Migration Flow and Its Impact on Tuberculosis Notification in Portugal

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[ 0 => "ana.pgrdias@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Rita" "apellidos" => "Gaio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Pedro" "apellidos" => "Sousa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Marta" "apellidos" => "Gomes" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] 1 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 4 => array:3 [ "nombre" => "Olena" "apellidos" => "Oliveira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "Raquel" "apellidos" => "Duarte" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] 1 => array:2 [ "etiqueta" => "f" "identificador" => "aff0030" ] 2 => array:2 [ "etiqueta" => "g" "identificador" => "aff0035" ] ] ] ] "afiliaciones" => array:7 [ 0 => array:3 [ "entidad" => "Centro Hospitalar Lisboa Norte EPE, Departamento do Tórax, Lisboa, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Matemática, Universidade do Porto and Centro de Matemática da Universidade do Porto, Porto, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Unidade de Saúde Familiar, Saúde em Família, Agrupamento de Centros de Saúde do Grande Porto III, Maia/Valongo, Maia, Portugal" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Centro Hospitalar Vila Nova de Gaia/Espinho EPE, Departamento de Saúde Ocupacional, Vila Nova de Gaia, Portugal" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "ISPUP-EPIUnit, Universidade do Porto, Porto, Portugal" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Centro Hospitalar Vila Nova de Gaia/Espinho EPE, Departamento de Pneumologia, Vila Nova de Gaia, Portugal" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal" "etiqueta" => "g" "identificador" => "aff0035" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El flujo de migratorio y su impacto en la notificación de tuberculosis en Portugal" ] ] "textoCompleto" => "IntroductionSince WHO declared tuberculosis (TB) a global emergency, many efforts have been made worldwide to decrease TB incidence.<a class="elsevierStyleCrossRef" href="#bib0185">1</a> In Portugal, a TB National Programme was implemented in 1995 and in 2006 the “STOP TB strategy” was launched to delineate specific goals and strengthen the struggle towards the end of TB.<a class="elsevierStyleCrossRefs" href="#bib0190">2,3</a>Eight years later, in 2014, Portugal reached the threshold of low incidence, registering 20 new cases per 100000 inhabitants.<a class="elsevierStyleCrossRef" href="#bib0200">4</a> Despite this, it remains the highest incidence country in the Western Europe and some areas still have an intermediate incidence. Lisbon and Oporto are the districts with the highest incidence.<a class="elsevierStyleCrossRefs" href="#bib0200">4,5</a>Homeless people, drug users, prisoners and migrants are at increased risk of developing TB. These groups concentrate in urban settings and their numbers tend to have an impact on TB.<a class="elsevierStyleCrossRefs" href="#bib0210">6-10</a> This work concentrates solely on the migrant movements’ effect on TB. In fact, in many European countries, most cases of tuberculosis occur within the immigrant population. About 26.8% of TB cases reported in the European Union (EU) and European Economic Area countries are of foreign origin.<a class="elsevierStyleCrossRef" href="#bib0205">5</a> Therefore, migrants from high incidence countries have a considerable impact on the tuberculosis burden in low incidence countries.<a class="elsevierStyleCrossRefs" href="#bib0205">5,10</a> Increased risk of TB in this group might be related to higher exposure in the country of origin and/or worse socioeconomic conditions, comparing to the resident population.<a class="elsevierStyleCrossRef" href="#bib0235">11</a>As opposed to other European countries, like Iceland, Cyprus, Norway or Sweden, where more than 70% of tuberculosis cases occur in foreign born individuals, in Portugal, this group represents only about 16% of cases.<a class="elsevierStyleCrossRefs" href="#bib0210">6,10,12</a> Nevertheless, TB incidence among immigrants in Portugal is much higher than in non-immigrants and it has been increasing.<a class="elsevierStyleCrossRef" href="#bib0245">13</a>As a consequence of the economic crisis, in the last few years, an increasing number of individuals have left the country to live abroad. Portugal is the EU country with the largest number of emigrants per capita.<a class="elsevierStyleCrossRef" href="#bib0250">14</a> In 2014, the number of emigrants had risen to the double, compared to 2008. The majority are young adults, aged 20–44 years old, that left Portugal seeking for better working and living conditions abroad.<a class="elsevierStyleCrossRefs" href="#bib0255">15,16</a> This age group overlaps with the one most affected by TB, between 25 and 54 years old.<a class="elsevierStyleCrossRef" href="#bib0200">4</a>The main aim of this study is to describe the decrease in TB in Portugal over the last years purely from a demographical point of view. As such, the authors quantify the effect of the migration movements (immigration and emigration) on the TB notification in Portugal (from 2008 to 2014).MethodsData and SourcesData on tuberculosis notification were collected from the Portuguese Tuberculosis Surveillance System (SVIG-TB) coordinated by the Directorate General of Health (DGH) during the seven year period ranging from 2008 to 2014. Data on migration movements for the period of study (2008-2014) were collected from Immigration and Borders Service Statistics and Statistics Portugal, the public Portuguese entity responsible for the official statistical information and included: 1) the absolute number of resident immigrants in each year; 2) the absolute number of immigrants entering the country per year; 3) the absolute number of emigrants per year; 4) the migration balance, which refers to the difference between the number of individuals entering and leaving the country, per year.For the purpose of this paper, TB cases with no information on the country of origin were excluded from the analysis.As this was a retrospective study and used routinely collected surveillance data, neither ethical approval nor informed consent were required.Mathematical AnalysisThe impact of the migration movements on the TB burden was initially addressed separately for immigration and emigration, and simultaneously afterwards. The separate analysis allowed for the study of the influence of each migration phenomenon in isolation.Firstly, the expected number of TB cases per 100000 inhabitants for year t (2008, 2009, …, 2014) under a steady situation of immigration (i.e., keeping both the number of immigrants and the number of TB-cases among immigrants at their 2008 values) was computed by:<elsevierMultimedia ident="eq0005"></elsevierMultimedia>Here, TBNI(t) denotes the number of TB-cases within the non-immigrant resident population in year t, TBI(t0) denotes the number of TB-cases within the immigrant population in t0=2008, and P(t) (resp. E(t), I(t0)) represents the number of Portuguese individuals (resp. emigrants, immigrants) in year t (resp. t, t0). Clearly, P(t)−E(t)+I(t0) corresponds to the total number of individuals resident in Portugal in year t.Then, for each year, the expected number was compared with the observed number of TB-cases (including different annual counts for the number of immigrants and TB-cases among immigrants). The magnitude of the differences allowed for the evaluation of the impact of the immigration process on the TB incidence.The model evaluating the impact of the emigration on TB in Portugal followed a similar reasoning; keeping both the number of emigrants and the number of TB-cases among emigrants at its 2008 value, the expected number of TB cases for year t per 100000 inhabitants was calculated by<elsevierMultimedia ident="eq0010"></elsevierMultimedia>where the number of TB-cases among emigrants in year t, TBE(t), assumed the same per-capita rate as TBNI(t), namely<elsevierMultimedia ident="eq0015"></elsevierMultimedia>Indeed, had the TB-emigrants in year t stayed in the country and the difference TBE(t)−TBE(t0) would have been accounted for in the total number of cases within national territory. The magnitude of the differences between observed and expected counts allowed for the evaluation of the impact of the emigration process on the TB incidence.The study of the simultaneous effect of immigration and emigration combined the previous two equations. Under a steady scenario of immigration and emigration, the expected number of TB cases for year t per 100000 inhabitants would be<elsevierMultimedia ident="eq0020"></elsevierMultimedia>Finally, the relative annual fluctuations observed within the total number of Portuguese residents were compared with the relative annual decreases in the number of TB-cases. For each variable, the relative annual fluctuation between year t+1 and year t was computed as<elsevierMultimedia ident="eq0025"></elsevierMultimedia>ResultsFrom 2009 to 2013 there was a steady annual increase in the number of emigrants and essentially a decrease in the number of immigrants. The years 2008 and 2014 have slightly contradicted this trend.Until 2010, the number of immigrants per year was higher than the number of emigrants. From 2011 to 2014, there was an inversion in the migration flow, and the number of emigrants exceeded the number of immigrants, thus turning the migration balance negative (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>The number of TB cases has been consistently decreasing since 2008. Cases occurring in immigrants represented 13.8% of all cases in 2008, 15.2% in 2009 and remained stable at about 16% since 2010. Immigrants have a much higher notification rate of TB than the Portuguese individuals (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Similar to the TB notification rate, the total resident population in Portugal, has essentially decreased over 2008–2014 (with the exception of a slight increase from 2008 to 2009). However, the relative annual decrease on the number of residents was lower than the decrease on the TB numbers (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>As shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>, from 2008 to 2014 there were relatively few immigrants entering Portugal. Fixing both the immigration rate and the TB rate among immigrants at their 2008 values, and considering the variation on emigration that has actually occurred, we’ve estimated the number of TB cases per 100000 inhabitants for each studied year (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>). The differences between the observed and the estimated numbers were residual, ranging from more 0.27 cases/100000 inhabitants in 2010 to less 0.49 cases/100000 inhabitants in 2014.