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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La tuberculosis &#40;TB&#41; sigue siendo una de las enfermedades infecciosas de mayor relevancia&#44; constituyendo un importante problema de salud p&#250;blica&#44; raz&#243;n por la cual la Organizaci&#243;n Mundial de la Salud &#40;OMS&#41; la declar&#243; urgencia global ya en 1993<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">En Espa&#241;a&#44; en 1996&#44; la tasa de incidencia de TB era de 38&#44;48 casos&#47;100&#46;000 habitantes<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">2</span></a>&#44; observ&#225;ndose grandes diferencias entre comunidades aut&#243;nomas &#40;CC&#46; AA&#46;&#41;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">3</span></a>&#44; disminuyendo a 26&#44;7 casos&#47;100&#46;000 habitantes en 1999<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">4</span></a> y hasta 9&#44;43 casos&#47;100&#46;000 habitantes en 2017<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">5</span></a>&#46; No obstante&#44; la incidencia real ser&#237;a superior&#44; ya que la subnotificaci&#243;n es importante<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">6-8</span></a>&#46; El aumento de la inmigraci&#243;n modific&#243; sustancialmente la epidemiolog&#237;a de la TB<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">9</span></a>&#46; As&#237;&#44; en Barcelona&#44; entre 1995 y 2001 pas&#243; del 5 al 47&#37;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">7</span></a>&#44; similar a lo observado en alguna CC&#46; AA&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Para facilitar y priorizar la investigaci&#243;n multidisciplinaria y multic&#233;ntrica&#44; la Sociedad Espa&#241;ola de Neumolog&#237;a y Cirug&#237;a Tor&#225;cica &#40;SEPAR&#41; cre&#243; en el a&#241;o 2004 el Programa Integrado de Investigaci&#243;n en Tuberculosis &#40;PII-TB&#41;&#44; cuyos objetivos son&#58; facilitar la investigaci&#243;n sobre TB en Espa&#241;a&#44; incorporar el concepto de evaluaci&#243;n en la pr&#225;ctica cl&#237;nica&#44; estimular la formaci&#243;n en investigaci&#243;n&#44; coordinar investigaciones en TB y mejorar su prevenci&#243;n y control<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La OMS&#44; ya en 1978&#44; prepar&#243; las directrices para la evaluaci&#243;n de los programas de salud y adaptarlas a los procesos de gesti&#243;n<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">12</span></a>&#44; iniciativa seguida por organismos como la Uni&#243;n Internacional de Lucha contra la Tuberculosis y Enfermedades Respiratorias &#40;UICTER&#41;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">13</span></a>&#46; En Espa&#241;a ya fue recomendada en el Documento de Consenso para los Programas de Prevenci&#243;n y Control de la TB<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">14</span></a> y tambi&#233;n en el reciente Plan para la Prevenci&#243;n y Control de la TB en Espa&#241;a<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Los objetivos de este trabajo fueron evaluar la tendencia de las variables relacionadas con la prevenci&#243;n y control de la TB<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">16</span></a> a partir del registro del PII-TB en Espa&#241;a&#44; y los objetivos cient&#237;ficos del mismo<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">11</span></a>&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">M&#233;todo</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Dise&#241;o</span><p id="par0030" class="elsevierStylePara elsevierViewall">Estudio transversal multic&#233;ntrico de base poblacional de todos los casos nuevos de TB registrados prospectivamente entre 2006 y 2016 por investigadores del PII-TB de 16 CC&#46; AA&#46; y una ciudad aut&#243;noma &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; Los criterios de inclusi&#243;n y de exclusi&#243;n previamente definidos<a class="elsevierStyleCrossRefs" href="#bib0285"><span class="elsevierStyleSup">17&#44;18</span></a> se recogen en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Se realiz&#243; un an&#225;lisis retrospectivo descriptivo de las principales variables en cada a&#241;o del periodo evaluado y&#44; posteriormente&#44; un test de tendencias para conocer las variaciones significativas&#44; favorables o desfavorables&#44; de las mismas&#46; El mismo tipo de an&#225;lisis se hizo con los indicadores de los objetivos cient&#237;ficos del PII-TB&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Variables y an&#225;lisis estad&#237;stico</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">1&#46; Variables implicadas en la tuberculosis</span><p id="par0040" class="elsevierStylePara elsevierViewall">N&#250;mero de casos &#40;total y por grupos de edad&#41;&#44; sexo&#44; pa&#237;s de origen&#44; factores de riesgo &#40;tabaco&#44; alcohol&#44; f&#225;rmacos&#41;&#44; enfermedades asociadas &#40;virus de inmunodeficiencia humana&#44; inmunodepresiones&#41;&#44; tratamiento previo&#44; localizaci&#243;n&#44; baciloscopia&#44; cultivo&#44; antibiograma&#44; tipo de tratamiento &#40;combinados de 3 f&#225;rmacos&#44; isoniacida&#44; rifampicina&#44; pirazinamida &#91;HRZ&#93; o de 4 f&#225;rmacos a&#241;adiendo etambutol &#91;HRZE&#93;&#41;&#44; o no combinados&#41;&#44; retraso diagn&#243;stico&#44; adherencia al tratamiento&#44; tratamiento directamente observado &#40;TDO&#41; y resultado del tratamiento &#40;curaci&#243;n&#44; tratamiento completado&#44; fracaso terap&#233;utico&#44; traslado&#44; muerte por TB o por otra causa&#44; abandono&#44; prolongaci&#243;n de tratamiento&#44; perdido&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">2&#46; Indicadores cient&#237;ficos del Programa Integrado de Investigaci&#243;n en Tuberculosis</span><p id="par0045" class="elsevierStylePara elsevierViewall">Investigadores y centros participantes&#44; publicaciones&#44; presentaciones a congresos y tesis&#47;tesinas&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Se analizaron las variables cualitativas y cuantitativas y la distribuci&#243;n de frecuencias&#44; y se calcularon medidas de tendencia central&#44; desviaci&#243;n est&#225;ndar e intervalos de confianza del 95&#37; &#40;IC&#41;&#46; En la comparaci&#243;n de proporciones se utiliz&#243; la prueba de la &#967;y&#46; Las diferencias se consideraron significativas para p &#60; 0&#44;05&#46; La tendencia temporal de variables cuantitativas se realiz&#243; utilizando un modelo de regresi&#243;n lineal simple&#44; considerando como variables dependientes las descritas anteriormente y como variable independiente el periodo&#46; Para variables cualitativas&#44; la tendencia temporal se analiz&#243; mediante la prueba de la &#967;y de tendencia lineal&#46; El declive medio anual se calcul&#243; dividiendo el porcentaje de reducci&#243;n de la incidencia entre el a&#241;o inicial y el final por el n&#250;mero de a&#241;os considerados&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Se utilizaron los paquetes estad&#237;sticos SPSS 18 IBM y R de libre distribuci&#243;n versi&#243;n 2&#46;13 &#40;<a href="http://cran.r-project.org/">http&#58;&#47;&#47;cran&#46;r-project&#46;org</a>&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Aspectos &#233;ticos</span><p id="par0060" class="elsevierStylePara elsevierViewall">La inclusi&#243;n de casos cumpli&#243; con los requerimientos de la Declaraci&#243;n de Helsinki &#40;revisi&#243;n de Tokio&#44; octubre del 2004&#41; y la ley Org&#225;nica Espa&#241;ola de Protecci&#243;n de Datos 15&#47;1999&#46; Cada paciente recibi&#243; la informaci&#243;n precisa&#44; solicitando su consentimiento para el manejo de sus datos cl&#237;nicos&#46; La confidencialidad se garantiza porque en las encuestas solo recoge las iniciales del paciente teniendo acceso a ellas el investigador y&#44; si fuera necesario&#44; el Comit&#233; &#201;tico de Investigaci&#243;n Cient&#237;fica &#40;CEIC&#41; correspondiente y las autoridades sanitarias&#46; Los resultados se publican sin ninguna referencia a su identidad&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Resultados</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">1&#46; Tendencia de las variables de inter&#233;s en tuberculosis de casos recogidos fue de 6&#46;892&#44; con una mediana anual de 531 &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#44; y su tendencia fue decreciente&#58; y<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>974&#44;38-57&#44;97x &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Considerando el n&#250;mero de casos de 2006 como un <span class="elsevierStyleItalic">outlier&#44;</span> la tendencia de los casos registrados&#44; sin tener en cuenta dicho a&#241;o&#44; fue tambi&#233;n decreciente&#44; aunque con una pendiente m&#225;s suavizada&#58; y<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>53654-26&#44;4x &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46; De estos datos se deduce un declive anual medio del 5&#44;61&#37; entre 2006 y 2016&#44; y del 3&#44;18&#37; entre 2007 y 2016&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Se incrementaron significativamente&#58; grupos etarios de 40-50 a&#241;os y &#62; 50 a&#241;os&#44; primera atenci&#243;n en especialista de zona&#44; hospitalizaci&#243;n&#44; retraso diagn&#243;stico mayor de 30 d&#237;as&#44; localizaciones diseminada y extrapulmonar &#250;nica&#44; cultivos &#40;&#43;&#41;&#44; realizaci&#243;n de antibiogramas&#44; resistencia a f&#225;rmacos&#44; prolongaci&#243;n del tratamiento y fallecimientos por causa diferente de TB&#46; Disminuyeron significativamente&#58; los casos en mujeres&#44; inmigrantes&#44; privados de libertad y el tratamiento inicial con HRZ en dosis fijas medicamentosas &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">2&#46; Tendencia de indicadores de objetivos cient&#237;ficos</span><p id="par0080" class="elsevierStylePara elsevierViewall">Investigadores y centros participantes tuvieron una tendencia decreciente pero las publicaciones anuales aumentaron de forma significativa alcanzando un m&#225;ximo de 8 en 2016 &#40;factor de impacto total&#58; 49&#44;664&#41;&#46; Tambi&#233;n mejoraron&#58; proyectos iniciados anualmente&#44; presentaciones en congresos y tesis&#47;tesinas&#44; aunque de forma no significativa &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#59; <a class="elsevierStyleCrossRef" href="#fig0020">fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discusi&#243;n</span><p id="par0085" class="elsevierStylePara elsevierViewall">En este trabajo se ha evaluado el PII-TB en sus primeros 11 a&#241;os de evoluci&#243;n&#44; siendo el primer PII de SEPAR que ha sido evaluado&#46; Ello ha permitido conocer la evoluci&#243;n de importantes variables relacionadas con la TB en Espa&#241;a a partir del registro del PII-TB y evaluar los objetivos cient&#237;ficos del mismo<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">19</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Destaca la tendencia decreciente en la evoluci&#243;n anual del n&#250;mero de casos lo que sugiere un control positivo de la enfermedad&#46; Programas de Barcelona y Galicia con muchos a&#241;os de vigilancia activa<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">20&#44;21</span></a> y el Ministerio de Sanidad<a class="elsevierStyleCrossRefs" href="#bib0310"><span class="elsevierStyleSup">22&#44;23</span></a> observaron tendencias similares&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">La aportaci&#243;n de casos es muy variable y se podr&#237;a relacionar con el mayor o menor inter&#233;s de los neum&#243;logos de cada CC&#46; AA&#46; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; La variabilidad anual del n&#250;mero de casos se explicar&#237;a por la posibilidad o no de financiar la aportaci&#243;n de casos&#44; el inter&#233;s por los distintos estudios y la mayor o menor motivaci&#243;n de los investigadores tras tantos a&#241;os de colaboraci&#243;n voluntaria&#46; De hecho&#44; el n&#250;mero de casos de 2006 podr&#237;a considerarse como valor at&#237;pico <span class="elsevierStyleItalic">&#40;outlier&#41;</span> porque ese a&#241;o se pag&#243; un incentivo por caso incluido&#44; lo que hace pensar que la motivaci&#243;n fue mayor y favoreci&#243; la inclusi&#243;n de casos&#46; En la <a class="elsevierStyleCrossRef" href="#fig0015">figura 3</a> se aprecia un declive menor cuando no se incluye dicho a&#241;o y ello estar&#237;a m&#225;s cercano a la realidad&#46; En el decrecimiento m&#225;s acusado en mujeres&#44; podr&#237;an influir temas socio-culturales<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">24</span></a>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">La tendencia decreciente en inmigrantes podr&#237;a relacionarse con la crisis econ&#243;mica que ha reducido su llegada a Espa&#241;a<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">25</span></a> y con limitaciones en el acceso sanitario durante los &#250;ltimos a&#241;os en diversas CC&#46; AA&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">26</span></a>&#46; La inmigraci&#243;n masiva de algunos a&#241;os s&#237; habr&#237;a influido en el incremento de resistencias<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">27</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">La tendencia decreciente en los m&#225;s j&#243;venes y la creciente en los de mayor edad indicar&#237;a que la transmisi&#243;n est&#225; m&#225;s controlada&#44; disminuyendo la transmisi&#243;n reciente a la par que aumentar&#237;a la reactivaci&#243;n