series of healthy Caucasian preschool children aged 3&#8211;6 years from the city of Barcelona &#40;Spain&#41;&#44; and to assess the validity and reliability of the forced spirometric technique in this age range&#44; by evaluating the different quality criteria of the test&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">The study was performed with the approval of the Clinical Research Ethics Committee&#46; The City Council of Barcelona and school heads agreed to the conduct of the study&#46; Informed consent for participating in the study was obtained in all cases from the parents or legal guardians of the children&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Population and Calculation of Sample Size</span><p id="par0025" class="elsevierStylePara elsevierViewall">The study population consisted of randomly selected&#44; healthy preschool children aged 3&#8211;6 years&#44; attending various private and public schools in Barcelona &#40;Spain&#41;&#46; The sample size was estimated according to the recommendations of Quanjer et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">24</span></a> which require the inclusion of at least 300 local controls &#40;150 boys and 150 girls&#41; to validate the reference equations and avoid differences of 0&#46;5 <span class="elsevierStyleItalic">z</span>-scores occurring by chance&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Methodology</span><p id="par0030" class="elsevierStylePara elsevierViewall">Parents were given a health questionnaire to distinguish &#8220;healthy&#8221; children from &#8220;non-healthy&#8221; children&#44; in terms of respiratory disease&#46; To avoid creating any sense of discrimination among the children&#44; spirometry was performed in all children whose parents authorized their participation in the study&#44; although those who did not meet the criteria for participation were subsequently excluded from the analysis&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Inclusion criteria were as follows&#58; age between 3 and 6&#46;99 years&#59; born at term &#40;&#62;37 weeks&#41;&#59; absence of repeated episodes of bronchitis or other chronic lung disease&#59; no significant heart disease&#59; no neuromuscular or bone disease that might contribute to a restricted lung capacity&#59; and no systemic disease with pulmonary involvement&#46; Children who had had an isolated episode of bronchitis without hospitalization were included&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Spirometries were performed in schools during school hours by the same pediatrician &#40;CMV&#41;&#44; who is experienced in the use of forced spirometry techniques adapted for children&#46; Weight was determined using weighing scales&#44; and height using a measuring rod &#40;Seca mod&#46; 173&#44; Seca<span class="elsevierStyleSup">&#174;</span>&#44; Hamburg&#41;&#59; both devices were correctly calibrated&#46; Spirometries were performed with a MasterScreen<span class="elsevierStyleSup">&#174;</span> spirometer with 5&#46;0 software &#40;VIASYS Healthcare&#44; H&#246;chberg&#44; Germany&#41;&#46; The spirometer was calibrated every day with a 3-liter syringe &#40;ViasysHealthcare&#44; Hochberg&#44; Germany&#41;&#46; Environmental calibration was performed on a daily basis&#46; Biological control was also performed&#46; Disposable mouthpieces with antibacterial filters &#40;Neumofilt<span class="elsevierStyleSup">&#174;</span>&#59; Hospital Hispania&#44; Madrid&#44; Spain&#41; were used&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Height was measured without shoes and weight with lightweight clothing&#46; Spirometry was conducted according to ERS&#47;ATS recommendations<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">5</span></a> with the subject in an upright seated position&#46; Nasal clips were not used&#46; Computer-animated systems were used to help subjects correctly achieve peak expiratory flow &#40;PEF&#41; &#40;blowing candles&#41; and forced vital capacity &#40;FVC&#41; &#40;knocking down bowling pins&#41;&#46; Each child performed up to 8 maneuvers&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Spirometric Variables and Quality Criteria</span><p id="par0050" class="elsevierStylePara elsevierViewall">The following parameters were collected for each child&#58; flow&#8211;volume &#40;<span class="elsevierStyleItalic">F</span>&#47;<span class="elsevierStyleItalic">V</span>&#41; and volume&#8211;time &#40;<span class="elsevierStyleItalic">V</span>&#47;<span class="elsevierStyleItalic">T</span>&#41; curves&#44; forced expiratory time&#44; PEF&#44; FVC&#44; forced expiratory volume in the first second &#40;FEV<span class="elsevierStyleInf">1</span>&#41;&#44; 0&#46;75<span class="elsevierStyleHsp" style=""></span>s &#40;FEV<span class="elsevierStyleInf">0&#46;75</span>&#41;&#44; and 0&#46;5<span class="elsevierStyleHsp" style=""></span>s &#40;FEV<span class="elsevierStyleInf">0&#46;5</span>&#41;&#44; forced expiratory flow at 75&#37; of FVC &#40;FEF<span class="elsevierStyleInf">75&#37;</span>&#41;&#44; forced expiratory flow between 25&#37; and 75&#37; of FVC &#40;FEF<span class="elsevierStyleInf">25&#37;&#8211;75&#37;</span>&#41;&#44; and back-extrapolated volume &#40;Vbe&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">All spirometries were assessed independently for quality by 2 of the investigators &#40;CMV&#44; IMM&#44; SRA&#44; ATV&#44; SG&#44; IIS&#44; AMG&#41;&#46; In case of discrepancies&#44; a third investigator performed an assessment and consensus was reached on interpretation&#46; The ATS&#47;ERS<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">5</span></a> quality criteria&#44; modified by Stanojevic et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">16</span></a> were used for this analysis&#44; as follows&#58; &#40;1&#41; rapid onset of expiration &#40;Vbe&#60;80<span class="elsevierStyleHsp" style=""></span>ml or Vbe&#47;FVC&#60;12&#46;5&#37;&#41;&#59; &#40;2&#41; clearly defined PEF&#59; &#40;3&#41; visually correct expiratory curve&#44; without artifacts&#44; cough&#44; glottic closure or air leaks&#59; &#40;4&#41; good repeatability&#58; difference of &#60;100<span class="elsevierStyleHsp" style=""></span>ml or &#60;10&#37; between the 2 best values of the forced expiratory volume in a given time &#40;FEVt&#41; and FVC&#44; with the requirement of at least 2 correct maneuvers&#59; &#40;5&#41; clearly defined final plateau in the <span class="elsevierStyleItalic">V</span>&#47;<span