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>On the other hand, emigration rose significantly during the period of study (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), which could have influenced the TB rate in the country to go lower.The official number of TB cases in emigrants leaving the country in 2008 was 4.87/100000 inhabitants. Assuming that this rate remained constant along 2008–2014 and that the total number of emigrants did not change either along that period, we estimated annual numbers for TB in Portugal. The observed numbers were only slightly higher than their estimates. The differences were even smaller than those found for the immigration impact (<0.1 cases/100000 inhabitants) (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>).<elsevierMultimedia ident="tbl0025"></elsevierMultimedia>When looking at both migration movements at the same time, the observed TB rate was again identical to the estimated TB rate (differences between less 0.43 cases/100000 inhabitants in 2014 and more 0.28 cases/100000 inhabitants in 2010) (<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>).<elsevierMultimedia ident="tbl0030"></elsevierMultimedia>DiscussionThe number of TB cases has been decreasing in Portugal (notification rate was 27.8/100000 inhabitants in 2008 vs 21.8 cases/100000 inhabitants in 2014). Since 2009, the resident population has also been decreasing, but at a slower pace, as shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>. As for that, the decreasing number of TB cases cannot only be due to the reduction in the resident population.Between 2008 and 2010, the number of immigrants exceeded the number of emigrants (positive migration balance). Since 2011 until 2014, migration balance turned negative. Moreover, TB rate has been consistently higher among immigrants compared to the native population (>90 cases/100000 inhabitants vs 18.3–23.9 cases/100000 inhabitants). The percentage of TB cases in this group has risen from 13.2% in 2008 to 15.2% in 2009 and remained at about 16% since 2010. This model allowed us to evaluate the impact of the immigration on the TB rate. It showed that, since 2011, as immigration is decreasing, there is a tendency to a lower number of TB cases. However, the differences are very small, representing less than 1 case per 100000 inhabitants, so the impact does not seem to be significant.A decrease in TB incidence has been the trend in the whole WHO European Region over the last years, where it has fallen by 5.2% each year, since 2005.<a class="elsevierStyleCrossRef" href="#bib0205">5</a>Efforts have been made to achieve lower TB rates in Europe, even in low incidence countries. Out of 31 low incidence countries evaluated, more than half (54.8%) reported to have a dedicated national TB programme.<a class="elsevierStyleCrossRef" href="#bib0265">17</a>Despite this global trend and even though we failed to demonstrate a significant impact of the immigration global decrease on TB rate, immigrants are still a risk group as in many of their origin countries, infectious diseases, such as TB, are still an important cause of death and morbidity.<a class="elsevierStyleCrossRef" href="#bib0270">18</a>In low incidence countries, the impact of immigration on the burden of TB has been largely studied.<a class="elsevierStyleCrossRefs" href="#bib0230">10,19-21</a> Addressing risk groups is one of the key strategies against TB.<a class="elsevierStyleCrossRefs" href="#bib0220">8,22</a>In the recently published action framework of the WHO towards TB elimination in low incidence countries<a class="elsevierStyleCrossRef" href="#bib0295">23</a> strategies involving migrants are mentioned in three of the eight priority action areas: 1) to address the most vulnerable and hard-to-reach groups; 2) to address special needs of migrants and crossborder issues and 3) to undertake screening for active TB and latent tuberculosis infection (LTBI) in TB contacts and selected high-risk groups, and provide appropriate treatment.Many efforts have been made to detect TB and LTBI among migrants.<a class="elsevierStyleCrossRef" href="#bib0240">12</a> Some EU countries have implemented screening of migrants before, or at entry.<a class="elsevierStyleCrossRef" href="#bib0300">24</a> Underwood et al. compared contact tracing with new entrant screening in London and found the former to be more effective, as it identifies families and communities at high risk.<a class="elsevierStyleCrossRef" href="#bib0285">21</a> With the recent increase in the number of immigrants coming to Europe as refugees (rising from about 219000 in 2014 to more than one million in 2015), TB control in this group is also a concern.<a class="elsevierStyleCrossRefs" href="#bib0305">25,26</a> Regarding this matter, the ERS/WHO European Region has performed a study in order to document the policies and practices of low and intermediate TB incidence European countries with regards to detection and management of TB and latent TB infection among this vulnerable group.<a class="elsevierStyleCrossRef" href="#bib0310">26</a>In countries where most cases of TB occur in foreign born individuals or where incidence in this group is increasing, despite a decreasing TB rate, as it occurs in Portugal, policies on this subject are of great importance.As for the emigration increase over the period of study, our model showed very little differences between the number of observed and expected cases (<0.1 cases/100000 inhabitants each year). The fact that the differences between observed and expected cases were smaller than those found for the immigration impact can mean that the increase in emigration that we observed over 2008–2014 has not significantly impact the national TB rate.We assumed the TB rate in emigrants to be similar to the TB rate in the Portuguese individuals that stayed in the country. However, we do not know if these individuals had other risk factors for TB or if they became more vulnerable for TB when they moved abroad.Torres Redondo et al.<a class="elsevierStyleCrossRef" href="#bib0315">27</a> retrospectively analyzed the Portuguese emigrants diagnosed with TB when returning to the country, in the Northern Region in 2014. Most cases (76.3%) had moved to low TB incidence countries and had lived there for more than 2 years (median time of 42.0 months), which could suggest that exposure to TB could have already occurred in the foreign country. About 67% shared housing with work colleagues. These data suggest that risk for TB might increase when emigrants leave the country as they might experience harder living conditions and economic adversity. Nevertheless, had they stayed in the country they might have been unemployed which also accounts as a risk factor for TB.<a class="elsevierStyleCrossRef" href="#bib0320">28</a>Despite the lack of knowledge about this group, our model failed to demonstrate an impact of emigration on TB notification rate.Individually, the migration movements did not influence TB rate when analyzed by our model, so we tried to look at the impact of both movement altogether. Differences were again very small (<0.5 cases/100000 inhabits each year), so, even when combined, migration movements do not seem to largely influence TB notification rate.This might mean that we have to concentrate our efforts in other risk factors. Sousa et al.<a class="elsevierStyleCrossRef" href="#bib0320">28</a> recently found HIV to be the factor with this highest impact: an increase of 10 HIV notifications per 100000 inhabitants was associated with a rise of 2 new TB cases per 100000 inhabitants. Also, an increase of 1000 unemployed subjects per 100000 inhabitants was associated with one new case of TB per 100000 inhabitants.Apart from HIV infection, poor living and working conditions, which can facilitate TB transmission and risk factors that impair host's defense, like malnutrition, smoking, diabetes, alcohol abuse and indoor air pollution have been pointed out as major determinants.<a class="elsevierStyleCrossRefs" href="#bib0325">29-32</a>Silicosis also increases the risk of TB by 2.8–39 times.<a class="elsevierStyleCrossRefs" href="#bib0345">33,34</a> Silico-TB can be a challenging diagnosis and treatment must be longer.<a class="elsevierStyleCrossRef" href="#bib0355">35</a>Preventive strategies that target these factors might have an important impact on TB burden.These risk factors also add to the risk for TB in the migrant population. Paulino et al.<a class="elsevierStyleCrossRef" href="#bib0245">13</a> found that foreign born patients were more likely to be HIV positive, to be employed, homeless or live in shelters. Reducing HIV infection and providing better living conditions might have an even greater impact on TB among migrants. A study performed in Italy by Ingrosso et al. also showed that HIV infection is three times more frequent in foreign born people affected by TB than among Italians.<a class="elsevierStyleCrossRef" href="#bib0360">36</a>Altogether, these factors represent areas of intervention towards TB elimination and should all be addressed in national and international TB programmes.<a class="elsevierStyleCrossRef" href="#bib0295">23</a>In this work, the authors tried to understand the impact of two demographic factors – the migration movements and the decrease in the total number of residents – on the burden of TB in Portugal over the 7-year period 2008–2014. As such, other risk factors such as HIV infection, homelessness or overcrowded housing were assumed to remain constant over that period.In conclusion, the changing pattern of migration in Portugal over the period of study (2008–2014) does not seem to have had a significant impact on the TB notification rate.AuthorshipAll authors contributed to drafting and review of the manuscript.Conflict of InterestThe authors declare to have no conflict of interest directly or indirectly related to the manuscript contents." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres963152" "titulo" => "Abstract" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Discussion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec933473" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres963151" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Discusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec933472" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Data and Sources" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Mathematical Analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0035" "titulo" => "Authorship" ] 9 => array:2 [ "identificador" => "sec0040" "titulo" => "Conflict of Interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-07-05" "fechaAceptado" => "2017-07-26" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec933473" "palabras" => array:3 [ 0 => "Emigration" 1 => "Immigration" 2 => "Tuberculosis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec933472" "palabras" => array:3 [ 0 => "Emigración" 1 => "Inmigración" 2 => "Tuberculosis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "IntroductionTuberculosis notification in Portugal has decreased in the last few years. As a consequence of the economic crisis, emigration has increased and immigration has decreased. Immigrants are a risk group for tuberculosis. Most emigrants are 20–44 years old and belong to the age group most affected by tuberculosis. ObjectiveTo describe the decrease in tuberculosis notification in Portugal over the last years from a demographical point of view. MethodsMathematical analysis was performed to quantify the effect of the migration movements (separately and simultaneously) on tuberculosis notification in Portugal from 2008 to 2014. We calculated the estimated tuberculosis notification for each year during the period of study: 1) fixing immigration rate and tuberculosis rate in immigrants at 2008 values; 2) fixing emigration rate and tuberculosis rate in emigrants at 2008 values; 3) fixing both phenomenons at 2008 values. ResultsThe differences between the observed and the estimated numbers were small (≤0.5 cases/100000 inhabitants). DiscussionImpact of the migration movements on tuberculosis notification rate does not seem to be significant when analyzed for each phenomenon individually and simultaneously, by our model. This might mean that we have to concentrate our efforts in other risk factors for tuberculosis." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Objective" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "abst0025" "titulo" => "Discussion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónLa notificación de casos de tuberculosis en Portugal ha disminuido en los últimos años. Como consecuencia de la crisis económica, la emigración ha aumentado y la inmigración ha disminuido. Los inmigrantes son un grupo de riesgo para la tuberculosis. La mayoría de los emigrantes tienen entre 20 y 44 años y pertenecen al grupo de edad más afectado por la tuberculosis. ObjetivoDescribir la disminución de la notificación de casos tuberculosis en Portugal en los últimos años, desde un punto de vista demográfico. MétodosSe realizó un análisis matemático para cuantificar el efecto de los movimientos migratorios (por separado y simultáneamente) en la notificación de casos de tuberculosis en Portugal de 2008 a 2014. Se calculó la notificación de casos de tuberculosis estimada para cada año durante el período de estudio.La notificación estimada de tuberculosis para cada año del periodo de estudio se calculó: 1) fijando las tasas de inmigración y de tuberculosis en inmigrantes con datos del año 2008; 2) fijando las tasas de emigración y de tuberculosis en emigrantes con datos del año 2008, y 3) fijando ambos fenómenos con datos del año 2008. ResultadosLas diferencias entre los valores observados y los valores estimados fueron pequeñas (≤ 0,5 casos/100.000 habitantes). DiscusiónSegún el modelo matemático propuesto en este trabajo, el impacto de los movimientos migratorios en la tasa de notificación de casos de tuberculosis en Portugal no parece ser significativo cuando se analiza cada fenómeno tanto individual como simultáneamente. Estos datos indicarían que deberíamos concentrar los esfuerzos en identificar otros factores de riesgo para la tuberculosis." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0030" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0035" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0040" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0045" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0050" "titulo" => "Discusión" ] ] ] ] "multimedia" => array:11 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "M: male; F: female." "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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Year \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 resident population N \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">Resident inmigrants N \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">Emigrants N \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">Immigrants<a class="elsevierStyleCrossRef" href="#tblfn0045">a</a> N \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">Migration balance<a class="elsevierStyleCrossRef" href="#tblfn0005">b</a> \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">Portuguese individuals<a class="elsevierStyleCrossRef" href="#tblfn0010">c</a> N \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2008 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10563014 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">440277 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20357 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29718 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9361 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10553653 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10573479 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">454191 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16899 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32307 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15408 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10558071 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10572721 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">445262 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23760 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27575 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3815 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10568906 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10542398 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">436822 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">43998 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19667 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−24331 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10566729 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10487289 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">417042 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51958 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">14606 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−37352 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10524641 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10427301 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">401320 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53786 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17554 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−36232 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10463533 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2014 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10374822 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">395195 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49572 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19516 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−30056 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10404878 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1631690.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0045" "etiqueta" => "a" "nota" => "Immigrants entering the country each year." ] 1 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "b" "nota" => "Migration balance: immigrants−emigrants." ] 2 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "c" "nota" => "Portuguese individuals=total resident population+emigrants−immigrants." ] ] ] "descripcion" => array:1 [ "en" => "Migration Movements." ] ] 1 => 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" ] ] "tabla" => array:3 [ "leyenda" => "M: male; F: female; TB: tuberculosis." "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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Year \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">TB cases<a class="elsevierStyleCrossRef" href="#tblfn0015">a</a> N \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">TB rate<a class="elsevierStyleCrossRef" href="#tblfn0020">b</a> \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">TBPI<a class="elsevierStyleCrossRef" href="#tblfn0025">c</a> N \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">TBPI rate<a class="elsevierStyleCrossRef" href="#tblfn0030">d</a> \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">TBI<a class="elsevierStyleCrossRef" href="#tblfn0035">e</a> N \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">% TBI \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">TBI rate<a class="elsevierStyleCrossRef" href="#tblfn0040">f</a> \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">TB cases missing origin N (%) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2008 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2967 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2523 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">410 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">93.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34 (1.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2869 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2432 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">437 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">96.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 (0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2714 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2273 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">438 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">98.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (0.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2609 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2203 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">404 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">92.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (0.