end&#243;gena<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">28</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Llama la atenci&#243;n el incremento de las hospitalizaciones cuando el manejo deber&#237;a ser prioritariamente ambulatorio&#46; Ello podr&#237;a deberse la inclusi&#243;n de casos de un centro que ingresa pacientes especialmente complicados&#44; pero el retraso diagn&#243;stico creciente tambi&#233;n podr&#237;a influir en ello&#44; ya que conllevar&#237;a TB avanzadas que requieran ingreso asoci&#225;ndose&#44; adem&#225;s&#44; a estancias hospitalarias mayores de 15 d&#237;as<a class="elsevierStyleCrossRef" href="#bib0345"><span class="elsevierStyleSup">29</span></a>&#46; Igualmente&#44; las tendencias crecientes de las localizaciones diseminadas y TB-EP que se han observado recientemente<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">23</span></a>&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Dos de los indicadores para evaluar los programas de control de la TB son un retraso diagn&#243;stico inferior a 30 d&#237;as y el TDO en pacientes con factores asociados a incumplimiento<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">30</span></a>&#46; Este trabajo muestra que el TDO s&#237; que ha aumentado en los a&#241;os evaluados&#44; pero el retraso diagn&#243;stico se ha ido incrementando de acuerdo con un estudio del PII-TB<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">31</span></a>&#44; lo que puede comportar transmisi&#243;n y brotes epid&#233;micos<a class="elsevierStyleCrossRefs" href="#bib0360"><span class="elsevierStyleSup">32-34</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">El &#250;ltimo informe global de la OMS<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">35</span></a> considera el test de sensibilidad a f&#225;rmacos como uno de los pilares b&#225;sicos del control de la TB y seg&#250;n este estudio su realizaci&#243;n se ha incrementado&#44; pero ning&#250;n a&#241;o ha alcanzado el 100&#37; recomendado&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">A pesar de las recomendaciones nacionales<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">36</span></a> e internacionales<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">37</span></a> de prescribir tratamientos con 4 f&#225;rmacos&#44; un estudio del PII-TB mostr&#243; que un elevado porcentaje de pacientes eran tratados con 3 f&#225;rmacos hasta el a&#241;o 2012<a class="elsevierStyleCrossRef" href="#bib0390"><span class="elsevierStyleSup">38</span></a>&#46; Se ha observado que esta pauta ha disminuido de forma significativa&#44; lo cual podr&#237;a estar relacionado con las recomendaciones realizadas desde dicho estudio&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Algunos centros han dejado de participar por el cese de la colaboraci&#243;n del investigador &#40;por cambio de hospital&#44; jubilaci&#243;n o enfermedad&#41;&#44; pero tambi&#233;n hay que pensar que no se ha sabido inculcar inter&#233;s suficiente para favorecer su continuidad&#46; Es posible que la acreditaci&#243;n de las Unidades de TB&#44; fomentadas por SEPAR<a class="elsevierStyleCrossRef" href="#bib0395"><span class="elsevierStyleSup">39</span></a>&#44; facilite una colaboraci&#243;n m&#225;s estable&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Los indicadores de los objetivos cient&#237;ficos han evolucionado favorablemente&#46; El n&#250;mero de publicaciones<a class="elsevierStyleCrossRef" href="#bib0400"><span class="elsevierStyleSup">40</span></a> se ha incrementado significativamente&#44; pero son mejorables el n&#250;mero de comunicaciones a congresos y el de tesis&#47;tesinas&#44; aunque han crecido especialmente en el &#250;ltimo a&#241;o&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">El an&#225;lisis retrospectivo facilita la recogida de informaci&#243;n&#44; pero tiene desventajas como la dificultad para recuperar <span class="elsevierStyleItalic">missings</span>&#44; la subjetividad de los profesionales en la interpretaci&#243;n de algunas actividades y la inclusi&#243;n exclusiva de los casos diagnosticados por los participantes&#46; Estas limitaciones se minimizaron mediante un control permanente de la base de datos y una elevada coordinaci&#243;n con los investigadores&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; este estudio muestra que el PII-TB de SEPAR proporciona importante informaci&#243;n sobre la evoluci&#243;n de la TB en Espa&#241;a&#46; En algunos casos positiva&#58; tendencia decreciente de casos&#44; mayor n&#250;mero de casos asistidos inicialmente por especialistas de zona o incremento de TDO&#46; En otros&#44; negativa&#58; incremento del retraso diagn&#243;stico&#44; de la hospitalizaci&#243;n y la resistencia a f&#225;rmacos o la necesidad de prolongar los tratamientos&#46; Con relaci&#243;n al PII-TB&#44; es necesario favorecer la participaci&#243;n de nuevos colaboradores&#44; y seguir evaluando este Programa para mejorar el control y la investigaci&#243;n sobre esta vieja enfermedad&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Financiaci&#243;n</span><p id="par0150" class="elsevierStylePara elsevierViewall">El trabajo ha sido financiado con una beca SEPAR&#58; 415&#47;2017&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Autor&#237;a</span><p id="par0155" class="elsevierStylePara elsevierViewall">TR&#58; concepci&#243;n del estudio&#44; an&#225;lisis de resultados y redacci&#243;n del manuscrito&#46; JMGG&#44; JAC&#44; JRM&#44; LA&#44; MMG&#44; JAG&#44; MAJ&#44; JFM&#44; IM&#44; AP&#44; FS&#44; MLS y JAC&#58; an&#225;lisis de resultados&#44; lectura cr&#237;tica&#44; revisi&#243;n de diversas versiones y aprobaci&#243;n final del manuscrito&#46; Grupo de Trabajo PIITB&#58; recogida de datos&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflicto de intereses</span><p id="par0160" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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              "titulo" => "1&#46; Tendencia de las variables de inter&#233;s en tuberculosis de casos recogidos fue de 6&#46;892&#44; con una mediana anual de 531 &#40;tabla 2&#41; &#40;fig&#46; 2&#41;&#44; y su tendencia fue decreciente&#58; y &#61; 974&#44;38-57&#44;97x &#40;fig&#46; 3&#41;&#46;"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El objetivo del estudio fue conocer la tendencia de las variables relacionadas con la tuberculosis &#40;TB&#41; en Espa&#241;a a partir del registro del Programa Integrado de Investigaci&#243;n en Tuberculosis &#40;PII-TB&#41; de la Sociedad Espa&#241;ola de Neumolog&#237;a y Cirug&#237;a Tor&#225;cica &#40;SEPAR&#41; y evaluar el PII-TB mediante indicadores relacionados con sus objetivos cient&#237;ficos&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todo</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal multic&#233;ntrico de base poblacional de casos nuevos de TB registrados prospectivamente por el PII-TB entre 2006 y 2016&#46; La tendencia temporal de variables cuantitativas se realiz&#243; mediante un modelo de regresi&#243;n lineal y las cualitativas mediante la prueba de &#967;<span class="elsevierStyleSup">2</span> de tendencia lineal&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Se analizaron 6&#46;892 casos de TB con una mediana anual de 531&#46; La tendencia general fue significativamente decreciente en mujeres&#44; inmigrantes&#44; privados de libertad y en tratados inicialmente con 3<span class="elsevierStyleHsp" style=""></span>f&#225;rmacos&#46; Se incrementaron significativamente la tendencia de grupos de 40 -50 a&#241;os y &#62; 50 a&#241;os&#44; primera atenci&#243;n por especialista de zona&#44; hospitalizaci&#243;n&#44; retraso diagn&#243;stico&#44; localizaci&#243;n diseminada y extrapulmonar &#250;nica&#44; cultivo &#40;&#43;&#41;&#44; realizaci&#243;n de antibiogramas&#44; resistencia a f&#225;rmacos&#44; tratamiento directamente observado&#44; prolongaci&#243;n del tratamiento y muerte por otra causa&#46; Los objetivos cient&#237;ficos del PII-TB que incrementaron significativamente fueron las publicaciones alcanzando un m&#225;ximo de 8 en 2016 y con un factor de impacto total de 49&#44;664&#44; y tambi&#233;n mejoraron los proyectos iniciados anualmente&#44; presentaciones en congresos y las tesis o tesinas&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El PII-TB proporciona informaci&#243;n relevante sobre la TB y sus factores asociados en Espa&#241;a&#46; Se ha formado un amplio equipo de investigadores y se han detectado aspectos cient&#237;ficos positivos y otros mejorables&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Objective</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The objective of the study was to determine the trend of variables related to tuberculosis &#40;TB&#41; from the Integrated Tuberculosis Research Program &#40;PII-TB&#41; registry of the Spanish Society of Pulmonology and Thoracic Surgery &#40;SEPAR&#41;&#44; and to evaluate the PII-TB according to indicators related to its scientific objectives&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Method</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Cross-sectional&#44; population-based&#44; multicenter study of new TB cases prospectively registered in the PII-TB between 2006 and 2016&#46; The time trend of quantitative variables was calculated using a lineal regression model&#44; and qualitative variables using the &#967;y test for lineal trend&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">A total of 6&#44;892 cases with an annual median of 531 were analyzed&#46; Overall&#44; a significant downward trend was observed in women&#44; immigrants&#44; prisoners&#44; and patients initially treated with 3 drugs&#46; Significant upward trends were observed in patients aged 40-50 and &#62; 50 years&#44; first visit conducted by a specialist&#44; hospitalization&#44; diagnostic delay&#44; disseminated disease and single extrapulmonary location&#44; culture&#40;&#43;&#41;&#44; sensitivity testing performed&#44; drug resistance&#44; directly observed treatment&#44; prolonged treatment&#44; and death from another cause&#46; The scientific objectives of the PII-TB that showed a significant upward trend were publications&#44; which reached a maximum of 8 in 2016 with a total impact factor of 49&#44;664&#44; numbers of projects initiated annually&#44; presentations at conferences&#44; and theses&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusions</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">PII-TB provides relevant information on TB and its associated factors in Spain&#46; A large team of researchers has been created&#59; some scientific aspects of the registry were positive&#44; while others could have been improved&#46;</p></span>"
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            "apendice" => "<p id="par0165" class="elsevierStylePara elsevierViewall">R&#46; Ag&#252;ero &#40;Hospital Marqu&#233;s de Valdecilla&#44; Santander&#41;&#59; J&#46;L&#46; Alc&#225;zar &#40;Instituto Nacional de Silicosis&#44; Oviedo&#41;&#59; N&#46; Altet &#40;Unidad de Prevenci&#243;n y Control de la Tuberculosis&#44; Barcelona&#41;&#59; L&#46; Altube &#40;Hospital Galdakao&#44; Galdakao&#41;&#59; F&#46; &#193;lvarez Navascu&#233;s &#40;Hospital San Agust&#237;n&#44; Avil&#233;s&#44; Asturias&#41;&#59; M&#46; Barr&#243;n &#40;Hospital San Mill&#225;n-San Pedro&#44; Logro&#241;o&#41;&#59; P&#46; Berm&#250;dez &#40;Hospital Universitario Carlos Haya&#44; M&#225;laga&#41;&#44; R&#46; Blanquer &#40;Hospital Dr&#46; Peset&#44; Valencia&#41;&#59; L&#46; Border&#237;as &#40;Hospital San Jorge&#44; Huesca&#41;&#59; A&#46; Bustamante &#40;Hospital Sierrallana&#44; Torrelavega&#41;&#59; J&#46;L&#46; Calpe &#40;Hospital La Marina Baixa&#44; Villajoyosa&#41;&#59; F&#46; Ca&#241;as &#40;Hospital Insular de Gran Canaria&#44; Las Palmas de Gran Canaria&#41;&#59; F&#46; Casas &#40;Hospital Cl&#237;nico San Cecilio&#44; Granada&#41;&#44; X&#46; Casas &#40;Hospital de Sant Boi&#44; Sant Boi de Llobregat&#41;&#44; E&#46; Cases &#40;Hospital Universitario La Fe&#44; Valencia&#41;&#59; R&#46; Castrodeza &#40;Hospital El Bierzo Ponferrada-Le&#243;n&#44; Ponferrada&#41;&#59; J&#46;J&#46; Cebri&#225;n &#40;Hospital Costa del Sol&#44; Marbella&#41;&#59; J&#46;E&#46; Ciruelos &#40;Hospital de Cruces&#44; Guetxo&#41;&#59; A&#46;E&#46; Delgado &#40;Hospital Santa Ana&#44; Motril&#41;&#59; D&#46; D&#237;az &#40;Complejo Hospitalario Juan Canalejo&#44; La Coru&#241;a&#41;&#59; B&#46; Fern&#225;ndez &#40;Hospital de Navarra&#44; Pamplona&#41;&#59; A&#46; Fern&#225;ndez &#40;Hospital R&#237;o Carri&#243;n&#44; Palencia&#41;&#59; J&#46; Gallardo &#40;Hospital Universitario de Guadalajara&#44; Guadalajara&#41;&#59; M&#46; Gallego &#40;Corporaci&#243;n Sanitaria Parc Taul&#237;&#44; Sabadell&#41;&#59; C&#46; Garc&#237;a &#40;Hospital General Isla Fuerteventura&#44; Puerto del Rosario&#41;&#59; F&#46;J&#46; Garc&#237;a &#40;Hospital Universitario de la Princesa&#44; Madrid&#41;&#59; F&#46;J&#46; Garros &#40;Hospital Santa Marina&#44; Bilbao&#41;&#59; C&#46; Hidalgo &#40;Hospital Universitario Virgen de las Nieves&#44; Granada&#41;&#44; M&#46; Iglesias &#40;Hospital Marqu&#233;s de Valdecilla&#44; Santander&#41;&#59; G&#46; Jim&#233;nez &#40;Hospital de Ja&#233;n&#41;&#59; J&#46;M&#46; Kindelan &#40;Hospital Universitario Reina Sof&#237;a&#44; C&#243;rdoba&#41;&#59; J&#46; Laparra &#40;Hospital Donostia-San Sebasti&#225;n&#44; San Sebasti&#225;n&#41;&#59; R&#46; Lera &#40;Hospital Dr&#46; Peset&#44; Valencia&#41;&#44; T&#46; Lloret &#40;Hospital General Universitario de