class="elsevierStyleItalic">T</span> curve&#46; For the analysis of FEV<span class="elsevierStyleInf">1</span>&#44; FEV<span class="elsevierStyleInf">0&#46;75</span>&#44; and FEV<span class="elsevierStyleInf">0&#46;5</span> to be considered acceptable&#44; criteria 1&#44; 3 and 4 had to be met&#46; For the analysis of FVC&#44; FEVt&#47;FVC ratios and flows &#40;FEF<span class="elsevierStyleInf">75</span> and FEF<span class="elsevierStyleInf">25&#8211;75</span>&#41; to be considered acceptable&#44; criterion 5 of a well-defined plateau was required&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Data Analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">z</span>-Scores were calculated from the GLI-2012 reference equations&#46; FEV<span class="elsevierStyleInf">0&#46;5</span> reference values are not included in GLI-2012&#44; so All ages equations were used to calculate the FEV<span class="elsevierStyleInf">0&#46;5</span><span class="elsevierStyleItalic">z</span>-score<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">16</span></a> &#40;see <a class="elsevierStyleCrossRef" href="#sec0055">Appendix A</a>&#41;&#46; Weight and height <span class="elsevierStyleItalic">z</span>-scores were calculated with the reference equations for the Spanish population&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">25</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">For the GLI-2012 equations to be applicable in our population&#44; the <span class="elsevierStyleItalic">z</span>-score &#40;mean&#41; of each parameter must be close to 0&#44; with a standard deviation &#40;SD&#41; of 1 and a maximum difference of &#177;0&#46;5 <span class="elsevierStyleItalic">z</span>-scores from the mean&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">20&#44;24</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Mean&#44; SD&#44; median and range were used to describe quantitative variables&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The Cochran&#8211;Armitage trend test was used to compare the different quality criteria of the spirometric maneuvers according to age&#46; The Student&#39;s t-test was used to compare values obtained between girls and boys&#46; A <span class="elsevierStyleItalic">P</span> value &#60;&#46;05 were considered statistically significant&#46; Analyses were performed using the MedCalc Statistical Software package&#44; version 13&#46;0&#46;2 &#40;MedCalc Software bvba&#44; Ostend&#44; Belgium&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><p id="par0080" class="elsevierStylePara elsevierViewall">The study was conducted in 10 schools with preschool and first grade classes&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> depicts the inclusion of children in the study&#46; Informed consent was signed by the parents of 640 children&#46; At the time of the study&#44; 47 were absent and 5 refused to participate&#46; In total&#44; 588 individuals performed spirometry&#44; of whom 45 were excluded because they had already turned 7&#44; and 138 &#40;25&#46;4&#37;&#41; due to underlying disease&#58; 91 &#40;16&#46;7&#37;&#41; had &#40;or had had&#41; repeated episodes of bronchitis&#59; 14 &#40;2&#46;6&#37;&#41; had been hospitalized for an episode of bronchitis&#59; 30 &#40;5&#46;5&#37;&#41; were premature at birth&#59; 1 had chronic granulomatous disease&#59; and 2 had rheumatoid arthritis&#46; Of the 405 healthy children who performed spirometry&#44; 380 Caucasians were selected&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the demographic characteristics of the 380 children&#46; Median age was 5&#46;21 years &#40;range 3&#46;36&#8211;6&#46;99 years&#41;&#46; Girls were slightly predominant &#40;53&#46;9&#37;&#41; and the 3-year-old group was somewhat less represented &#40;17&#46;1&#37;&#41;&#46; Weight and height <span class="elsevierStyleItalic">z</span>-scores for all age groups were within the normal range&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">In total&#44; 81&#46;6&#37; of the children &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41; presented a spirometry with quality criteria permitting the assessment of FEVt&#46; Of the 380 children&#44; 67&#46;6&#37; were able to perform FEV<span class="elsevierStyleInf">1</span> correctly&#44; 78&#46;9&#37; FEV<span class="elsevierStyleInf">0&#46;75</span>&#44; and 81&#46;6&#37; FEV<span class="elsevierStyleInf">0&#46;5</span>&#46; Older children tended to achieve more valid maneuvers &#40;75&#46;4&#37; in 3-year-olds vs 85&#46;4&#37; in 6-year-olds&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;054&#41;&#46; The percentage of spirometries with a correct plateau was 69&#46;5&#37;&#44; with no differences observed between the different ages &#40;64&#46;6&#37; in 3-year-olds vs 71&#46;9&#37; in 6-year-olds&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;247&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">When quality criteria were analyzed separately&#44; we observed that the older the children&#44; the more they tended to achieve maneuvers with good repeatability &#40;76&#46;9&#37; in 3-year-olds vs 92&#46;7&#37; in 6 year-olds&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;002&#41;&#46; No differences were observed in the remaining criteria &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> lists the <span class="elsevierStyleItalic">z</span>-score values of the spirometric variables calculated according to the GLI-2012 equations in our overall population&#46; As can be seen&#44; all values are within &#177;0&#46;5 <span class="elsevierStyleItalic">z</span>-scores&#44; with the exception of FEV<span class="elsevierStyleInf">1</span>&#47;FVC &#40;0&#46;53 <span class="elsevierStyleItalic">z</span>-scores&#41;&#46; At least 95&#37; of all values were within &#177;2 <span class="elsevierStyleItalic">z</span>-scores&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">No significant differences were observed between values for the various spirometric variables by sex &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#44; with all <span class="elsevierStyleItalic">z</span>-scores falling within &#177;0&#46;5&#44; except for FEV<span class="elsevierStyleInf">1</span>&#47;FVC in boys &#40;0&#46;53&#41; and girls &#40;0&#46;52&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> shows the discreet relationship between FEV<span class="elsevierStyleInf">0&#46;75</span>&#47;FVC ratio and age &#40;<span class="elsevierStyleItalic">r</span>&#61;0&#46;24&#44; <span