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2606 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2176 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">408 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (0.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2399 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1989 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">19.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">393 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">97.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2014 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2264 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1904 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">18.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">357 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (0.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1631689.png" ] ] ] "notaPie" => array:6 [ 0 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "a" "nota" => "As documented in SVIG-TB; includes the cases for which the country of origin is missing." ] 1 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "b" "nota" => "TB rate: TB cases (excluding TB cases with missing origin) per 100000 inhabitants." ] 2 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "c" "nota" => "TBPI: TB cases in Portuguese individuals=TB cases−TB cases in immigrants−TB cases with missing origin." ] 3 => array:3 [ "identificador" => "tblfn0030" "etiqueta" => "d" "nota" => "TBPI rate: TBPI cases per 100000 inhabitants." ] 4 => array:3 [ "identificador" => "tblfn0035" "etiqueta" => "e" "nota" => "TBI: TB cases in immigrants." ] 5 => array:3 [ "identificador" => "tblfn0040" "etiqueta" => "f" "nota" => "TBI rate: TBI cases per 100000 resident immigrants." ] ] ] "descripcion" => array:1 [ "en" => "Tuberculosis Numbers." ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Period \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">Resident population decrease \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">Tuberculosis cases decrease \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2008–2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2009–2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2010–2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.04 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2011–2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2012–2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.08 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2013–2014 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.01 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">−0.06 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1631692.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Variation of the Total Number of Residents and TB Notification Rate." ] ] 3 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "O: observed; E: expected." "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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Year \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">Observed number of TB cases per 100000 in inhabitants (O) \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">Expected TB cases per 100000 inhabitants (E) \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">O−E \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2008 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26.89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25.37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.27 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24.76 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.03 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24.62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22.98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.14 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2014 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22.28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.49 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1631687.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Differences Between Observed and Estimated Numbers of TB Cases When Evaluating the Impact of the Immigration on the TB Notification Rate." ] ] 4 => array:8 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at5" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "O: observed; E: estimated." "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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Year \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">Observed number of TB cases per 100000 in inhabitants (O) \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">Estimated TB cases per 100000 inhabitants (E) \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">O−E \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2008 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">27.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25.64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.00 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24.71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24.62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22.82 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2014 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21.77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1631691.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Differences Between Observed and Estimated Numbers of TB Cases When Evaluating the Impact of the Emigration on the TB Notification Rate." ] ] 5 => array:8 [ "identificador" => "tbl0030" "etiqueta" => "Table 6" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at6" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "O: observed; E: estimated." "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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Year \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">Observed number of TB cases per 100000 in inhabitants (O) \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">Estimated TB cases per 100000 inhabitants (E) \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">O−E \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2008 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.77 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NA \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2009 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">26.89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.24 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">25.36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.28 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24.71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">24.55 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.08 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2013 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22.84 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22.91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.07 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2014 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21.79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22.22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−0.43 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1631688.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Differences Between Observed and Estimated Numbers of TB Cases When Evaluating Simultaneously the Impact of Immigration and Emigration on the TB Notification Rate." ] ] 6 => array:5 [ "identificador" => "eq0005" "tipo" => "MULTIMEDIAFORMULA" "mostrarFloat" => false "mostrarDisplay" => true "Formula" => array:5 [ "Matematica" => "Expected TB cases (t)=TBNI(t)+TBI(t0)P(t)−E(t)+I(t0)×100 000." "Fichero" => "STRIPIN_si1.jpeg" "Tamanyo" => 4451 "Alto" => 35 "Ancho" => 354 ] ] 7 => array:5 [ "identificador" => "eq0010" "tipo" => "MULTIMEDIAFORMULA" "mostrarFloat" => false "mostrarDisplay" => true "Formula" => array:5 [ "Matematica" => "Expected TB cases (t)=TBNI(t)+(TBE(t)−TBE(t0))+TBI(t)P(t)−E(t0)+I(t)×100 000" "Fichero" => "STRIPIN_si2.jpeg" "Tamanyo" => 5684 "Alto" => 35 "Ancho" => 468 ] ] 8 => array:5 [ "identificador" => "eq0015" "tipo" => "MULTIMEDIAFORMULA" "mostrarFloat" => false "mostrarDisplay" => true "Formula" => array:5 [ "Matematica" => "TBE(t) = E(t) × TBNI(t)P(t) − E(t)." "Fichero" => "STRIPIN_si3.jpeg" "Tamanyo" => 2400 "Alto" => 35 "Ancho" => 198 ] ] 9 => array:5 [ "identificador" => "eq0020" "tipo" => "MULTIMEDIAFORMULA" "mostrarFloat" => false "mostrarDisplay" => true "Formula" => array:5 [ "Matematica" => "Expected TB cases (t)=TBNI(t)+(TBE(t)−TBE(t0))+TBI(t0)P(t)−E(t0)+I(t0)×100 000." "Fichero" => "STRIPIN_si4.jpeg" "Tamanyo" => 6007 "Alto" => 35 "Ancho" => 478 ] ] 10 => array:5 [ "identificador" => "eq0025" "tipo" => "MULTIMEDIAFORMULA" "mostrarFloat" => false "mostrarDisplay" => true "Formula" => array:5 [ "Matematica" => "Number(t+1) − Number(t)Number(t)." "Fichero" => "STRIPIN_si5.jpeg" "Tamanyo" => 2818 "Alto" => 35 "Ancho" => 201 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:36 [ 0 => array:3 [ "identificador" => "bib0185" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "WHO declares tuberculosis a global emergency" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "World Health Organization" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Sozial-und Präventivmedizin" "fecha" => "1993" "volumen" => "38" "paginaInicial" => "251" "paginaFinal" => "252" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8212917" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0190" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Programa Nacional de Luta contra a Tuberculose" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Direcção Geral da Saúde" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "1995" "editorial" => "Ministério da Saúde, Comissão Nacional de Luta contra a Tuberculose" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0195" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "http://www.who.int/tb/publications/2006/stoptb_strategy_por.pdf [last accessed 25.09.16]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A estratégia stop TB" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Organização Mundial de Saúde" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2006" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0200" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "www.dgs.pt [last accessed 25.09.16]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Direcção Geral da Saúde. 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Original Article