Valencia&#44; Valencia&#41;&#59; M&#46; Mar&#237;n &#40;Hospital General de Castell&#243;n&#44; Castell&#243;n&#41;&#59; J&#46;T&#46; Mart&#237;nez &#40;Hospital Mutua de Terrassa&#44; Terrassa&#41;&#59; E&#46; Mart&#237;nez &#40;Hospital de Sagunto&#44; Sagunto&#41;&#59; A&#46; Mart&#237;nez &#40;Hospital de La Marina Baixa&#44; Villajoyosa&#41;&#59; C&#46; Melero &#40;Hospital 12 de Octubre&#44; Madrid&#41;&#59; C&#46; Mil&#224; &#40;Unidad de Prevenci&#243;n y Control de la Tuberculosis&#44; Barcelona&#41;&#59; C&#46; Morales &#40;Hospital Universitario Virgen de las Nieves&#44; Granada&#41;&#44; M&#46;A&#46; Morales &#40;Hospital Cruz Roja Inglesa&#44; Ceuta&#41;&#59; V&#46; Moreno &#40;Hospital Carlos III&#44; Madrid&#41;&#59; A&#46; Mu&#241;oz &#40;Hospital Universitario Carlos Haya&#44; M&#225;laga&#41;&#44; L&#46; Mu&#241;oz &#40;Hospital Reina Sof&#237;a&#44; C&#243;rdoba&#41;&#59; C&#46; Mu&#241;oz &#40;Hospital Cl&#237;nico Universitario de Valencia&#44; Valencia&#41;&#59; J&#46;A&#46; Mu&#241;oz &#40;Hospital Universitario Central&#44; Oviedo&#41;&#59; I&#46; Parra &#40;Hospital Universitario Virgen de la Arrixaca&#44; El Palmar&#41;&#59; J&#46;A&#46; P&#233;rez &#40;Hospital Arnau de Vilanova&#44; Valencia&#41;&#59; P&#46; Rivas &#40;Hospital Virgen Blanca&#44; Le&#243;n&#41;&#59; J&#46; Rodr&#237;guez &#40;Hospital Universitario Virgen de las Nieves&#44; Granada&#41;&#59; J&#46; Sala &#40;Hospital Universitario Joan XXIII&#44; Tarragona&#41;&#59; M&#46; S&#225;nchez &#40;Unidad de Tuberculosis Distrito Poniente&#44; Almer&#237;a&#41;&#59; P&#46; S&#225;nchez &#40;Hospital del Mar&#44; Barcelona&#41;&#59; F&#46; Sanz &#40;Hospital General Universitario de Valencia&#44; Valencia&#41;&#59; M&#46; Somoza &#40;Consorcio Sanitario de Tarrasa&#44; Barcelona&#41;&#44; E&#46; Trujillo &#40;Complejo Hospitalario de &#193;vila&#44; &#193;vila&#41;&#59; E&#46; Valencia &#40;Hospital Carlos III&#44; Madrid&#41;&#59; A&#46; Vargas &#40;Hospital Universitario Puerto Real&#44; C&#225;diz&#41;&#59; I&#46; Vidal &#40;Complejo Hospitalario Juan Canalejo&#44; La Coru&#241;a&#41;&#59; R&#46; Vidal &#40;Hospital Vall d&#8217;Hebron&#44; Barcelona&#41;&#59; M&#46;A&#46; Villanueva &#40;Hospital San Agust&#237;n&#44; Avil&#233;s&#44; Asturias&#41;&#59; A&#46; Villar &#40;Hospital Vall d&#8217;Hebron&#44; Barcelona&#41;&#59; M&#46; Vizcaya &#40;Complejo Hospitalario Universitario de Albacete&#44; Albacete&#41;&#59; M&#46; Zabaleta &#40;Hospital de Laredo&#44; Laredo&#41;&#59; G&#46; Zubillaga &#40;Hospital Donostia-San Sebasti&#225;n&#44; San Sebasti&#225;n&#41;&#46;</p>"
            "etiqueta" => "Anexo"
            "titulo" => "Grupo de Trabajo del Programa Integrado de Investigaci&#243;n en Tuberculosis &#40;PII-TB&#41;"
            "identificador" => "sec0075"
          ]
        ]
      ]
    ]
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          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Distribuci&#243;n total y porcentual de los casos de tuberculosis aportados por cada comunidad aut&#243;noma entre 2006 y 2016 al Programa Integrado de Investigaci&#243;n en Tuberculosis&#46;</p>"
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Evoluci&#243;n anual del n&#250;mero de casos incluidos &#40;2006-2016&#41;&#46;</p>"
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        "etiqueta" => "Figura 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Criterios&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Inclusi&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Exclusi&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Edad igual o superior a 18 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Baciloscopia &#40;&#43;&#41; o baciloscopia &#40;&#8211;&#41; con cultivo &#40;&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TB-EP con granulomas en histolog&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sospecha de TB con tratamiento antituberculoso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Consentimiento informado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Menores de 18 a&#241;os&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No confirmaci&#243;n de tuberculosis extrapulmonar&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Falta de consentimiento informado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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        "descripcion" => array:1 [
          "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Criterios de inclusi&#243;n y exclusi&#243;n de casos</p>"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">TB&#58; tuberculosis&#59; TDO&#58; tratamiento directamente observado&#59; VIH&#58; virus de la inmunodeficiencia humana&#46;</p>"
          "tablatextoimagen" => array:2 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">2013&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">2015&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">2016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Mediana&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&#46;&#176; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N&#46;&#176; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t">59&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2408994.png"
              ]
            ]
            1 => array:2 [
              "tabla" => array:1 [
                0 => """
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No realizado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="13" align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Positivo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1027 &#40;84&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">520 &#40;84&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">96 &#40;19&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">68 &#40;13&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">79&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">968 &#40;79&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">513 &#40;78&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="13" align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">917 &#40;70&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="13" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Resultado tratamiento</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Curaci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tratamiento completado&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-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fracaso terap&#233;utico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;0&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;0&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;0&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;0&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Muerte por otra causa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">22 &#40;1&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17 &#40;2&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;2&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 &#40;2&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Pa&#237;s de origen</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Otros&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;711 &#40;0&#44;575-0&#44;879&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Convivencia</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Confinado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Hospitalizaci&#243;n</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;345 &#40;1&#44;073-1&#44;686&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Retraso diagn&#243;stico&#58; &#62; 30 d&#237;as&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#44;491 &#40;1&#44;179-1&#44;886&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">y<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8211;12&#44;17 &#43;2&#44;85x&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;888 &#40;1&#44;239-2&#44;879&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;003&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Extrapulmonar &#250;nica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">y<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8211;5&#44;04 &#43;1&#44;57x&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;490 &#40;1&#44;108-2&#44;003&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;008&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Microbiolog&#237;a</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Cultivo &#40;&#43;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">y<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8211;3&#44;49 &#43;0&#44;59x&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;462 &#40;1&#44;063-2&#44;011&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Test sensibilidad</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">y<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05 &#43;0&#44;14x&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;720 &#40;1&#44;286-2&#44;299&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Resistencia a f&#225;rmacos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">y<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8211;4&#44;82 &#43;2&#44;26x&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;323 &#40;1&#44;665-3&#44;240&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tratamiento inicial</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Combinado 3 f&#225;rmacos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">y<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;39 &#8211;1&#44;90x&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;065 &#40;0&#44;048-0&#44;089&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Otro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">y<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>16&#44;09 &#43;1&#44;88x&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;515 &#40;0&#44;370-0&#44;715&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">TDO</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">y<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8211;10&#44;83 &#43;4&#44;65x&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;934 &#40;2&#44;996-5&#44;165&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Resultado tratamiento</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Curado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">y<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;05-0&#44;36x&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;650 &#40;0&#44;526-0&#44;804&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Prolongaci&#243;n tratamiento&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">y<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8211;31&#44;75 &#43;5&#44;14x&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#44;188 &#40;1&#44;660-2&#44;883&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Muerte por otra causa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">y<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8211;20&#44;15 &#43;6&#44;78x&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#44;923 &#40;1&#44;002-3&#44;691&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;049&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">VA &#37;&#58; variaci&#243;n interanual&#58; variaci&#243;n porcentual con relaci&#243;n al a&#241;o previo&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Indicadores de objetivos de programa&#47;a&#241;o&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2006N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2007N&#40;VA &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2008N&#40;VA &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2009N&#40;VA &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2010N&#40;VA &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2011N&#40;VA &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2012N&#40;VA &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2013N&#40;VA &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2014N&#40;VA &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2015N&#40;VA &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">2016N&#40;VA &#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tendencia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">valor p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&#46;&#176; investigadores&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">40&#40;21&#44;21&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">y<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>43&#44;31 &#8211;0&#44;76x&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">N&#46;&#176; centros participantes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">N&#46;&#176; estudios iniciados&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">N&#46;&#176; comunicaciones en congresos&nbsp;\t\t\t\t\t\t\n
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Journal Information
Vol. 56. Issue 8.
Pages 483-492 (August 2020)
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3234
Vol. 56. Issue 8.
Pages 483-492 (August 2020)
Original
Full text access
Evaluación del Programa Integrado de Investigación en Tuberculosis promovido por la sociedad española de Neumología y Cirugía Torácica tras 11 años de funcionamiento
Evaluation of the Integrated Tuberculosis Research Program Sponsored by the Spanish Society of Pulmonology and Thoracic Surgery: 11 Years on
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3234
Teresa Rodrigoa,b,c,
Corresponding author
pii_tb_teresa_rodrigo@separ.es