class="elsevierStyleItalic">P</span>&#61;&#46;001&#41;&#44; with a value of between 0&#46;8 and 1&#44; except in 7 children&#46; <a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a> is a comparison between mean FVC&#44; FEV<span class="elsevierStyleInf">1</span>&#44; FEV<span class="elsevierStyleInf">0&#46;75</span>&#44; and FEF<span class="elsevierStyleInf">25&#37;&#8211;75&#37;</span>&#44; expressed as percentage of the predicted value for age&#44; using the GLI-2012&#44; All ages&#44; and CANDELA equations&#46; The All ages and GLI-2012 equations show a better fit with our population&#44; whereas the values from the CANDELA equations deviated more from the 100&#37; predicted value&#44; particularly in 3- and 4-year-olds&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0115" class="elsevierStylePara elsevierViewall">Our results indicate that the GLI-2012 and All ages equations for FEV<span class="elsevierStyleInf">0&#46;5</span> are suitable for Spanish preschoolers of Caucasian ethnicity&#46; In total&#44; 81&#46;6&#37; of preschool children aged 3&#8211;6 years were able to perform a quality spirometry to assess FEVt&#44; and 69&#46;5&#37; achieved spirometry with a correct plateau and FVC&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">For many years&#44; the most widespread criterion for the interpretation of spirometry has been the use of local reference values representative of the target population&#44; selecting subjects in the same age group and race&#44; and using different equations for different age groups&#58; 3&#8211;6 years&#44; 6&#8211;7 to 18&#8211;19 years&#44; and adults&#46; The CANDELA equations are currently recommended for preschool children in Spain&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">12</span></a> After the age of 7&#44; other reference equations must be used&#44; usually those developed by Casan et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">26</span></a> but this can cause gaps and discontinuities in the values&#44; and may lead to misinterpretations&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">14</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">GLI-2012 equations<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">17</span></a> can continue to be used after 7 years of age and throughout adulthood&#46; It is important that the GLI-2012 equations continue to be validated in older children&#46; Since they were first published&#44; they have been validated in British children aged 5&#8211;11 years from different ethnic groups&#44;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">19</span></a> in a Caucasian population aged 4&#8211;80 years in Australia and New Zealand&#44;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">20</span></a> and in a Norwegian population aged 12&#8211;90 years&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">27</span></a> However&#44; in a German population aged 4&#8211;19 years&#44; a good fit was observed for children younger than 10 years&#44; but deviations were rather high for adolescent boys&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">28</span></a> Systematic deviations have also been observed in adults in studies conducted in Finland&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">29</span></a> This would suggest that the GLI-2012 equations may not be a perfect fit for some specific age ranges and certain populations&#46; For this reason&#44; validation studies should be performed before they are used systematically&#46; In our series&#44; we have seen that the GLI-2012 equations adapt better to our population than the CANDELA equations&#44; particularly in children aged 3&#8211;4 years&#44; in whom the CANDELA equations overestimate percentages of the predicted value&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">The advantage of the statistical approach used to develop the GLI-2012 equations is that it takes into account the wide variability that occurs with age&#44; which is greater in younger and in older individuals&#46; Results expressed as <span class="elsevierStyleItalic">z</span>-scores and the precise definition of lower limits of normal for each age range allows results to be better categorized&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">18</span></a> As our results show&#44; the FEVt&#47;FVC ratio &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41; is greater than in adults&#44; calling for equations that precisely define normal limits for each age group&#44; instead of using fixed limits such as 0&#46;7 that would lead to underdiagnosis&#44; since at these ages the lower limit of normal is higher&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Our study confirms that quality spirometry can be obtained in preschool children with no prior training&#46; The success rate &#40;81&#46;6&#37; for FEVt and 69&#46;5&#37; for FVC&#41; is similar to that of previous studies&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">30</span></a> The 2 parameters that the children achieved less frequently were a clearly defined PEF&#44; although this parameter is not considered essential for analyzing the data obtained&#44; and an adequate plateau&#46; Repeatability was also difficult to achieve&#44; and was lowest in 3-year-old children &#40;76&#37;&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">In our study&#44; we obtained a valid FEV<span class="elsevierStyleInf">1</span> in 67&#46;6&#37; of the children&#44; a valid FEV<span class="elsevierStyleInf">0&#46;75</span> in 78&#46;9&#37;&#44; and a valid FEV<span class="elsevierStyleInf">0&#46;5</span> in 81&#46;6&#37;&#46; These results are similar to those of Neve et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">31</span></a> who reported 69&#37;&#44; 82&#37;&#44; and 99&#37;&#44; and Santos et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">32</span></a> who reported 65&#37;&#44; 86&#37;&#44; and 88&#37;&#44; respectively&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">In preschool children aged 3&#8211;6 years&#44; the GLI group<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">33</span></a> recommends using FEV<span class="elsevierStyleInf">0&#46;75</span> only&#44; and this parameter was finally included in their calculations&#46; They recommend that practitioners reserve FEV<span class="elsevierStyleInf">0&#46;5</span> for infants and use FEV<span class="elsevierStyleInf">1</span> in children over 7 