Migration Flow and Its Impact on Tuberculosis Notification in Portugal

El flujo de migratorio y su impacto en la notificación de tuberculosis en Portugal

Ana Diasa,

Corresponding author

ana.pgrdias@gmail.com

Corresponding author.

, Rita Gaiob, Pedro Sousac, Marta Gomesd,e, Olena Oliveirae, Raquel Duartee,f,g

a Centro Hospitalar Lisboa Norte EPE, Departamento do Tórax, Lisboa, Portugal

b Departamento de Matemática, Universidade do Porto and Centro de Matemática da Universidade do Porto, Porto, Portugal

c Unidade de Saúde Familiar, Saúde em Família, Agrupamento de Centros de Saúde do Grande Porto III, Maia/Valongo, Maia, Portugal

d Centro Hospitalar Vila Nova de Gaia/Espinho EPE, Departamento de Saúde Ocupacional, Vila Nova de Gaia, Portugal

e ISPUP-EPIUnit, Universidade do Porto, Porto, Portugal

f Centro Hospitalar Vila Nova de Gaia/Espinho EPE, Departamento de Pneumologia, Vila Nova de Gaia, Portugal

g Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal

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            "entidad" => "Centro Hospitalar Lisboa Norte EPE&#44; Departamento do T&#243;rax&#44; Lisboa&#44; Portugal"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Departamento de Matem&#225;tica&#44; Universidade do Porto and Centro de Matem&#225;tica da Universidade do Porto&#44; Porto&#44; Portugal"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Unidade de Sa&#250;de Familiar&#44; Sa&#250;de em Fam&#237;lia&#44; Agrupamento de Centros de Sa&#250;de do Grande Porto III&#44; Maia&#47;Valongo&#44; Maia&#44; Portugal"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Centro Hospitalar Vila Nova de Gaia&#47;Espinho EPE&#44; Departamento de Sa&#250;de Ocupacional&#44; Vila Nova de Gaia&#44; Portugal"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "ISPUP-EPIUnit&#44; Universidade do Porto&#44; Porto&#44; Portugal"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
          5 => array:3 [
            "entidad" => "Centro Hospitalar Vila Nova de Gaia&#47;Espinho EPE&#44; Departamento de Pneumologia&#44; Vila Nova de Gaia&#44; Portugal"
            "etiqueta" => "f"
            "identificador" => "aff0030"
          ]
          6 => array:3 [
            "entidad" => "Departamento de Ci&#234;ncias da Sa&#250;de P&#250;blica e Forenses e Educa&#231;&#227;o M&#233;dica&#44; Faculdade de Medicina&#44; Universidade do Porto&#44; Porto&#44; Portugal"
            "etiqueta" => "g"
            "identificador" => "aff0035"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "El flujo de migratorio y su impacto en la notificaci&#243;n de tuberculosis en Portugal"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Since WHO declared tuberculosis &#40;TB&#41; a global emergency&#44; many efforts have been made worldwide to decrease TB incidence&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">1</span></a> In Portugal&#44; a TB National Programme was implemented in 1995 and in 2006 the &#8220;STOP TB strategy&#8221; was launched to delineate specific goals and strengthen the struggle towards the end of TB&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Eight years later&#44; in 2014&#44; Portugal reached the threshold of low incidence&#44; registering 20 new cases per 100<span class="elsevierStyleHsp" style=""></span>000 inhabitants&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">4</span></a> Despite this&#44; it remains the highest incidence country in the Western Europe and some areas still have an intermediate incidence&#46; Lisbon and Oporto are the districts with the highest incidence&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Homeless people&#44; drug users&#44; prisoners and migrants are at increased risk of developing TB&#46; These groups concentrate in urban settings and their numbers tend to have an impact on TB&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">6-10</span></a> This work concentrates solely on the migrant movements&#8217; effect on TB&#46; In fact&#44; in many European countries&#44; most cases of tuberculosis occur within the immigrant population&#46; About 26&#46;8&#37; of TB cases reported in the European Union &#40;EU&#41; and European Economic Area countries are of foreign origin&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">5</span></a> Therefore&#44; migrants from high incidence countries have a considerable impact on the tuberculosis burden in low incidence countries&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">5&#44;10</span></a> Increased risk of TB in this group might be related to higher exposure in the country of origin and&#47;or worse socioeconomic conditions&#44; comparing to the resident population&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">11</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">As opposed to other European countries&#44; like Iceland&#44; Cyprus&#44; Norway or Sweden&#44; where more than 70&#37; of tuberculosis cases occur in foreign born individuals&#44; in Portugal&#44; this group represents only about 16&#37; of cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">6&#44;10&#44;12</span></a> Nevertheless&#44; TB incidence among immigrants in Portugal is much higher than in non-immigrants and it has been increasing&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">13</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">As a consequence of the economic crisis&#44; in the last few years&#44; an increasing number of individuals have left the country to live abroad&#46; Portugal is the EU country with the largest number of emigrants per capita&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">14</span></a> In 2014&#44; the number of emigrants had risen to the double&#44; compared to 2008&#46; The majority are young adults&#44; aged 20&#8211;44 years old&#44; that left Portugal seeking for better working and living conditions abroad&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">15&#44;16</span></a> This age group overlaps with the one most affected by TB&#44; between 25 and 54 years old&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The main aim of this study is to describe the decrease in TB in Portugal over the last years purely from a demographical point of view&#46; As such&#44; the authors quantify the effect of the migration movements &#40;immigration and emigration&#41; on the TB notification in Portugal &#40;from 2008 to 2014&#41;&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Data and Sources</span><p id="par0040" class="elsevierStylePara elsevierViewall">Data on tuberculosis notification were collected from the Portuguese Tuberculosis Surveillance System &#40;SVIG-TB&#41; coordinated by the Directorate General of Health &#40;DGH&#41; during the seven year period ranging from 2008 to 2014&#46; Data on migration movements for the period of study &#40;2008-2014&#41; were collected from Immigration and Borders Service Statistics and Statistics Portugal&#44; the public Portuguese entity responsible for the official statistical information and included&#58; 1&#41; the absolute number of resident immigrants in each year&#59; 2&#41; the absolute number of immigrants entering the country per year&#59; 3&#41; the absolute number of emigrants per year&#59; 4&#41; the migration balance&#44; which refers to the difference between the number of individuals entering and leaving the country&#44; per year&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">For the purpose of this paper&#44; TB cases with no information on the country of origin were excluded from the analysis&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">As this was a retrospective study and used routinely collected surveillance data&#44; neither ethical approval nor informed consent were required&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Mathematical Analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">The impact of the migration movements on the TB burden was initially addressed separately for immigration and emigration&#44; and simultaneously afterwards&#46; The separate analysis allowed for the study of the influence of each migration phenomenon in isolation&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Firstly&#44; the expected number of TB cases per 100<span class="elsevierStyleHsp" style=""></span>000 inhabitants for year <span class="elsevierStyleItalic">t</span> &#40;2008&#44; 2009&#44; &#8230;&#44; 2014&#41; under a steady situation of immigration &#40;<span class="elsevierStyleItalic">i&#46;e</span>&#46;&#44; keeping both the number of immigrants and the number of TB-cases among immigrants at their 2008 values&#41; was computed by&#58;<elsevierMultimedia ident="eq0005"></elsevierMultimedia></p><p id="par0275" class="elsevierStylePara elsevierViewall">Here&#44; <span class="elsevierStyleItalic">TB</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">NI</span></span>&#40;<span class="elsevierStyleItalic">t</span>&#41; denotes the number of TB-cases within the non-immigrant resident population in year <span class="elsevierStyleItalic">t</span>&#44; <span class="elsevierStyleItalic">TB</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">I</span></span>&#40;<span class="elsevierStyleItalic">t</span><span class="elsevierStyleInf">0</span>&#41; denotes the number of TB-cases within the immigrant population in <span class="elsevierStyleItalic">t</span><span class="elsevierStyleInf">0</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2008&#44; and <span class="elsevierStyleItalic">P</span>&#40;<span class="elsevierStyleItalic">t</span>&#41; &#40;resp&#46; <span class="elsevierStyleItalic">E</span>&#40;<span class="elsevierStyleItalic">t</span>&#41;&#44; <span class="elsevierStyleItalic">I</span>&#40;<span class="elsevierStyleItalic">t</span><span class="elsevierStyleInf">0</span>&#41;&#41; represents the number of Portuguese individuals &#40;resp&#46; emigrants&#44; immigrants&#41; in year <span class="elsevierStyleItalic">t</span> &#40;resp&#46; <span class="elsevierStyleItalic">t</span>&#44; <span class="elsevierStyleItalic">t</span><span class="elsevierStyleInf">0</span>&#41;&#46; Clearly&#44; <span class="elsevierStyleItalic">P</span>&#40;<span class="elsevierStyleItalic">t</span>&#41;<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">E</span>&#40;<span class="elsevierStyleItalic">t</span>&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">I</span>&#40;<span class="elsevierStyleItalic">t</span><span class="elsevierStyleInf">0</span>&#41; corresponds to the total number of individuals resident in Portugal in year <span class="elsevierStyleItalic">t</span>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Then&#44; for each year&#44; the expected number was compared with the observed number of TB-cases &#40;including different annual counts for the number of immigrants and TB-cases among immigrants&#41;&#46; The magnitude of the differences allowed for the evaluation of the impact of the immigration process on the TB incidence&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The model evaluating the impact of the emigration on TB in Portugal followed a similar reasoning&#59; keeping both the number of emigrants and the number of TB-cases among emigrants at its 2008 value&#44; the expected number of TB cases for year <span class="elsevierStyleItalic">t</span> per 100<span class="elsevierStyleHsp" style=""></span>000 inhabitants was calculated by<elsevierMultimedia ident="eq0010"></elsevierMultimedia>where the number of TB-cases among emigrants in year <span class="elsevierStyleItalic">t</span>&#44; <span class="elsevierStyleItalic">TB</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">E</span></span>&#40;<span class="elsevierStyleItalic">t</span>&#41;&#44; assumed the same per-capita rate as <span class="elsevierStyleItalic">TB</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">NI</span></span>&#40;<span class="elsevierStyleItalic">t</span>&#41;&#44; namely<elsevierMultimedia ident="eq0015"></elsevierMultimedia></p><p id="par0080" class="elsevierStylePara elsevierViewall">Indeed&#44; had the TB-emigrants in year <span class="elsevierStyleItalic">t</span> stayed in the country and the difference <span class="elsevierStyleItalic">TB</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">E</span></span>&#40;<span class="elsevierStyleItalic">t</span>&#41;<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">TB</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">E</span></span>&#40;<span class="elsevierStyleItalic">t</span><span class="elsevierStyleInf">0</span>&#41; would have been accounted for in the total number of cases within national territory&#46; The magnitude of the differences between observed and expected counts allowed for the evaluation of the impact of the emigration process on the TB incidence&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The