Autor para correspondencia.
, José-María García-Garcíad,a, José A. Camineroe,f,a, Juan Ruiz-Manzanog,a, Luis Anibarroh,a, Marta M. García-Clementei,a, José A. Gullónd,a, M. Ángeles Jiménez-Fuentesj,a, Juan F. Medinak,a, Isabel Mirl,a, Antón Penasm,a, Francisca Sánchezn,a, Maria Luiza De Souza-Galvãoj,a, Joan A. Caylàc,a, Grupo de Trabajo del Programa Integrado de Investigación en Tuberculosis (PII-TB)
a Fundación Respira, Programa Integrado de Investigación en Tuberculosis (PII-TB), Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, España
b Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, España
c Fundación Unidad de Investigación en Tuberculosis (fuiTB), Barcelona, España
d Servicio de Neumología, Hospital Universitario San Agustín, Avilés, Asturias, España
e Servicio de Neumología, Hospital General Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, España
f International Union Against Tuberculosis and Lung Disease, París, Francia
g Servicio de Neumología, Hospital Universitario Germans Trials i Pujol, Badalona, Barcelona, España
h Unidad de Tuberculosis, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España
i Servicio de Neumología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
j Unidad de Prevención y Control de Tuberculosis, Hospital Universitario Vall d’Hebrón, Barcelona, España
k Unidad de Tuberculosis, Hospitales Universitarios Virgen del Rocío, Sevilla, España
l Servicio de Neumología, Hospital Son Llàtzer, Palma de Mallorca, Baleares, España
m Unidad de Tuberculosis, Hospital Universitario Lucus Augusti, Lugo, España
n Servicio de Medicina Interna, Hospital del Mar, Barcelona, España
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Grupo de Trabajo del Programa Integrado de Investigación en Tuberculosis (PII-TB)
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Tables (4)
Tabla 1. Criterios de inclusión y exclusión de casos
Tabla 2. Descriptivo de las variables relacionadas con la enfermedad tuberculosa a lo largo del periodo 2006-2016
Tabla 3. Tendencias significativas de las proporciones de las principales variables analizadas a lo largo del periodo 2006-2016
Tabla 4. Descripción, variación anual y tendencias de los indicadores de objetivos del PII-TB (2006-2016)
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Resumen
Objetivo