years of age&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">33</span></a> Due to changes in postnatal lung growth&#44; the airways are relatively large in relation to lung volume&#44; and infants expel air from the lungs during forced expiration in a very short time &#8722; less than 1 second &#8722; so FEV<span class="elsevierStyleInf">0&#46;5</span> would provide a good picture of central and peripheral airway function in children younger than 2 years&#46; In preschoolers&#44; air is expelled rather more slowly&#44; and lower lung volumes would be achieved somewhat later&#44; so FEV<span class="elsevierStyleInf">0&#46;75</span> may be more sensitive for reflecting changes in central and peripheral airways&#46; In contrast&#44; few children achieve FEV<span class="elsevierStyleInf">1</span>&#44; as occurred in our study&#44; and the FEV<span class="elsevierStyleInf">1</span> value is often very similar to that of FVC&#44; a fact that might limit its use in preschool children&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">33</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">The GLI developers also argue that FEV<span class="elsevierStyleInf">0&#46;5</span> is of less use than FEV<span class="elsevierStyleInf">0&#46;75</span> for discriminating between preschoolers with and without lung disease&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">33</span></a> However&#44; although some studies have shown that FEV<span class="elsevierStyleInf">0&#46;75</span> was more sensitive for identifying preschool children with lung disease than FEV<span class="elsevierStyleInf">0&#46;5</span>&#44; others have found that FEV<span class="elsevierStyleInf">0&#46;5</span> was useful for detecting lung disease&#44;<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">34</span></a> and it seems likely that this debate will continue&#46; For this reason&#44; we also validated the GLI-2012 equations for FEV<span class="elsevierStyleInf">1</span> and the All ages equations for FEV<span class="elsevierStyleInf">0&#46;5</span>&#44; which at the time of the study were available in the software tools published by these groups&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">One of the strengths of our study is that the inclusion criteria used allow our results to be extrapolated to the general population of children aged 3&#8211;6 years&#46; We did not exclude children with risk factors such as exposure to tobacco smoke&#44; pollution or a history of mild respiratory symptoms&#44; such a previous episode of bronchitis&#46; We did exclude children with more severe respiratory symptoms&#44; such as hospitalization for bronchitis or repeated episodes of bronchitis&#44; and children who had been born premature&#44; factors which would clearly affect the results&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">35</span></a> Other strengths include strict adherence to international quality criteria for the performance of spirometry in preschool children and an appropriate sample size&#46; One limitation of our study is the inclusion of Caucasian children and preschool children only&#44; which prevents validation of the GLI equations from being extrapolated to other races or ages&#46; While the equations show a very good fit for the overall population&#44; we observed small deviations in the analysis of age subgroups&#44; although the sample size had not been calculated for these subanalyses&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">In conclusion&#44; our study shows that the performance of valid spirometries meeting strict quality criteria is possible in preschool children&#46; The GLI-2012 and All ages equations &#40;for FEV<span class="elsevierStyleInf">0&#46;5</span>&#41; are appropriate for Spanish preschool children of Caucasian ethnicity&#44; so we recommend their use in this age group&#46; These equations must continue to be validated in other age groups and ethnic groups to endorse their widespread use&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Funding</span><p id="par0165" class="elsevierStylePara elsevierViewall">This study was conducted with the help of a grant from the Fundaci&#243; Catalana de Pneumologia &#40;<span class="elsevierStyleGrantSponsor" id="gs1">FUCAP</span>&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflict of Interest</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors state that they have no conflict of interests&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Recent publication of multi-ethnic spirometry reference equations for subjects aged from 3 to 95 years aim to avoid age-related discontinuities and provide a worldwide standard for interpreting spirometric test results&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objectives</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To assess the agreement of the Global Lung Function Initiative &#40;GLI-2012&#41; and All ages &#40;FEV<span class="elsevierStyleInf">0&#46;5</span>&#41; reference equations with the Spanish preschool lung function data&#46; To verify the appropriateness of these reference values for clinical use in Spanish preschool children&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Spirometric measurements were obtained from children aged 3&#8211;6 years attending 10 randomly selected schools in Barcelona &#40;Spain&#41;&#46; Stanojevic&#39;s quality control criteria were applied&#46; <span class="elsevierStyleItalic">z</span>-Scores were calculated for the spirometry outcomes based on the GLI equations&#46; If the <span class="elsevierStyleItalic">z</span>-score &#40;mean&#41; of each parameter was close to 0&#44; with a maximum difference of &#177;0&#46;5 from the mean and a standard deviation of 1&#44; the GLI-2012 equations would be applicable in our population&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Of 543 children recruited&#44; 405 &#40;74&#46;6&#37;&#41; were &#8216;healthy&#8217;&#44; and of these&#44; 380 were Caucasians&#46; Of these 380&#44; 81&#46;6&#37; &#40;169 females&#44; 141 males&#41; performed technically acceptable and reproducible maneuvers to assess FEVt&#44; and 69&#46;5&#37; achieved a clear end-expiratory plateau&#46; <span class="elsevierStyleItalic">z</span>-Scores for FVC&#44; FEV<span class="elsevierStyleInf">1</span>&#44; FEV<span class="elsevierStyleInf">1</span>&#47;FVC&#44; FEV<span class="elsevierStyleInf">0&#46;75</span>&#44; FEV<span class="elsevierStyleInf">0&#46;75</span>&#47;FVC&#44; FEV<span