study of the simultaneous effect of immigration and emigration combined the previous two equations&#46; Under a steady scenario of immigration and emigration&#44; the expected number of TB cases for year <span class="elsevierStyleItalic">t</span> per 100<span class="elsevierStyleHsp" style=""></span>000 inhabitants would be<elsevierMultimedia ident="eq0020"></elsevierMultimedia></p><p id="par0090" class="elsevierStylePara elsevierViewall">Finally&#44; the relative annual fluctuations observed within the total number of Portuguese residents were compared with the relative annual decreases in the number of TB-cases&#46; For each variable&#44; the relative annual fluctuation between year <span class="elsevierStyleItalic">t</span><span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>1 and year <span class="elsevierStyleItalic">t</span> was computed as<elsevierMultimedia ident="eq0025"></elsevierMultimedia></p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0095" class="elsevierStylePara elsevierViewall">From 2009 to 2013 there was a steady annual increase in the number of emigrants and essentially a decrease in the number of immigrants&#46; The years 2008 and 2014 have slightly contradicted this trend&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Until 2010&#44; the number of immigrants per year was higher than the number of emigrants&#46; From 2011 to 2014&#44; there was an inversion in the migration flow&#44; and the number of emigrants exceeded the number of immigrants&#44; thus turning the migration balance negative &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0105" class="elsevierStylePara elsevierViewall">The number of TB cases has been consistently decreasing since 2008&#46; Cases occurring in immigrants represented 13&#46;8&#37; of all cases in 2008&#44; 15&#46;2&#37; in 2009 and remained stable at about 16&#37; since 2010&#46; Immigrants have a much higher notification rate of TB than the Portuguese individuals &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">Similar to the TB notification rate&#44; the total resident population in Portugal&#44; has essentially decreased over 2008&#8211;2014 &#40;with the exception of a slight increase from 2008 to 2009&#41;&#46; However&#44; the relative annual decrease on the number of residents was lower than the decrease on the TB numbers &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">As shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#44; from 2008 to 2014 there were relatively few immigrants entering Portugal&#46; Fixing both the immigration rate and the TB rate among immigrants at their 2008 values&#44; and considering the variation on emigration that has actually occurred&#44; we&#8217;ve estimated the number of TB cases per 100<span class="elsevierStyleHsp" style=""></span>000 inhabitants for each studied year &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46; The differences between the observed and the estimated numbers were residual&#44; ranging from more 0&#46;27 cases&#47;100<span class="elsevierStyleHsp" style=""></span>000 inhabitants in 2010 to less 0&#46;49 cases&#47;100<span class="elsevierStyleHsp" style=""></span>000 inhabitants in 2014&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">On the other hand&#44; emigration rose significantly during the period of study &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#44; which could have influenced the TB rate in the country to go lower&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">The official number of TB cases in emigrants leaving the country in 2008 was 4&#46;87&#47;100<span class="elsevierStyleHsp" style=""></span>000 inhabitants&#46; Assuming that this rate remained constant along 2008&#8211;2014 and that the total number of emigrants did not change either along that period&#44; we estimated annual numbers for TB in Portugal&#46; The observed numbers were only slightly higher than their estimates&#46; The differences were even smaller than those found for the immigration impact &#40;&#60;0&#46;1 cases&#47;100<span class="elsevierStyleHsp" style=""></span>000 inhabitants&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">When looking at both migration movements at the same time&#44; the observed TB rate was again identical to the estimated TB rate &#40;differences between less 0&#46;43 cases&#47;100<span class="elsevierStyleHsp" style=""></span>000 inhabitants in 2014 and more 0&#46;28 cases&#47;100<span class="elsevierStyleHsp" style=""></span>000 inhabitants in 2010&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0140" class="elsevierStylePara elsevierViewall">The number of TB cases has been decreasing in Portugal &#40;notification rate was 27&#46;8&#47;100<span class="elsevierStyleHsp" style=""></span>000 inhabitants in 2008 vs 21&#46;8 cases&#47;100<span class="elsevierStyleHsp" style=""></span>000 inhabitants in 2014&#41;&#46; Since 2009&#44; the resident population has also been decreasing&#44; but at a slower pace&#44; as shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; As for that&#44; the decreasing number of TB cases cannot only be due to the reduction in the resident population&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Between 2008 and 2010&#44; the number of immigrants exceeded the number of emigrants &#40;positive migration balance&#41;&#46; Since 2011 until 2014&#44; migration balance turned negative&#46; Moreover&#44; TB rate has been consistently higher among immigrants compared to the native population &#40;&#62;90 cases&#47;100<span class="elsevierStyleHsp" style=""></span>000 inhabitants vs 18&#46;3&#8211;23&#46;9 cases&#47;100<span class="elsevierStyleHsp" style=""></span>000 inhabitants&#41;&#46; The percentage of TB cases in this group has risen from 13&#46;2&#37; in 2008 to 15&#46;2&#37; in 2009 and remained at about 16&#37; since 2010&#46; This model allowed us to evaluate the impact of the immigration on the TB rate&#46; It showed that&#44; since 2011&#44; as immigration is decreasing&#44; there is a tendency to a lower number of TB cases&#46; However&#44; the differences are very small&#44; representing less than 1 case per 100<span class="elsevierStyleHsp" style=""></span>000 inhabitants&#44; so the impact does not seem to be significant&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">A decrease in TB incidence has been the trend in the whole WHO European Region over the last years&#44; where it has fallen by 5&#46;2&#37; each year&#44; since 2005&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">5</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Efforts have been made to achieve lower TB rates in Europe&#44; even in low incidence countries&#46; Out of 31 low incidence countries evaluated&#44; more than half &#40;54&#46;8&#37;&#41; reported to have a dedicated national TB programme&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">17</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Despite this global trend and even though we failed to demonstrate a significant impact of the immigration global decrease on TB rate&#44; immigrants are still a risk group as in many of their origin countries&#44; infectious diseases&#44; such as TB&#44; are still an important cause of death and morbidity&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">18</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">In low incidence countries&#44; the impact of immigration on the burden of TB has been largely studied&#46;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">10&#44;19-21</span></a> Addressing risk groups is one of the key strategies against TB&#46;<a class="elsevierStyleCrossRefs" href="#bib0220"><span class="elsevierStyleSup">8&#44;22</span></a></p><p id="par0170" class="elsevierStylePara elsevierViewall">In the recently published action framework of the WHO towards TB elimination in low incidence countries<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">23</span></a> strategies involving migrants are mentioned in three of the eight priority action areas&#58; 1&#41; to address the most vulnerable and hard-to-reach groups&#59; 2&#41; to address special needs of migrants and crossborder issues and 3&#41; to undertake screening for active TB and latent tuberculosis infection &#40;LTBI&#41; in TB contacts and selected high-risk groups&#44; and provide appropriate treatment&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Many efforts have been made to detect TB and LTBI among migrants&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">12</span></a> Some EU countries have implemented screening of migrants before&#44; or at entry&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">24</span></a> Underwood et al&#46; compared contact tracing with new entrant screening in London and found the former to be more effective&#44; as it identifies families and communities at high risk&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">21</span></a> With the recent increase in the number of immigrants coming to Europe as refugees &#40;rising from about 219<span class="elsevierStyleHsp" style=""></span>000 in 2014 to more than one million in 2015&#41;&#44; TB control in this group is also a concern&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">25&#44;26</span></a> Regarding this matter&#44; the ERS&#47;WHO European Region has performed a study in order to document the policies and practices of low and intermediate TB incidence European countries with regards to detection and management of TB and latent TB infection among this vulnerable group&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">26</span></a></p><p id="par0180" class="elsevierStylePara elsevierViewall">In countries where most cases of TB occur in foreign born individuals or where incidence in this group is increasing&#44; despite a decreasing TB rate&#44; as it occurs in Portugal&#44; policies on this subject are of great importance&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">As for the emigration increase over the period of study&#44; our model showed very little differences between the number of observed and expected cases &#40;&#60;0&#46;1 cases&#47;100<span class="elsevierStyleHsp" style=""></span>000 inhabitants each year&#41;&#46; The fact that the differences between observed and expected cases were smaller than those found for the immigration impact can mean that the increase in emigration that we observed over 2008&#8211;2014 has not significantly impact the national TB rate&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">We assumed the TB rate in emigrants to be similar to the TB rate in the Portuguese individuals that stayed in the country&#46; However&#44; we do not know if these individuals had other risk factors for TB or if they became more vulnerable for TB when they moved abroad&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Torres Redondo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">27</span></a> retrospectively analyzed the Portuguese emigrants diagnosed with TB when returning to the country&#44; in the Northern Region in 2014&#46; Most cases &#40;76&#46;3&#37;&#41; had moved to low TB incidence countries and had lived there for more than 2 years &#40;median time of 42&#46;0 months&#41;&#44; which could suggest that exposure to TB could have already occurred in the foreign country&#46; About 67&#37; shared housing with work colleagues&#46; These data suggest that risk for TB might increase when emigrants leave the country as they might experience harder living conditions and economic adversity&#46; Nevertheless&#44; had they stayed in the country they might have been unemployed which also accounts as a risk factor for TB&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">28</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">Despite the lack of knowledge about this group&#44; our model failed to demonstrate an impact of emigration on TB notification rate&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Individually&#44; the migration movements did not influence TB rate when analyzed by our model&#44; so we tried to look at the impact of both movement altogether&#46; Differences were again very small &#40;&#60;0&#46;5 cases&#47;100<span class="elsevierStyleHsp" style=""></span>000 inhabits each year&#41;&#44; so&#44; even when combined&#44; migration movements do not seem to largely influence TB notification rate&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">This might mean that we have to concentrate our efforts in other risk factors&#46; Sousa et al&#46;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">28</span></a> recently found HIV to be the factor with this highest impact&#58; an increase of 10 HIV notifications per 100<span class="elsevierStyleHsp" style=""></span>000 inhabitants was associated with a rise of 2 new TB cases per 100<span