El objetivo del estudio fue conocer la tendencia de las variables relacionadas con la tuberculosis (TB) en España a partir del registro del Programa Integrado de Investigación en Tuberculosis (PII-TB) de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR) y evaluar el PII-TB mediante indicadores relacionados con sus objetivos científicos.

Método

Estudio transversal multicéntrico de base poblacional de casos nuevos de TB registrados prospectivamente por el PII-TB entre 2006 y 2016. La tendencia temporal de variables cuantitativas se realizó mediante un modelo de regresión lineal y las cualitativas mediante la prueba de χ2 de tendencia lineal.

Resultados

Se analizaron 6.892 casos de TB con una mediana anual de 531. La tendencia general fue significativamente decreciente en mujeres, inmigrantes, privados de libertad y en tratados inicialmente con 3fármacos. Se incrementaron significativamente la tendencia de grupos de 40 -50 años y > 50 años, primera atención por especialista de zona, hospitalización, retraso diagnóstico, localización diseminada y extrapulmonar única, cultivo (+), realización de antibiogramas, resistencia a fármacos, tratamiento directamente observado, prolongación del tratamiento y muerte por otra causa. Los objetivos científicos del PII-TB que incrementaron significativamente fueron las publicaciones alcanzando un máximo de 8 en 2016 y con un factor de impacto total de 49,664, y también mejoraron los proyectos iniciados anualmente, presentaciones en congresos y las tesis o tesinas.

Conclusiones

El PII-TB proporciona información relevante sobre la TB y sus factores asociados en España. Se ha formado un amplio equipo de investigadores y se han detectado aspectos científicos positivos y otros mejorables.

Palabras clave:
Tuberculosis
Programas
Control
Investigación
Evaluación
Abstract
Objective

The objective of the study was to determine the trend of variables related to tuberculosis (TB) from the Integrated Tuberculosis Research Program (PII-TB) registry of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR), and to evaluate the PII-TB according to indicators related to its scientific objectives.

Method

Cross-sectional, population-based, multicenter study of new TB cases prospectively registered in the PII-TB between 2006 and 2016. The time trend of quantitative variables was calculated using a lineal regression model, and qualitative variables using the χy test for lineal trend.

Results

A total of 6,892 cases with an annual median of 531 were analyzed. Overall, a significant downward trend was observed in women, immigrants, prisoners, and patients initially treated with 3 drugs. Significant upward trends were observed in patients aged 40-50 and > 50 years, first visit conducted by a specialist, hospitalization, diagnostic delay, disseminated disease and single extrapulmonary location, culture(+), sensitivity testing performed, drug resistance, directly observed treatment, prolonged treatment, and death from another cause. The scientific objectives of the PII-TB that showed a significant upward trend were publications, which reached a maximum of 8 in 2016 with a total impact factor of 49,664, numbers of projects initiated annually, presentations at conferences, and theses.

Conclusions

PII-TB provides relevant information on TB and its associated factors in Spain. A large team of researchers has been created; some scientific aspects of the registry were positive, while others could have been improved.

Keywords:
Tuberculosis
Programs
Control
Research
Evaluation
Full Text
Introducción

La tuberculosis (TB) sigue siendo una de las enfermedades infecciosas de mayor relevancia, constituyendo un importante problema de salud pública, razón por la cual la Organización Mundial de la Salud (OMS) la declaró urgencia global ya en 19931.

En España, en 1996, la tasa de incidencia de TB era de 38,48 casos/100.000 habitantes2, observándose grandes diferencias entre comunidades autónomas (CC. AA.)3, disminuyendo a 26,7 casos/100.000 habitantes en 19994 y hasta 9,43 casos/100.000 habitantes en 20175. No obstante, la incidencia real sería superior, ya que la subnotificación es importante6-8. El aumento de la inmigración modificó sustancialmente la epidemiología de la TB9. Así, en Barcelona, entre 1995 y 2001 pasó del 5 al 47%7, similar a lo observado en alguna CC. AA.10.

Para facilitar y priorizar la investigación multidisciplinaria y multicéntrica, la Sociedad Española de Neumología y Cirugía Torácica (SEPAR) creó en el año 2004 el Programa Integrado de Investigación en Tuberculosis (PII-TB), cuyos objetivos son: facilitar la investigación sobre TB en España, incorporar el concepto de evaluación en la práctica clínica, estimular la formación en investigación, coordinar investigaciones en TB y mejorar su prevención y control11.

La OMS, ya en 1978, preparó las directrices para la evaluación de los programas de salud y adaptarlas a los procesos de gestión12, iniciativa seguida por organismos como la Unión Internacional de Lucha contra la Tuberculosis y Enfermedades Respiratorias (UICTER)13. En España ya fue recomendada en el Documento de Consenso para los Programas de Prevención y Control de la TB14 y también en el reciente Plan para la Prevención y Control de la TB en España15.

Los objetivos de este trabajo fueron evaluar la tendencia de las variables relacionadas con la prevención y control de la TB16 a partir del registro del PII-TB en España, y los objetivos científicos del mismo11.

MétodoDiseño

Estudio transversal multicéntrico de base poblacional de todos los casos nuevos de TB registrados prospectivamente entre 2006 y 2016 por investigadores del PII-TB de 16 CC. AA. y una ciudad autónoma (fig. 1). Los criterios de inclusión y de exclusión previamente definidos17,18 se recogen en la tabla 1.

Figura 1.

Distribución total y porcentual de los casos de tuberculosis aportados por cada comunidad autónoma entre 2006 y 2016 al Programa Integrado de Investigación en Tuberculosis.

(0.14MB).
Tabla 1.

Criterios de inclusión y exclusión de casos

Criterios  Inclusión  Exclusión 
Edad igual o superior a 18 años   
Baciloscopia (+) o baciloscopia (–) con cultivo (+)   
TB-EP con granulomas en histología   
Sospecha de TB con tratamiento antituberculoso   
Consentimiento informado   
Menores de 18 años   
No confirmación de tuberculosis extrapulmonar   
Falta de consentimiento informado   

Se realizó un análisis retrospectivo descriptivo de las principales variables en cada año del periodo evaluado y, posteriormente, un test de tendencias para conocer las variaciones significativas, favorables o desfavorables, de las mismas. El mismo tipo de análisis se hizo con los indicadores de los objetivos científicos del PII-TB.

Variables y análisis estadístico1. Variables implicadas en la tuberculosis

Número de casos (total y por grupos de edad), sexo, país de origen, factores de riesgo (tabaco, alcohol, fármacos), enfermedades asociadas (virus de inmunodeficiencia humana, inmunodepresiones), tratamiento previo, localización, baciloscopia, cultivo, antibiograma, tipo de tratamiento (combinados de 3 fármacos, isoniacida, rifampicina, pirazinamida [HRZ] o de 4 fármacos añadiendo etambutol [HRZE]), o no combinados), retraso diagnóstico, adherencia al tratamiento, tratamiento directamente observado (TDO) y resultado del tratamiento (curación, tratamiento completado, fracaso terapéutico, traslado, muerte por TB o por otra causa, abandono, prolongación de tratamiento, perdido).

2. Indicadores científicos del Programa Integrado de Investigación en Tuberculosis

Investigadores y centros participantes, publicaciones, presentaciones a congresos y tesis/tesinas.

Se analizaron las variables cualitativas y cuantitativas y la distribución de frecuencias, y se calcularon medidas de tendencia central, desviación estándar e intervalos de confianza del 95% (IC). En la comparación de proporciones se utilizó la prueba de la χy. Las diferencias se consideraron significativas para p < 0,05. La tendencia temporal de variables cuantitativas se realizó utilizando un modelo de regresión lineal simple, considerando como variables dependientes las descritas anteriormente y como variable independiente el periodo. Para variables cualitativas, la tendencia temporal se analizó mediante la prueba de la χy de tendencia lineal. El declive medio anual se calculó dividiendo el porcentaje de reducción de la incidencia entre el año inicial y el final por el número de años considerados.

Se utilizaron los paquetes estadísticos SPSS 18 IBM y R de libre distribución versión 2.13 (http://cran.r-project.org).

Aspectos éticos

La inclusión de casos cumplió con los requerimientos de la Declaración de Helsinki (revisión de Tokio, octubre del 2004) y la ley Orgánica Española de Protección de Datos 15/1999. Cada paciente recibió la información precisa, solicitando su consentimiento para el manejo de sus datos clínicos. La confidencialidad se garantiza porque en las encuestas solo recoge las iniciales del paciente teniendo acceso a ellas el investigador y, si fuera necesario, el Comité Ético de Investigación Científica (CEIC) correspondiente y las autoridades sanitarias. Los resultados se publican sin ninguna referencia a su identidad.

Resultados1. Tendencia de las variables de interés en tuberculosis de casos recogidos fue de 6.892, con una mediana anual de 531 (tabla 2) (fig. 2), y su tendencia fue decreciente: y=974,38-57,97x (fig. 3).

Considerando el número de casos de 2006 como un outlier, la tendencia de los casos registrados, sin tener en cuenta dicho año, fue también decreciente, aunque con una pendiente más suavizada: y=53654-26,4x (fig. 3). De estos datos se deduce un declive anual medio del 5,61% entre 2006 y 2016, y del 3,18% entre 2007 y 2016.

Tabla 2.