class="elsevierStyleInf">0&#46;5</span>&#44; FEF<span class="elsevierStyleInf">75</span> and FEF<span class="elsevierStyleInf">25&#8211;75</span> all fell within &#177;0&#46;5&#44; except for FEV<span class="elsevierStyleInf">1</span>&#47;FVC &#40;0&#46;53 <span class="elsevierStyleItalic">z</span>-scores&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">GLI equations are appropriate for Spanish preschool children&#46; These data provide further evidence to support widespread application of the GLI reference equations&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La publicaci&#243;n reciente de ecuaciones de referencia de espirometr&#237;a multi&#233;tnicas para edades de 3 a 95 a&#241;os tiene como objetivo evitar las discontinuidades relacionadas con la edad y proporcionar un est&#225;ndar mundial para la interpretaci&#243;n de los resultados de la espirometr&#237;a&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Validar las ecuaciones de la Global Lung Function Initiative &#40;GLI-2012&#41; y All ages &#40;FEV<span class="elsevierStyleInf">0&#44;5</span>&#41; en ni&#241;os preescolares espa&#241;oles&#44; para verificar la adecuaci&#243;n de estas ecuaciones para su uso cl&#237;nico&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se realizaron espirometr&#237;as forzadas en ni&#241;os de 3 a 6 a&#241;os de edad de 10 colegios seleccionados aleatoriamente en Barcelona &#40;Espa&#241;a&#41;&#46; Se aplicaron los criterios de control de calidad de Stanojevic et al&#46; Se calcul&#243; el z-score seg&#250;n las ecuaciones GLI-2012&#46; Se consider&#243; que para que las ecuaciones GLI-2012 pudieran ser aplicables en nuestra poblaci&#243;n&#44; la media expresada en z-score de cada par&#225;metro deb&#237;a de tener un valor pr&#243;ximo a 0 y una desviaci&#243;n est&#225;ndar &#40;DS&#41; de 1&#44; aceptando como m&#225;ximo una diferencia de &#177; 0&#44;5 z-scores respecto a la media&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">De los 543 ni&#241;os reclutados&#44; 405 &#40;74&#44;6&#37;&#41; eran &#171;sanos&#187;&#44; y de ellos 380 cauc&#225;sicos&#46; De estos&#44; 81&#44;6&#37; &#40;169 mujeres&#44; 141 hombres&#41; realizaron maniobras t&#233;cnicamente aceptables y reproducibles para evaluar la FEVt&#44; y el 69&#44;5&#37; logr&#243; una meseta espiratoria final adecuada&#46; Los z-scores para FVC&#44; FEV<span class="elsevierStyleInf">1</span>&#44; FEV<span class="elsevierStyleInf">1</span>&#47;FVC&#44; FEV<span class="elsevierStyleInf">0&#44;75</span>&#44; FEV<span class="elsevierStyleInf">0&#44;75</span>&#47;FVC&#44; FEV<span class="elsevierStyleInf">0&#44;5</span>&#44; FEF<span class="elsevierStyleInf">75</span> y FEF<span class="elsevierStyleInf">25-75</span> estuvieron incluidos entre &#177; 0&#44;5 z-scores&#44; salvo el FEV<span class="elsevierStyleInf">1</span>&#47;FVC &#40;0&#44;53 z-scores&#41;&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Las ecuaciones GLI son apropiadas para los ni&#241;os preescolares espa&#241;oles&#46; Estos datos proporcionan nuevas evidencias para apoyar su utilizaci&#243;n&#46;</p></span>"
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        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Mart&#237;n de Vicente C&#44; de Mir Messa I&#44; Rovira Amigo S&#44; Torrent Vernetta A&#44; Gartner S&#44; Iglesias Serrano I&#44; et al&#46; Validaci&#243;n de las ecuaciones de referencia de la Global Lung Function Iniciative y All ages para la espirometr&#237;a forzada en ni&#241;os sanos preescolares espa&#241;oles&#46; Arch Bronconeumol&#46; 2018&#59;54&#58;24&#8211;30&#46;</p>"
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            "apendice" => "<p id="par0185" class="elsevierStylePara elsevierViewall">The GLI-2012 equations and software tools for calculating values for individuals or data sets are available for consultation at the following links&#58; <span class="elsevierStyleInterRef" id="intr0010" href="http://www.lungfunction.org/">www&#46;lungfunction&#46;org</span> and <span class="elsevierStyleInterRef" id="intr0015" href="http://www.ers-education.org/guidelines/global-lung-function-initiative.aspx">http&#58;&#47;&#47;www&#46;ers-education&#46;org&#47;guidelines&#47;global-lung-function-initiative&#46;aspx</span>&#46;</p> <p id="par0190" class="elsevierStylePara elsevierViewall">The All ages equations for FEV<span class="elsevierStyleInf">0&#46;5</span> were consulted on <span class="elsevierStyleInterRef" id="intr0020" href="http://www.growinglungs.org.uk/">www&#46;growinglungs&#46;org&#46;uk</span> of the Asthma UK Spirometry Collaborative Group&#44; not currently available for consultation&#46; The equations&#44; in Excel nomenclature&#44; are as follows&#58;</p> <p id="par0195" class="elsevierStylePara elsevierViewall">FEV<span class="elsevierStyleInf">0&#46;5</span> males<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><p id="par0200" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">z</span>-Score FEV<span class="elsevierStyleInf">0&#46;5</span> males&#61;&#40;&#40;&#40;FEV<span class="elsevierStyleInf">0&#46;5</span> observed&#47;M&#41;&#8722;1&#41;&#47;S&#41;</p></li><li class="elsevierStyleListItem" id="lsti0010"><p id="par0205" class="elsevierStylePara elsevierViewall">M&#61;EXP&#40;&#8722;2&#46;048&#43;0&#46;0156&#42;height &#40;cm&#41;&#43;0&#46;049&#42;age &#40;years&#41;&#41;</p></li><li class="elsevierStyleListItem" id="lsti0015"><p id="par0210" class="elsevierStylePara elsevierViewall">S&#61;EXP&#40;&#8722;1&#46;847&#8722;0&#46;0005&#42;POWER &#40;age &#40;years&#41;&#59;3&#41;&#41;</p></li></ul></p> <p id="par0215" class="elsevierStylePara elsevierViewall">FEV<span class="elsevierStyleInf">0&#46;5</span> females<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><p id="par0220" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">z</span>-Score FEV<span class="elsevierStyleInf">0&#46;5</span> females&#61;&#40;&#40;&#40;FEV<span class="elsevierStyleInf">0&#46;5</span> observed&#47;M&#41;&#8722;1&#41;&#47;S&#41;</p></li><li class="elsevierStyleListItem" id="lsti0025"><p id="par0225" class="elsevierStylePara elsevierViewall">M&#61;EXP&#40;3&#46;927&#8722;42&#46;94&#42;POWER &#40;height &#40;cm&#41;&#59; &#8722;0&#46;5&#41;&#43;0&#46;000298&#42;POWER &#40;age &#40;years&#41;&#59;3&#41;&#41;</p></li><li class="elsevierStyleListItem" id="lsti0030"><p id="par0230" class="elsevierStylePara elsevierViewall">S&#61;EXP&#40;&#8722;1&#46;745&#8722;0&#46;004&#42;POWER &#40;age &#40;years&#41;&#59;2&#41;&#41;</p></li></ul></p>"