class="elsevierStyleHsp" style=""></span>000 inhabitants&#46; Also&#44; an increase of 1000 unemployed subjects per 100<span class="elsevierStyleHsp" style=""></span>000 inhabitants was associated with one new case of TB per 100<span class="elsevierStyleHsp" style=""></span>000 inhabitants&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Apart from HIV infection&#44; poor living and working conditions&#44; which can facilitate TB transmission and risk factors that impair host&#39;s defense&#44; like malnutrition&#44; smoking&#44; diabetes&#44; alcohol abuse and indoor air pollution have been pointed out as major determinants&#46;<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">29-32</span></a>Silicosis also increases the risk of TB by 2&#46;8&#8211;39 times&#46;<a class="elsevierStyleCrossRefs" href="#bib0345"><span class="elsevierStyleSup">33&#44;34</span></a> Silico-TB can be a challenging diagnosis and treatment must be longer&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">35</span></a></p><p id="par0225" class="elsevierStylePara elsevierViewall">Preventive strategies that target these factors might have an important impact on TB burden&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">These risk factors also add to the risk for TB in the migrant population&#46; Paulino et al&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">13</span></a> found that foreign born patients were more likely to be HIV positive&#44; to be employed&#44; homeless or live in shelters&#46; Reducing HIV infection and providing better living conditions might have an even greater impact on TB among migrants&#46; A study performed in Italy by Ingrosso et al&#46; also showed that HIV infection is three times more frequent in foreign born people affected by TB than among Italians&#46;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">36</span></a></p><p id="par0235" class="elsevierStylePara elsevierViewall">Altogether&#44; these factors represent areas of intervention towards TB elimination and should all be addressed in national and international TB programmes&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">23</span></a></p><p id="par0240" class="elsevierStylePara elsevierViewall">In this work&#44; the authors tried to understand the impact of two demographic factors &#8211; the migration movements and the decrease in the total number of residents &#8211; on the burden of TB in Portugal over the 7-year period 2008&#8211;2014&#46; As such&#44; other risk factors such as HIV infection&#44; homelessness or overcrowded housing were assumed to remain constant over that period&#46;</p><p id="par0245" class="elsevierStylePara elsevierViewall">In conclusion&#44; the changing pattern of migration in Portugal over the period of study &#40;2008&#8211;2014&#41; does not seem to have had a significant impact on the TB notification rate&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Authorship</span><p id="par0250" class="elsevierStylePara elsevierViewall">All authors contributed to drafting and review of the manuscript&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflict of Interest</span><p id="par0255" class="elsevierStylePara elsevierViewall">The authors declare to have no conflict of interest directly or indirectly related to the manuscript contents&#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">Tuberculosis notification in Portugal has decreased in the last few years&#46; As a consequence of the economic crisis&#44; emigration has increased and immigration has decreased&#46; Immigrants are a risk group for tuberculosis&#46; Most emigrants are 20&#8211;44 years old and belong to the age group most affected by tuberculosis&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To describe the decrease in tuberculosis notification in Portugal over the last years from a demographical point of view&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Mathematical analysis was performed to quantify the effect of the migration movements &#40;separately and simultaneously&#41; on tuberculosis notification in Portugal from 2008 to 2014&#46; We calculated the estimated tuberculosis notification for each year during the period of study&#58; 1&#41; fixing immigration rate and tuberculosis rate in immigrants at 2008 values&#59; 2&#41; fixing emigration rate and tuberculosis rate in emigrants at 2008 values&#59; 3&#41; fixing both phenomenons at 2008 values&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The differences between the observed and the estimated numbers were small &#40;&#8804;0&#46;5 cases&#47;100<span class="elsevierStyleHsp" style=""></span>000 inhabitants&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discussion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Impact of the migration movements on tuberculosis notification rate does not seem to be significant when analyzed for each phenomenon individually and simultaneously&#44; by our model&#46; This might mean that we have to concentrate our efforts in other risk factors for tuberculosis&#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 notificaci&#243;n de casos de tuberculosis en Portugal ha disminuido en los &#250;ltimos a&#241;os&#46; Como consecuencia de la crisis econ&#243;mica&#44; la emigraci&#243;n ha aumentado y la inmigraci&#243;n ha disminuido&#46; Los inmigrantes son un grupo de riesgo para la tuberculosis&#46; La mayor&#237;a de los emigrantes tienen entre 20 y 44 a&#241;os y pertenecen al grupo de edad m&#225;s afectado por la tuberculosis&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Describir la disminuci&#243;n de la notificaci&#243;n de casos tuberculosis en Portugal en los &#250;ltimos a&#241;os&#44; desde un punto de vista demogr&#225;fico&#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 realiz&#243; un an&#225;lisis matem&#225;tico para cuantificar el efecto de los movimientos migratorios &#40;por separado y simult&#225;neamente&#41; en la notificaci&#243;n de casos de tuberculosis en Portugal de 2008 a 2014&#46; Se calcul&#243; la notificaci&#243;n de casos de tuberculosis estimada para cada a&#241;o durante el per&#237;odo de estudio&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">La notificaci&#243;n estimada de tuberculosis para cada a&#241;o del periodo de estudio se calcul&#243;&#58; <span class="elsevierStyleItalic">1&#41;</span> fijando las tasas de inmigraci&#243;n y de tuberculosis en inmigrantes con datos del a&#241;o 2008&#59; <span class="elsevierStyleItalic">2&#41;</span> fijando las tasas de emigraci&#243;n y de tuberculosis en emigrantes con datos del a&#241;o 2008&#44; y <span class="elsevierStyleItalic">3&#41;</span> fijando ambos fen&#243;menos con datos del a&#241;o 2008&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Las diferencias entre los valores observados y los valores estimados fueron peque&#241;as &#40;&#8804; 0&#44;5 casos&#47;100&#46;000 habitantes&#41;&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discusi&#243;n</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Seg&#250;n el modelo matem&#225;tico propuesto en este trabajo&#44; el impacto de los movimientos migratorios en la tasa de notificaci&#243;n de casos de tuberculosis en Portugal no parece ser significativo cuando se analiza cada fen&#243;meno tanto individual como simult&#225;neamente&#46; Estos datos indicar&#237;an que deber&#237;amos concentrar los esfuerzos en identificar otros factores de riesgo para la tuberculosis&#46;</p></span>"
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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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Year&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 resident population<br><span class="elsevierStyleItalic">N</span>&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">Resident inmigrants<br><span class="elsevierStyleItalic">N</span>&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">Emigrants<br><span class="elsevierStyleItalic">N</span>&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">Immigrants<a class="elsevierStyleCrossRef" href="#tblfn0045"><span class="elsevierStyleSup">a</span></a><br><span class="elsevierStyleItalic">N</span>&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">Migration balance<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">b</span></a>&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">Portuguese individuals<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">c</span></a><br><span class="elsevierStyleItalic">N</span>&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" title="table-entry  " align="char" valign="top">2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10<span class="elsevierStyleHsp" style=""></span>563<span class="elsevierStyleHsp" style=""></span>014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">440<span class="elsevierStyleHsp" style=""></span>277&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20<span class="elsevierStyleHsp" style=""></span>357&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">29<span class="elsevierStyleHsp" style=""></span>718&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9361&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10<span class="elsevierStyleHsp" style=""></span>553<span class="elsevierStyleHsp" style=""></span>653&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10<span class="elsevierStyleHsp" style=""></span>573<span class="elsevierStyleHsp" style=""></span>479&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">454<span class="elsevierStyleHsp" style=""></span>191&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16<span class="elsevierStyleHsp" style=""></span>899&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32<span class="elsevierStyleHsp" style=""></span>307&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15<span class="elsevierStyleHsp" style=""></span>408&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10<span class="elsevierStyleHsp" style=""></span>558<span class="elsevierStyleHsp" style=""></span>071&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10<span class="elsevierStyleHsp" style=""></span>572<span class="elsevierStyleHsp" style=""></span>721&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">445<span class="elsevierStyleHsp" style=""></span>262&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23<span class="elsevierStyleHsp" style=""></span>760&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27<span class="elsevierStyleHsp" style=""></span>575&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3815&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10<span class="elsevierStyleHsp" style=""></span>568<span class="elsevierStyleHsp" style=""></span>906&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">10<span class="elsevierStyleHsp" style=""></span>542<span class="elsevierStyleHsp" style=""></span>398&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">436<span class="elsevierStyleHsp" style=""></span>822&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">10<span class="elsevierStyleHsp" style=""></span>566<span class="elsevierStyleHsp" style=""></span>729&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">417<span class="elsevierStyleHsp" style=""></span>042&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14<span class="elsevierStyleHsp" style=""></span>606&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;37<span class="elsevierStyleHsp" style=""></span>352&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10<span class="elsevierStyleHsp" style=""></span>524<span class="elsevierStyleHsp" style=""></span>641&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10<span class="elsevierStyleHsp" style=""></span>427<span class="elsevierStyleHsp" style=""></span>301&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">401<span class="elsevierStyleHsp" style=""></span>320&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">53<span class="elsevierStyleHsp" style=""></span>786&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17<span class="elsevierStyleHsp" style=""></span>554&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;36<span class="elsevierStyleHsp" style=""></span>232&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10<span class="elsevierStyleHsp" style=""></span>463<span class="elsevierStyleHsp" style=""></span>533&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10<span class="elsevierStyleHsp" style=""></span>374<span class="elsevierStyleHsp" style=""></span>822&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">395<span class="elsevierStyleHsp" style=""></span>195&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49<span class="elsevierStyleHsp" style=""></span>572&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19<span class="elsevierStyleHsp" style=""></span>516&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8722;30<span class="elsevierStyleHsp" style=""></span>056&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10<span class="elsevierStyleHsp" style=""></span>404<span class="elsevierStyleHsp" style=""></span>878&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1631690.png"