Descriptivo de las variables relacionadas con la enfermedad tuberculosa a lo largo del periodo 2006-2016

  2006  2007  2008  2009  2010  2011  2012  2013  2014  2015  2016  Mediana 
  N.° (%)  N.° (%)  N.° (%)  N.° (%)  N.° (%)  N.° (%)  N.° (%)  N.° (%)  N.° (%)  N.° (%)  N.° (%)   
N.° total de casos: 6.892  1.390 (20,2)  779 (11,3)  528 (7,7)  559 (8,1)  497 (7,2)  737 (10,7)  643 (9,3)  462 (6,7)  398 (5,8)  368 (5,3)  531 (7,7)  531 
Edad
≤ 30  465 (33,5)  246 (31,6)  171 (32,4)  173 (30,9)  149 (30,0)  214 (29,1)  167 (26,1)  103 (22,4)  96 (24,2)  88 (24,2)  111 (20,9)  167 
31-39  294 (21,2)  171 (22,0)  112 (21,39  118 (21,1)  109 (21,9)  167 (22,7)  138 (21,6)  115 (25,0)  82 (20,7)  84 (23,1)  82 (15,4)  115 
40-50  252 (18,2)  151 (19,4)  115 (21,8)  101 (18,1)  95 (19,1)  139 (18,9)  123 (19,2)  97 (21,1)  87 (22,0)  72 (19,8)  126 (23,7)  115 
> 50  375 (27,1)  210 (27,0)  129 (24,5)  167 (29,9)  144 (29,0)  216 (29,3)  211 (33,0)  145 (31,5)  131 (33,1)  120 (33,0)  212 (39,9)  167 
Sexo
Hombre  877 (64,7)  483 (62,7)  335 (64,5)  342 (61,7)  305 (62,5)  473 (65,5)  396 (62,8)  273 (62,2)  249 (65,9)  247 (69,2)  391 (74,6)  342 
Mujer  476 (35,1)  287 (37,3)  184 (35,5)  212 (38,3)  180 (36,9)  248 (34,3)  234 (37,1)  165 (37,6)  129 (34,1)  110 (30,8)  133 (25,4)  184 
NC  37 (2,7)  7 (1,2)  9 (1,7)  5 (0,9)  12 (2,4)  16 (2,8)  13 (2,0)  241 (5,2)  20 (5,0)  11 (3,0)  7 (1,3)  12 
País de origen
España  998 (71,8)  500 (64,2)  339 (64,2)  371 (66,4)  315 (63,4)  503 (68,2)  418 (65,0)  284 (61,5)  276 (69,3)  242 (65,8)  342 (64,4)  342 
Otros  392 (28,2)  279 (35,8)  189 (35,8)  188 (33,6)  182 (36,6)  234 (31,8)  225 (35,0)  178 (38,5)  122 (30,7)  126 (34,2)  189 (35,6)  189 
Convivencia
Confinamiento  27 (2,0)  12 (1,6)  2 (0,4)  3 (0,5)  7 (1,4)  12 (1,7)  9 (1,5)  5 (1,2)  6 (1,6)  8 (2,2)  3 (0,6) 
Familia  995 (73,1)  541 (70,5)  392 (76,6)  435 (78,5)  363 (74,7)  549 (77,9)  485 (79,1)  332 (77,6)  300 (77,9)  278 (76,2)  394 (74,9)  394 
Grupo  172 (12,6)  112 (14,6)  58 (11,3)  57 (10,3)  59 (12,4)  69 (9,8)  59 (9,6)  42 (9,8)  47 (12,2)  27 (7,4)  45 (8,6)  58 
Sin domicilio  23 (1,7)  16 (2,1)  8 (1,6)  3 (0,5)  8 (1,6)  13 (1,8)  12 (2,0)  11 (2,6)  10 (2,6)  7 (1,9)  16 (3,0)  11 
Vive solo  144 (10,6)  86 (11,2)  52 (10,2)  56 (10,1)  49 (10,1)  62 (8,8)  48 (7,8)  38 (8,9)  22 (5,7)  45 (12,3)  68 (12,9)  52 
Lugar primera asistencia
Especialista de zona  200 (15,4)  128 (17,3)  91 (18,1)  104 (18,7)  83 (16,8)  107 (14,6)  81 (12,8)  51 (11,1)  73 (18,5)  60 (16,4)  108 (20,8)  91 
Médico de primaria  232 (17,8)  121 (16,4)  83 (16,5)  96 (17,2)  87 (17,6)  153 (20,9)  150 (23,6)  121 (26,3)  89 (22,5)  91 (24,9)  110 (21,2)  110 
Urgencias hospital  651 (50,0)  382 (51,6)  252 (50,1)  286 (51,3)  278 (56,3)  384 (52,5)  328 (51,7)  232 50,4  195 (49,4)  180 (49,3)  258 (49,6)  278 
Otros  219 (16,8)  109 (14,7)  77 (15,3)  71 (12,7)  46 (9,3)  88 (12,0)  76 (12,0)  56 (12,2)  38 (9,6)  34 (9,3)  44 (8,5)  71 
Tratamiento previo
No  1237 (91,3)  703 (90,8)  484 (92,4)  510 (91,9)  459 (92,4)  679 (93,8)  587 (93,5)  401 (92,4)  352 (94,4)  340 (93,4)  491 (92,6)  491 
Sí  118 (8,7)  71 (9,2)  40 (7,6)  45 (8,1)  38 (7,6)  45 (6,2)  41 (6,5)  33 (7,6)  21 (5,6)  24 (6,6)  39 (7,4)  40 
VIH
No  990 (71,00)  577 (74,5)  408 (77,7)  479 (85,8)  401 (80,8)  566 (77,9)  520 (81,6)  384 (84,6)  346 (87,6)  330 (89,9)  474 (89,6)  474 
No sabe  326 (23,7)  147 (19,0)  83 (15,8)  64 (11,5)  75 (15,1)  123 (16,9)  93 (14,6)  50 (11,0)  40 (10,1)  23 (6,3)  33 (6,2)  75 
Sí  61 (4,4)  51 (6,6)  34 (6,5)  15 (2,7)  20 (4,0)  38 (5,2)  24 (3,8)  20 (4,4)  9 (2,3)  14 (3,8)  22 (4,2)  22 
Localización
Pulmonar  1065 (76,6)  598 (76,8)  416 (78,8)  433 (77,5)  396 (79,7)  573 (77,7)  484 (75,3)  361 (78,1)  297 (74,6)  271 (73,6)  405 (76,3)  416 
Pleural  185 (13,3)  112 (14,4)  68 (12,9)  77 (13,8)  52 (10,5)  102 13,8  76 (11,8)  55 (11,9)  55 (13,8)  50 (13,6)  63 (11,9)  68 
Diseminada  56 (4,0)  37 (4,7)  28 (5,3)  22 (3,9)  17 (3,4)  39 (5,3)  37 (5,8)  34 (7,4)  24 (6,0)  18 (4,9)  39 (7,3)  34 
Extrapulmonar única  144 (10,4)  78 (10,0)  44 (8,3)  49 (8,8)  39 (7,8)  70 (9,5)  94 (14,6)  59 (12,8)  51 (12,8)  53 (14,4)  78 (14,7)  59 
Baciloscopia
Positiva  1313 (60,2)  421 (59,1)  296 (57,4)  272 (49,8)  243 (50,6)  368 (51,9)  309 (49,3)  246 (53,5)  200 (50,9)  179 (48,9)  254 (47,8)  272 
Negativa  523 (39,8)  290 (40,7)  220 (42,6)  274 (50,2)  237 (49,4)  336 (47,4)  279 (44,5)  194 (42,4)  164 (41,7)  168 (45,9)  262 (49,3)  262 
No realizado  0 (0,0)  1 (0,1)  0 (0,0)  0 (0,0)  0 (0,0)  5 (0,7)  39 (6,2)  19 (4,1)  29 (7,4)  19 (5,2)  15 (2,8) 
Cultivo
Positivo  1027 (84,8)  520 (84,1)  413 (84,6)  435 (80,9)  382 (83,6)  550 (83,6)  462 (76,9)  340 (78,3)  294 (78,8)  296 (82,5)  457 (86,9)  437 
Negativo  184 (15,2)  96 (15,5)  75 (15,4)  103 (19,1)  74 (16,2)  103 (15,7)  120 (20,0)  78 (18,0)  55 (14,7)  47 (13,1)  56 (10,6)  78 
No realizado  0 (0,0)  2 (0,3)  0 (0,0)  0 (0,0)  1 (0,2)  5 (0,8)  19 (3,2)  16 (3,7)  24 (6,4)  16 (4,5)  13 (2,5) 
Antibiograma
No  251 (20,6)  145 (22,0)  79 (17,6)  96 (19,2)  59 (16,3)  93 (17,0)  79 (14,9)  60 (15,9)  65 (20,3)  61 (18,1)  68 (13,1)  79 
Sí  968 (79,4)  513 (78,0)  371 (82,4)  404 (80,8)  304 (83,7)  454 (83,0)  452 (85,1)  318 (84,1)  255 (79,7)  276 (81,9)  451 (86,9)  404 
Resistencia a fármacos
Sí  86 (6,2)  60 (7,7)  33 (6,3)  44 (8,0)  37 (7,4)  52 (7,1)  47 (7,3)  32 (7,0)  28 (7,1)  41 (11,3)  70 (13,3)  44 
No  1304(93,8)  719 (92,39)  494 (93,7)  507 (92,0)  460 (92,6)  684 (92,9)  593 (92,7)  428 (93,0)  368 (92,9)  321 (88,7)  457 (86,7)  494 
TDO
No  1154 (90,5)  593 (90,39  402 (93,5)  459 (93,7)  375 (90,6)  588 (94,1)  481 (87,9)  330 (79,3)  292 (77,5)  265 (78,4)  337 (70,8)  402 
Sí  121 (9,5)  64 (9,7)  28 (6,5)  31 (6,3)  39 (9,4)  37 (5,9)  66 (12,1)  86 (20,7)  85 (22,5)  73 (21,6)  139 (29,2)  66 
Hospitalizado
No  917 (70,9)  525 (79,5)  309 (71,2)  369 (75,0)  318 (78,1)  385 (68,1)  339 (65,7)  257 (62,4)  194 (53,4)  205 (61,2)  293 (64,4)  318 
Sí  377 (29,1)  135 (20,5)  125 (28,8)  123 (25,0)  89 (21,9)  180 (31,9)  177 (34,3)  155 (37,6)  169 (46,6)  130 (38,8)  162 (35,6)  155 
Resultado tratamiento
Curación  575 (41,7)  278 (36,2)  215 (41,6)  233 (42,0)  179 (36,3)  290 (40,2)  238 (37,7)  167 (36,7)  134 (34,2)  116 (32,0)  168 (31,8)  215 
Tratamiento completado  430 (31,2)  246 (32,0)  150 (29,0)  151 (27,2)  146 (29,6)  200 (27,7)  168 (26,6)  115 (25,3)  129 (32,9)  98 (27,1)  141 (26,7)  150 
Fracaso terapéutico  2 (0,1)  2 (0,3)  –  –  1 (0,2)  1 (0,1)  –  1 (0,2)  –  –  1 (0,2) 
Muerte por otra causa  22 (1,6)  17 (2,2)  13 (2,5)  13 (2,3)  10 (2,0)  19 (2,6)  18 (2,9)  5 (1,1)  3 (0,8)  10 (2,8)  16 (3,0)  13 
Muerte por TB  4 (0,3)  4 (0,5)  5 (1,0)  3 (0,5)  5 (1,0)  15 (2,1)  11 (1,7)  9 (2,0)  7 (1,8)  4 (1,1)  8 (1,5) 
Otro+perdido+abandono  87 (6,3)  84 (10,8)  56 (10,6)  41 (7,3)  37 (7,4)  49 (6,6)  40 (6,2)  18 (3,9)  16(4,0)  17 (4,6)  19 (3,6)  40 
Prolongación tratamiento  230 (16,7)  118 (15,4)  62 (12,0)  101 (18,2)  87 (17,6)  134 (18,6)  130 (20,6)  132 (29,0)  96 (24,5)  110 (30,4)  165 (31,2)  118 
Traslado  28 (2,0)  19 (2,5)  16 (3,1)  13 (2,3)  28 (5,7)  13 (1,8)  26 (4,1)  8 (1,8)  7 (1,8)  7 (1,9)  11 (2,1)  13 
Tipo de tratamiento
4 fármacos  425 (30,6)  373 (47,9)  306 (58,0)  367 (65,7)  251 (50,5)  342 (46,4)  241 (37,5)  335 (72,5)  284 (71,4)  290 (78,8)  433 (81,5)  335 
3 fármacos  846 (60,9)  352 (45,2)  202 (38,3)  169 (30,2)  214 (43,1)  319 (43,3)  311 (48,4)  100 (21,6)  94 (23,6)  58 (15,8)  49 (9,2)  202 
Individual  298 (21,4)  110 (14,1)  25 (4,7)  40 (7,2)  108 (18,9)  180 (26,1)  178 (27,7)  39 (8,4)  13 (3,3)  34 (9,2)  82 (15,4)  82 
Retraso diagnóstico
≤ 30 días  438 (32,8)  225 (31,6)  167 (33,4)  166 (31,1)  141 (30,7)  236 (33,9)  159 (26,0)  119 (27,8)  108 (29,3)  94 (26,5)  121 (24,7)  159 
> 30 días  896 (67,2)  488 (68,4)  333 (66,6)  367 (68,9)  319 (69,3)  461 (66,1)  452 (74,0)  309 (72,2)  261 (70,7)  261 (73,5)  369 (75,3)  367 