            "etiqueta" => "Appendix A"
            "identificador" => "sec0055"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">FEV<span class="elsevierStyleInf">0&#46;75</span>&#47;FVC values by age&#46; The solid line represents the regression line and the dashed line the 95&#37; confidence interval of the regression line&#46;</p>"
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Comparison between mean FVC&#44; FEV<span class="elsevierStyleInf">1</span>&#44; FEV<span class="elsevierStyleInf">0&#46;75</span>&#44; and FEF<span class="elsevierStyleInf">25&#37;&#8211;75&#37;</span>&#44; expressed as percentage predicted for age&#44; in our series&#44; using the GLI-2012&#44; All ages&#44; and CANDELA equations&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
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                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total Population &#40;<span class="elsevierStyleItalic">n</span>&#61;380&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">3 Years &#40;<span class="elsevierStyleItalic">n</span>&#61;65&#59; 17&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">4 Years &#40;<span class="elsevierStyleItalic">n</span>&#61;101&#59; 26&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">5 Years &#40;<span class="elsevierStyleItalic">n</span>&#61;118&#59; 31&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">6 Years &#40;<span class="elsevierStyleItalic">n</span>&#61;96&#59; 25&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sex&#44; M &#40;&#37;&#41;&#44; F &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 &#40;47&#46;7&#41;&#44; 34 &#40;52&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44 &#40;43&#46;6&#41;&#44; 57 &#40;56&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54 &#40;45&#46;8&#41;&#44; 64 &#40;54&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46 &#40;47&#46;9&#41;&#44; 50 &#40;52&#46;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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age &#40;years&#41;&#59; median &#40;range&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;21 &#40;3&#46;36&#8211;6&#46;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3&#46;73 &#40;3&#46;36&#8211;3&#46;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;48 &#40;4&#46;02&#8211;4&#46;96&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;55 &#40;5&#46;00&#8211;5&#46;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46;46 &#40;6&#46;00&#8211;6&#46;99&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Height &#40;cm&#41;&#59; median &#40;range&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">111&#46;9 &#40;92&#46;4&#8211;135&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">101&#46;3 &#40;92&#46;4&#8211;124&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">106&#46;3 &#40;96&#46;5&#8211;118&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">114&#46;4 &#40;102&#46;4&#8211;125&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">119&#46;9 &#40;105&#8211;135&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">z</span>-Score height&#59; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;14 &#40;0&#46;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;09 &#40;1&#46;06&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;06 &#40;0&#46;92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;24 &#40;0&#46;87&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;14 &#40;0&#46;99&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top">Weight &#40;kg&#41;&#59; median &#40;range&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">19&#46;80 &#40;13&#46;4&#8211;39&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46;6 &#40;13&#46;4&#8211;29&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&#46;2 &#40;14&#46;5&#8211;25&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20&#46;9 &#40;14&#46;7&#8211;37&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22&#46;5 &#40;15&#46;7&#8211;39&#46;9&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">z</span>-Score weight&#59; mean &#40;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;17 &#40;0&#46;91&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;26 &#40;0&#46;92&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;13 &#40;0&#46;85&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;25 &#40;0&#46;93&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;05 &#40;0&#46;97&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab1631694.png"
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Demographic Characteristics of the 380 Children Included in the Study&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">n</span>&#58; number of individuals&#59; SD&#58; standard deviation&#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="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total Population &#40;<span class="elsevierStyleItalic">n</span>&#61;380&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">3 Years &#40;<span class="elsevierStyleItalic">n</span>&#61;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">4 Years &#40;<span class="elsevierStyleItalic">n</span>&#61;101&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">5 Years &#40;<span class="elsevierStyleItalic">n</span>&#61;118&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">6 Years &#40;<span class="elsevierStyleItalic">n</span>&#61;96&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#40;1&#41; Rapid onset of expiration&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">366 &#40;96&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63 &#40;96&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97 &#40;96&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">116 &#40;98&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90 &#40;93&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;436&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#40;2&#41; Clearly defined PEF&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">286 &#40;75&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">48 &#40;73&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">71 &#40;70&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">88 &#40;74&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79 &#40;82&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;119&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#40;3&#41; Correct expiratory