              ]
            ]
          ]
          "notaPie" => array:3 [
            0 => array:3 [
              "identificador" => "tblfn0045"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Immigrants entering the country each year&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Migration balance&#58; immigrants<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>emigrants&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Portuguese individuals<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>total resident population<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>emigrants<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>immigrants&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Migration Movements&#46;</p>"
        ]
      ]
      1 => 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"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">M&#58; male&#59; F&#58; female&#59; TB&#58; tuberculosis&#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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Year&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">TB cases<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a><br><span class="elsevierStyleItalic">N</span>&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">TB rate<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&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">TBPI<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">c</span></a><br><span class="elsevierStyleItalic">N</span>&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">TBPI rate<a class="elsevierStyleCrossRef" href="#tblfn0030"><span class="elsevierStyleSup">d</span></a>&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">TBI<a class="elsevierStyleCrossRef" href="#tblfn0035"><span class="elsevierStyleSup">e</span></a><br><span class="elsevierStyleItalic">N</span>&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; TBI&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">TBI rate<a class="elsevierStyleCrossRef" href="#tblfn0040"><span class="elsevierStyleSup">f</span></a>&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">TB cases missing origin<br><span class="elsevierStyleItalic">N</span> &#40;&#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" title="table-entry  " align="char" valign="top">2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2967&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2523&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">410&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">93&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34 &#40;1&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2869&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2432&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">437&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;2&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;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2714&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2273&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">438&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">98&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;0&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2609&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2203&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">404&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">92&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;0&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2606&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2176&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">408&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;0&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2399&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1989&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">393&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">97&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;0&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2264&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1904&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">18&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">357&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">90&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;0&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1631689.png"
              ]
            ]
          ]
          "notaPie" => array:6 [
            0 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">As documented in SVIG-TB&#59; includes the cases for which the country of origin is missing&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">TB rate&#58; TB cases &#40;excluding TB cases with missing origin&#41; per 100<span class="elsevierStyleHsp" style=""></span>000 inhabitants&#46;</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0025"
              "etiqueta" => "c"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0030">TBPI&#58; TB cases in Portuguese individuals<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>TB cases<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>TB cases in immigrants<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>TB cases with missing origin&#46;</p>"
            ]
            3 => array:3 [
              "identificador" => "tblfn0030"
              "etiqueta" => "d"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0035">TBPI rate&#58; TBPI cases per 100<span class="elsevierStyleHsp" style=""></span>000 inhabitants&#46;</p>"
            ]
            4 => array:3 [
              "identificador" => "tblfn0035"
              "etiqueta" => "e"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0040">TBI&#58; TB cases in immigrants&#46;</p>"
            ]
            5 => array:3 [
              "identificador" => "tblfn0040"
              "etiqueta" => "f"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0045">TBI rate&#58; TBI cases per 100<span class="elsevierStyleHsp" style=""></span>000 resident immigrants&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Tuberculosis Numbers&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Period&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">Resident population decrease&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">Tuberculosis cases decrease&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" title="table-entry  " align="char" valign="top">2008&#8211;2009&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;00&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;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2009&#8211;2010&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;00&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;05&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2010&#8211;2011&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;00&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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2011&#8211;2012&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&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;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2012&#8211;2013&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&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;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2013&#8211;2014&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&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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  <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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Year&nbsp;\t\t\t\t\t\t\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">O<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>E&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" title="table-entry  " align="char" valign="top">2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#46;89&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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#46;37&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;27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;0&#46;03&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#46;62&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;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;84&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;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;0&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;79&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;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;0&#46;49&nbsp;\t\t\t\t\t\t\n
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                  <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="left" valign="top" scope="col" style="border-bottom: 2px solid black">Year&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" title="table-entry  " align="char" valign="top">2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#46;13&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;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#46;64&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;00&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#46;71&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;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#46;62&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;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22&#46;84&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;82&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;02&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&#46;77&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;02&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26&#46;89&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&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25&#46;64&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25&#46;36&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;28&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24&#46;71&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2012&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">24&#46;55&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="char" valign="top">2013&nbsp;\t\t\t\t\t\t\n
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        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0260" class="elsevierStylePara elsevierViewall">Rita Gaio was partially supported by <span class="elsevierStyleGrantSponsor" id="gs1">CMUP</span> &#40;<span class="elsevierStyleGrantNumber" refid="gs1">UID&#47;MAT&#47;00144&#47;2013</span>&#41;&#44; which is funded by <span class="elsevierStyleGrantSponsor" id="gs2">FCT</span> &#40;Portugal&#41; with national &#40;<span class="elsevierStyleGrantSponsor" id="gs3">MEC</span>&#41; and European structural funds &#40;<span class="elsevierStyleGrantSponsor" id="gs4">FEDER</span>&#41;&#44; under the partnership agreement PT2020&#46;</p> <p id="par0265" class="elsevierStylePara elsevierViewall">This work was supported by the contribution of Iceland&#44; Liechtenstein and Norway&#44; through the <span class="elsevierStyleGrantSponsor" id="gs5">EEA</span> Grants&#44; under the Public Health Initiatives Programme &#40;PT 06&#41;&#44; grant number <span class="elsevierStyleGrantNumber" refid="gs5">138DT1</span>&#46;</p>"
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Article information

ISSN: 15792129
Original language: English

DOI:10.1016/j.arbr.2017.07.017

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Year/Month	Html	Pdf	Total

2024 November	7	2	9
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2022 December	55	35	90
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2021 May	41	50	91
2021 April	73	93	166
2021 March	38	24	62
2021 February	28	25	53
2021 January	22	17	39
2020 December	29	14	43
2020 November	39	15	54
2020 October	28	20	48
2020 September	17	14	31
2020 August	37	12	49
2020 July	23	30	53
2020 June	35	6	41
2020 May	34	12	46
2020 April	47	21	68
2020 March	35	12	47
2020 February	27	16	43
2020 January	21	15	36
2019 December	33	14	47
2019 November	16	16	32
2019 October	21	17	38
2019 September	11	5	16
2019 August	27	30	57
2019 July	31	22	53
2019 June	17	10	27
2019 May	39	21	60
2019 April	37	25	62
2019 March	35	15	50
2019 February	25	24	49
2019 January	32	24	56
2018 December	41	24	65
2018 November	133	27	160
2018 October	270	33	303
2018 September	75	15	90
2018 May	1	0	1
2018 April	23	7	30
2018 January	1	0	1

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