TB: tuberculosis; TDO: tratamiento directamente observado; VIH: virus de la inmunodeficiencia humana.

Figura 2.

Evolución anual del número de casos incluidos (2006-2016).

(0.09MB).
Figura 3.

Tendencia del número de casos incluidos en el periodo 2006-2016 y en el periodo 2007-2016.

(0.06MB).

Se incrementaron significativamente: grupos etarios de 40-50 años y > 50 años, primera atención en especialista de zona, hospitalización, retraso diagnóstico mayor de 30 días, localizaciones diseminada y extrapulmonar única, cultivos (+), realización de antibiogramas, resistencia a fármacos, prolongación del tratamiento y fallecimientos por causa diferente de TB. Disminuyeron significativamente: los casos en mujeres, inmigrantes, privados de libertad y el tratamiento inicial con HRZ en dosis fijas medicamentosas (tabla 3).

Tabla 3.

Tendencias significativas de las proporciones de las principales variables analizadas a lo largo del periodo 2006-2016

Variable  Tendencia(+): creciente(–): decreciente  OR (IC del 95%)  Valor p 
Edad       
40-50  y=–0,09+0,51x  1,400 (1,099-1,783)  0,006 
> 50  y=–2,53+1,07x  1,792 (1,452-2,211)  < 0,001 
Género       
Mujer  y=9,13 –1,84x  0,627 (0,500-0,786)  < 0,001 
País de origen       
Otros  y=9,89 –1,03x  0,711 (0,575-0,879)  0,002 
Convivencia       
Confinado  y=20,75 –1,69x  0,283 (0,086-0,938)  0,039 
Lugar 1.ª asistencia       
Especialista de zona  y=–7,52 +1,98x  1,444 (1,114-1,873)  0,006 
Hospitalización  y=4,53 +0,03x  1,345 (1,073-1,686)  0,010 
Retraso diagnóstico: > 30 días  y=–0,03 +0,20x  1,491 (1,179-1,886)  0,001 
Localización       
Diseminada  y=–12,17 +2,85x  1,888 (1,239-2,879)  0,003 
Extrapulmonar única  y=–5,04 +1,57x  1,490 (1,108-2,003)  0,008 
Microbiología       
Cultivo (+)  y=–3,49 +0,59x  1,462 (1,063-2,011)  0,017 
Test sensibilidad  y=0,05 +0,14x  1,720 (1,286-2,299)  < 0,001 
Resistencia a fármacos  y=–4,82 +2,26x  2,323 (1,665-3,240)  < 0,001 
Tratamiento inicial       
Combinado 3 fármacos  y=2,39 –1,90x  0,065 (0,048-0,089)  < 0,001 
Otro  y=16,09 +1,88x  0,515 (0,370-0,715)  < 0,001 
TDO  y=–10,83 +4,65x  3,934 (2,996-5,165)  <0,001 
Resultado tratamiento       
Curado  y=0,05-0,36x  0,650 (0,526-0,804)  < 0,001 
Prolongación tratamiento  y=–31,75 +5,14x  2,188 (1,660-2,883)  < 0,001 
Muerte por otra causa  y=–20,15 +6,78x  1,923 (1,002-3,691)  0,049 

IC: intervalo de confianza; OR: odds ratio; TDO: tratamiento directamente observado.

2. Tendencia de indicadores de objetivos científicos

Investigadores y centros participantes tuvieron una tendencia decreciente pero las publicaciones anuales aumentaron de forma significativa alcanzando un máximo de 8 en 2016 (factor de impacto total: 49,664). También mejoraron: proyectos iniciados anualmente, presentaciones en congresos y tesis/tesinas, aunque de forma no significativa (tabla 4; fig. 4).

Tabla 4.

Descripción, variación anual y tendencias de los indicadores de objetivos del PII-TB (2006-2016)

Indicadores de objetivos de programa/año  2006N  2007N(VA %)  2008N(VA %)  2009N(VA %)  2010N(VA %)  2011N(VA %)  2012N(VA %)  2013N(VA %)  2014N(VA %)  2015N(VA %)  2016N(VA %)  Tendencia  valor p 
N.° investigadores  54  41(–24,07)  33(–19,51)  33(0)  40(21,21)  44(10)  43(–2,27)  27(-37,21)  29(7,41)  39(34,48)  43(10,26)  y=43,31 –0,76x  0,224 
N.° centros participantes  48  40(–16,67)  28(–30,00)  29(3,57)  34(17,24)  36(5,88)  36(0,00)  24(–33,33)  24(0,00)  32(33,33)  37(15,63)  y=39,07 –0,89x  0,154 
N.° estudios iniciados  0(–100)  1(–)  2(100)  2(0,00)  3(50,00)  3(0,00)  3(0,00)  4(33,33)  4(0,00)  2(-50,00)  y=0,47+0,30x  0,346 
N.° publicaciones  0(–)  2(–)  4(100)  1(–75,00)  1(0,00)  1(0,00)  1(0,00)  1(0,00)  2(100)  8(300)  y=0,22+0,36x  0,006 
N.° comunicaciones en congresos  1(–50,00)  1(0,00)  4(300)  7(75,00)  2(–71,43)  1(–50,00)  3(200)  5(66,67)  5(0,00)  5(0,00)  y=–1,36+0,32x  0,426 
N.° tesis/tesinas  0(–)  0(–)  0(–)  0(–)  0(–)  1(–)  0(–100)  0(–)  1(–)  3(200)  y=0,64+0,18x  > 0,999 

VA %: variación interanual: variación porcentual con relación al año previo.

Figura 4.

Tendencia de los indicadores relacionados con los objetivos científicos del Programa Integrado de Investigación en Tuberculosis de SEPAR (2006-2016).

(0.13MB).
Discusión

En este trabajo se ha evaluado el PII-TB en sus primeros 11 años de evolución, siendo el primer PII de SEPAR que ha sido evaluado. Ello ha permitido conocer la evolución de importantes variables relacionadas con la TB en España a partir del registro del PII-TB y evaluar los objetivos científicos del mismo19.