curve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">354 &#40;93&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">60 &#40;92&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92 &#40;91&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">109 &#40;92&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">93 &#40;96&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;186&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#40;4&#41; Repeatability&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">330 &#40;86&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50 &#40;76&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85 &#40;84&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">106 &#40;89&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89 &#40;92&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#40;5&#41; Expiratory plateau&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">313 &#40;82&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">50 &#40;76&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85 &#40;84&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100 &#40;84&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">78 &#40;81&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;587&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Acceptable maneuvers &#40;1&#41;&#43;&#40;3&#41;&#43;&#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">310 &#40;81&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49 &#40;75&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79 &#40;78&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100 &#40;84&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">82 &#40;85&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;054&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Acceptable maneuvers with plateau &#40;1&#41;&#43;&#40;3&#41;&#43;&#40;4&#41;&#43;&#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">264 &#40;69&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42 &#40;64&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">68 &#40;67&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">85 &#40;72&#46;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">69 &#40;71&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;247&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Comparison between different age groups&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Number of Children Achieving Correct Spirometric Maneuvers Meeting the Different Quality Criteria&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
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        "detalles" => array:1 [
          0 => array:3 [
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">FEV<span class="elsevierStyleInf">0&#46;5</span> calculated according to All ages equations&#46;</p><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">n</span>&#58; number of individuals&#59; SD&#58; standard deviation&#46;</p><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Data expressed as mean &#40;SD&#41;&#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="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total Population&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#37; Between &#177;2 <span class="elsevierStyleItalic">z</span>-scores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group Aged 3 Years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group Aged 4 Years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group Aged 5 Years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group Aged 6 Years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FVC <span class="elsevierStyleItalic">z</span>-score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;35 &#40;0&#46;98&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;264&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;27 &#40;0&#46;83&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;57 &#40;0&#46;99&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;39 &#40;1&#46;03&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;16 &#40;0&#46;97&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FEV<span class="elsevierStyleInf">1</span><span class="elsevierStyleItalic">z</span>-score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;02 &#40;0&#46;99&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;257&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;15 &#40;0&#46;85&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;26 &#40;1&#46;02&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;04 &#40;0&#46;95&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;31 &#40;0&#46;99&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FEV<span class="elsevierStyleInf">1</span>&#47;FVC <span class="elsevierStyleItalic">z</span>-score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;53 &#40;0&#46;72&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;228&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">100&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;21 &#40;0&#46;74&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;40 &#40;0&#46;59&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;58 &#40;0&#46;63&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;74 &#40;0&#46;81&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FEV<span class="elsevierStyleInf">0&#46;75</span><span class="elsevierStyleItalic">z</span>-score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;01 &#40;1&#46;00&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;300&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;15 &#40;0&#46;85&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;26 &#40;1&#46;03&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;04 &#40;0&#46;95&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;31 &#40;0&#46;99&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FEV<span class="elsevierStyleInf">0&#46;75</span>&#47;FVC <span class="elsevierStyleItalic">z</span>-score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;46 &#40;0&#46;85&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;259&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">96&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;08 &#40;0&#46;76&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;48 &#40;0&#46;74&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;51 &#40;0&#46;79&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;61 &#40;1&#46;04&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FEF<span class="elsevierStyleInf">25&#8211;75</span><span class="elsevierStyleItalic">z</span>-score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;04 &#40;0&#46;95&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;254&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;40 &#40;0&#46;98&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;09 &#40;0&#46;86&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;02 &#40;0&#46;81&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;17 &#40;1&#46;10&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FEF<span class="elsevierStyleInf">75</span><span class="elsevierStyleItalic">z</span>-score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;42 &#40;0&#46;99&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;253&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">96&#46;0&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;05 &#40;1&#46;3&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;54 &#40;0&#46;83&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;44 &#40;0&#46;85&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;48 &#40;1&#46;06&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FEV<span class="elsevierStyleInf">0&#46;5</span><span class="elsevierStyleItalic">z</span>-score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;14 &#40;0&#46;82&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;310&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">96&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;10 &#40;0&#46;84&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;17 &#40;0&#46;78&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;15 &#40;0&#46;77&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;13 &#40;0&#46;91&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;82&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">z</span>-Score Values of the Spirometric Variables Calculated According to GLI-2012 Equations by Total Population and Various Age Groups&#46;</p>"
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          "leyenda" => "<p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">FEV<span class="elsevierStyleInf">0&#46;5</span> calculated according to All ages equations&#46; Data expressed as mean &#40;SD&#41;&#46;</p><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">n</span>&#58; number of individuals&#59; SD&#58; standard deviation&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Males&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FVC <span class="elsevierStyleItalic">z</span>-score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;28 &#40;0&#46;99&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;117&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;42 &#40;0&#46;97&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;147&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FEV<span class="elsevierStyleInf">1</span><span class="elsevierStyleItalic">z</span>-score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;11 &#40;0&#46;96&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;118&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;06 &#40;1&#46;00&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;139&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FEV<span class="elsevierStyleInf">1</span>&#47;FVC <span class="elsevierStyleItalic">z</span>-score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;53 &#40;0&#46;67&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;101&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;52 &#40;0&#46;76&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;127&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FEV<span class="elsevierStyleInf">0&#46;75</span><span class="elsevierStyleItalic">z</span>-score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;07 &#40;1&#46;00&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;136&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;07 &#40;0&#46;99&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;164&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FEV<span class="elsevierStyleInf">0&#46;75</span>&#47;FVC <span class="elsevierStyleItalic">z</span>-score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;49 &#40;0&#46;82&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;114&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;43 &#40;0&#46;88&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;145&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;61&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FEF<span class="elsevierStyleInf">25&#8211;75</span><span class="elsevierStyleItalic">z</span>-score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;03 &#40;0&#46;90&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;112&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;10 &#40;0&#46;98&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;142&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FEF<span class="elsevierStyleInf">75</span><span class="elsevierStyleItalic">z</span>-score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;41 &#40;0&#46;92&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;112&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;42 &#40;1&#46;04&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;141&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">FEV<span class="elsevierStyleInf">0&#46;5</span><span class="elsevierStyleItalic">z</span>-score&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;0&#46;10 &#40;0&#46;84&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;141&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;17 &#40;0&#46;81&#41;&#44; <span class="elsevierStyleItalic">n</span>&#61;169&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;46&nbsp;\t\t\t\t\t\t\n
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        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0175" class="elsevierStylePara elsevierViewall">We would like to thank the principals and teachers of the participating schools for their help and for their collaboration in the recruitment of the children&#46; We also especially thank the parents and the children who participated in the study&#46;</p> <p id="par0180" class="elsevierStylePara elsevierViewall">We are especially grateful for the advice and guidance of Prof&#46; Janet Stocks in the design and conduct of the study&#46;</p>"
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