Destaca la tendencia decreciente en la evolución anual del número de casos lo que sugiere un control positivo de la enfermedad. Programas de Barcelona y Galicia con muchos años de vigilancia activa20,21 y el Ministerio de Sanidad22,23 observaron tendencias similares.

La aportación de casos es muy variable y se podría relacionar con el mayor o menor interés de los neumólogos de cada CC. AA. (fig. 1). La variabilidad anual del número de casos se explicaría por la posibilidad o no de financiar la aportación de casos, el interés por los distintos estudios y la mayor o menor motivación de los investigadores tras tantos años de colaboración voluntaria. De hecho, el número de casos de 2006 podría considerarse como valor atípico (outlier) porque ese año se pagó un incentivo por caso incluido, lo que hace pensar que la motivación fue mayor y favoreció la inclusión de casos. En la figura 3 se aprecia un declive menor cuando no se incluye dicho año y ello estaría más cercano a la realidad. En el decrecimiento más acusado en mujeres, podrían influir temas socio-culturales24.

La tendencia decreciente en inmigrantes podría relacionarse con la crisis económica que ha reducido su llegada a España25 y con limitaciones en el acceso sanitario durante los últimos años en diversas CC. AA.26. La inmigración masiva de algunos años sí habría influido en el incremento de resistencias27.

La tendencia decreciente en los más jóvenes y la creciente en los de mayor edad indicaría que la transmisión está más controlada, disminuyendo la transmisión reciente a la par que aumentaría la reactivación endógena28.

Llama la atención el incremento de las hospitalizaciones cuando el manejo debería ser prioritariamente ambulatorio. Ello podría deberse la inclusión de casos de un centro que ingresa pacientes especialmente complicados, pero el retraso diagnóstico creciente también podría influir en ello, ya que conllevaría TB avanzadas que requieran ingreso asociándose, además, a estancias hospitalarias mayores de 15 días29. Igualmente, las tendencias crecientes de las localizaciones diseminadas y TB-EP que se han observado recientemente23.

Dos de los indicadores para evaluar los programas de control de la TB son un retraso diagnóstico inferior a 30 días y el TDO en pacientes con factores asociados a incumplimiento30. Este trabajo muestra que el TDO sí que ha aumentado en los años evaluados, pero el retraso diagnóstico se ha ido incrementando de acuerdo con un estudio del PII-TB31, lo que puede comportar transmisión y brotes epidémicos32-34.

El último informe global de la OMS35 considera el test de sensibilidad a fármacos como uno de los pilares básicos del control de la TB y según este estudio su realización se ha incrementado, pero ningún año ha alcanzado el 100% recomendado.

A pesar de las recomendaciones nacionales36 e internacionales37 de prescribir tratamientos con 4 fármacos, un estudio del PII-TB mostró que un elevado porcentaje de pacientes eran tratados con 3 fármacos hasta el año 201238. Se ha observado que esta pauta ha disminuido de forma significativa, lo cual podría estar relacionado con las recomendaciones realizadas desde dicho estudio.

Algunos centros han dejado de participar por el cese de la colaboración del investigador (por cambio de hospital, jubilación o enfermedad), pero también hay que pensar que no se ha sabido inculcar interés suficiente para favorecer su continuidad. Es posible que la acreditación de las Unidades de TB, fomentadas por SEPAR39, facilite una colaboración más estable.

Los indicadores de los objetivos científicos han evolucionado favorablemente. El número de publicaciones40 se ha incrementado significativamente, pero son mejorables el número de comunicaciones a congresos y el de tesis/tesinas, aunque han crecido especialmente en el último año.

El análisis retrospectivo facilita la recogida de información, pero tiene desventajas como la dificultad para recuperar missings, la subjetividad de los profesionales en la interpretación de algunas actividades y la inclusión exclusiva de los casos diagnosticados por los participantes. Estas limitaciones se minimizaron mediante un control permanente de la base de datos y una elevada coordinación con los investigadores.

En conclusión, este estudio muestra que el PII-TB de SEPAR proporciona importante información sobre la evolución de la TB en España. En algunos casos positiva: tendencia decreciente de casos, mayor número de casos asistidos inicialmente por especialistas de zona o incremento de TDO. En otros, negativa: incremento del retraso diagnóstico, de la hospitalización y la resistencia a fármacos o la necesidad de prolongar los tratamientos. Con relación al PII-TB, es necesario favorecer la participación de nuevos colaboradores, y seguir evaluando este Programa para mejorar el control y la investigación sobre esta vieja enfermedad.

Financiación

El trabajo ha sido financiado con una beca SEPAR: 415/2017.

Autoría

TR: concepción del estudio, análisis de resultados y redacción del manuscrito. JMGG, JAC, JRM, LA, MMG, JAG, MAJ, JFM, IM, AP, FS, MLS y JAC: análisis de resultados, lectura crítica, revisión de diversas versiones y aprobación final del manuscrito. Grupo de Trabajo PIITB: recogida de datos.

Conflicto de intereses

Los autores declaran no tener ningún conflicto de intereses.

Anexo
Grupo de Trabajo del Programa Integrado de Investigación en Tuberculosis (PII-TB)

R. Agüero (Hospital Marqués de Valdecilla, Santander); J.L. Alcázar (Instituto Nacional de Silicosis, Oviedo); N. Altet (Unidad de Prevención y Control de la Tuberculosis, Barcelona); L. Altube (Hospital Galdakao, Galdakao); F. Álvarez Navascués (Hospital San Agustín, Avilés, Asturias); M. Barrón (Hospital San Millán-San Pedro, Logroño); P. Bermúdez (Hospital Universitario Carlos Haya, Málaga), R. Blanquer (Hospital Dr. Peset, Valencia); L. Borderías (Hospital San Jorge, Huesca); A. Bustamante (Hospital Sierrallana, Torrelavega); J.L. Calpe (Hospital La Marina Baixa, Villajoyosa); F. Cañas (Hospital Insular de Gran Canaria, Las Palmas de Gran Canaria); F. Casas (Hospital Clínico San Cecilio, Granada), X. Casas (Hospital de Sant Boi, Sant Boi de Llobregat), E. Cases (Hospital Universitario La Fe, Valencia); R. Castrodeza (Hospital El Bierzo Ponferrada-León, Ponferrada); J.J. Cebrián (Hospital Costa del Sol, Marbella); J.E. Ciruelos (Hospital de Cruces, Guetxo); A.E. Delgado (Hospital Santa Ana, Motril); D. Díaz (Complejo Hospitalario Juan Canalejo, La Coruña); B. Fernández (Hospital de Navarra, Pamplona); A. Fernández (Hospital Río Carrión, Palencia); J. Gallardo (Hospital Universitario de Guadalajara, Guadalajara); M. Gallego (Corporación Sanitaria Parc Taulí, Sabadell); C. García (Hospital General Isla Fuerteventura, Puerto del Rosario); F.J. García (Hospital Universitario de la Princesa, Madrid); F.J. Garros (Hospital Santa Marina, Bilbao); C. Hidalgo (Hospital Universitario Virgen de las Nieves, Granada), M. Iglesias (Hospital Marqués de Valdecilla, Santander); G. Jiménez (Hospital de Jaén); J.M. Kindelan (Hospital Universitario Reina Sofía, Córdoba); J. Laparra (Hospital Donostia-San Sebastián, San Sebastián); R. Lera (Hospital Dr. Peset, Valencia), T. Lloret (Hospital General Universitario de Valencia, Valencia); M. Marín (Hospital General de Castellón, Castellón); J.T. Martínez (Hospital Mutua de Terrassa, Terrassa); E. Martínez (Hospital de Sagunto, Sagunto); A. Martínez (Hospital de La Marina Baixa, Villajoyosa); C. Melero (Hospital 12 de Octubre, Madrid); C. Milà (Unidad de Prevención y Control de la Tuberculosis, Barcelona); C. Morales (Hospital Universitario Virgen de las Nieves, Granada), M.A. Morales (Hospital Cruz Roja Inglesa, Ceuta); V. Moreno (Hospital Carlos III, Madrid); A. Muñoz (Hospital Universitario Carlos Haya, Málaga), L. Muñoz (Hospital Reina Sofía, Córdoba); C. Muñoz (Hospital Clínico Universitario de Valencia, Valencia); J.A. Muñoz (Hospital Universitario Central, Oviedo); I. Parra (Hospital Universitario Virgen de la Arrixaca, El Palmar); J.A. Pérez (Hospital Arnau de Vilanova, Valencia); P. Rivas (Hospital Virgen Blanca, León); J. Rodríguez (Hospital Universitario Virgen de las Nieves, Granada); J. Sala (Hospital Universitario Joan XXIII, Tarragona); M. Sánchez (Unidad de Tuberculosis Distrito Poniente, Almería); P. Sánchez (Hospital del Mar, Barcelona); F. Sanz (Hospital General Universitario de Valencia, Valencia); M. Somoza (Consorcio Sanitario de Tarrasa, Barcelona), E. Trujillo (Complejo Hospitalario de Ávila, Ávila); E. Valencia (Hospital Carlos III, Madrid); A. Vargas (Hospital Universitario Puerto Real, Cádiz); I. Vidal (Complejo Hospitalario Juan Canalejo, La Coruña); R. Vidal (Hospital Vall d’Hebron, Barcelona); M.A. Villanueva (Hospital San Agustín, Avilés, Asturias); A. Villar (Hospital Vall d’Hebron, Barcelona); M. Vizcaya (Complejo Hospitalario Universitario de Albacete, Albacete); M. Zabaleta (Hospital de Laredo, Laredo); G. Zubillaga (Hospital Donostia-San Sebastián, San Sebastián).

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Los miembros del Grupo de Trabajo del Programa Integrado de Investigación en Tuberculosis (PII-TB) se presentan en el anexo.

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