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the Spanish study group on Itch Severity in Patients With Atopic Dermatitis &#40;PSEDA&#44; the Spanish acronym&#41; sought to produce a culturally adapted version of the ISS for use in both children and adults with AD&#46; We present an analysis of the measurement properties of the Spanish version of the scale&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Material and Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">This naturalistic&#44; prospective&#44; epidemiologic&#44; multicenter study was carried out in Spain between October 2007 and November 2008&#46; A total of 115 dermatologists from hospitals all over the country participated&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The dermatologists selected subjects for 3 study groups&#58; patients with AD who had clinically unstable or active lesions&#44; patients with AD who had stable or inactive lesions&#44; and a control group of patients who had benign skin tumors&#46; Enrolled patients had been diagnosed at least 1 year earlier with AD &#40;according to the criteria of Hanifin and Rajka<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#41; or with a benign tumor&#46; All pediatric patients were older than 2 years and younger than 18 years of age&#46; Adults were aged 18 years or older&#46; Patients with AD were seen at baseline and at 3 and 6 months&#59; patients with tumors &#40;control group&#41; were seen only at baseline&#46; Written informed consent was obtained from all patients &#40;or from the parent or legal guardian of the children&#41;&#46; The clinical research ethics committee of Hospital Universitario de La Princesa in Madrid approved the study&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The baseline visit was used to record sociodemographic variables &#40;age&#44; sex and education&#44; and in adults&#44; occupational status&#41; and clinical variables related to AD &#40;time since onset and severity&#41;&#44; and concomitant diseases&#46; Changes in AD severity were noted during both follow-up visits&#46; Patient-centered information &#40;self- or parent-reported&#41; was collected at all visits by means of the ISS<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and the Dermatology Life Quality Index &#40;DLQI&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> or the Children&#39;s Dermatology Life Quality Index &#40;cDLQI&#41; in the case of the pediatric AD group&#46; The patient&#39;s own health assessment was also noted&#46; The pediatric questionnaire was completed by the parent or legal guardian&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">AD severity was assessed on the modified Eczema Area and Severity Index &#40;mEASI&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> which gives an overall score between 0 &#40;no disease&#41; and 90 &#40;maximum severity of disease&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The cDLQI and the DLQI are generic dermatologic HRQOL inventories&#46; Each has 10 items and gives a score between 0 &#40;minimal impact on HRQOL&#47;good HRQOL&#41; and 30 &#40;maximum impact on HRQOL&#47;poor HRQOL&#41;&#46; The patients&#8217; perception of their health status was assessed with a questionnaire with 7 categorical responses from &#8220;very good&#8221; to &#8220;very bad&#46;&#8221;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The ISS<a class="elsevierStyleCrossRef" href="#fn0005"><span class="elsevierStyleSup">a</span></a> is a specific instrument for assessing and quantifying the intensity of pruritus&#46; To develop the Spanish ISS&#44; the original version<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> was translated and culturally adapted for use in Spain following standard methods&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a> In the definitive Spanish version finally developed &#40;<a class="elsevierStyleCrossRef" href="#sec0100">Appendix A</a>&#41;&#44; items are scored exactly as in the original version&#46; The ISS contains 7 items and provides a global score between 0 &#40;no itching&#41; and 21 &#40;very severe itching&#41;&#46; Item 6&#44; which refers to sexual desire and function is omitted from the pediatric version&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Statistical Analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">Descriptive statistics for the baseline sociodemographic variables were compiled by patient group &#40;patients with active AD lesions&#44; patients with inactive AD lesions&#44; and control patients with benign tumors&#41; and by age group &#40;children and adults&#41;&#46; Continuous variables were described as mean &#40;SD&#41;&#46; Categorical variables were summarized by number of cases and percentage&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">To validate the Spanish version of the ISS&#44; we studied its measurement properties &#40;feasibility&#44; validity&#44; sensitivity to change&#44; and reliability&#41;&#46; Feasibility was reflected by the number of test items and the percentage of items patients answered&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">To analyze the structural validity and confirm the unidimensionality of the ISS&#44; we carried out principal component analysis&#44; calculated Pearson correlation coefficients&#44; and performed analysis of variance &#40;ANOVA&#41;&#46; To estimate the correlation between the ISS score and the mEASI&#44; cDLQI&#44; and DLQI scores at baseline we used the Pearson or Spearman correlation coefficient&#44; depending on the nature of the variable&#46; Weak correlation was indicated by a coefficient of 0&#46;3 or less&#44; moderate correlation by a coefficient over 0&#46;3 and less than 0&#46;5&#44; and strong correlation by a coefficient of 0&#46;5 or more&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">To analyze sensitivity to change&#44; the change in ISS score from baseline to each follow-up visit in relation to changes in the patient&#39;s own perception of state of health at that time was subjected to repeated-measures ANOVA&#46; The effect size was calculated for each category&#46; Change was recorded as improvement &#40;positive change in category&#41;&#44; no change &#40;same category&#41;&#44; or worsening &#40;negative change in category&#41;&#46; We also calculated the minimal important difference &#40;MID&#41;&#44; defined as the difference in ISS score associated with the patients&#8217; perception of an important change in health&#46; For that purpose&#44; we selected patients who showed improvement in 2 categories between the baseline and 3-month visits as well as a change in DLQI of 2 to 5 points in the same period&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Reliability was reflected by internal consistency &#40;Cronbach &#945;&#41;&#46; Test-retest reliability was assessed based on scores recorded during the 3-month and 6-month follow-up visits&#44; for patients whose condition remained stable&#46; An intraclass correlation coefficient &#40;ICC&#41; of 0&#46;7 or higher was considered to indicate acceptable reliability&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Statistics were compiled using the SAS software package&#44; version 9&#46;1 for Windows&#46; In all statistical tests the level of significance was set at a value of <span class="elsevierStyleItalic">P</span> less than &#46;05&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Study Population Characteristics</span><p id="par0085" class="elsevierStylePara elsevierViewall">We recruited 468 patients with AD or benign tumors detected at least 1 year earlier&#59; 207 were pediatric patients &#40;aged 2-17 years&#41; and 207 were adults &#40;&#8805;18 years old&#41;&#46; Among the pediatric participants&#44; 103 and 48 had active and inactive AD lesions&#44; respectively&#44; and 56 had tumors &#40;controls&#41;&#46; Among the adult patients&#44; 124 and 48 had active and inactive AD lesions&#44; respectively&#44; and 89 had tumors&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The mean age of children with AD was 8&#46;1 &#40;4&#46;0&#41; years&#44; while the mean age of the pediatric control patients was 9&#46;4 &#40;4&#46;5&#41; years &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0030">Table 1</a> shows the sociodemographic characteristics for all 3 pediatric groups&#46; The adults with AD had a mean age of 32&#46;3 &#40;13&#46;4&#41; years&#44; while the mean age for the adult controls was 35&#46;2 &#40;14&#46;7&#41; years &#40;<a class="elsevierStyleCrossRef" href="#tbl0035">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><elsevierMultimedia ident="tbl0035"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Congenital melanocytic nevus &#40;50&#46;0&#37;&#41; and intradermal melanocytic nevus &#40;53&#46;9&#37;&#41; were the most common tumor types in the pediatric and adult control groups&#44; respectively&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Concomitant diseases were noted in 43&#46;7&#37; of the pediatric patients with AD&#44; whereas only 17&#46;9&#37; of the pediatric controls had comorbidity &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; In the group of adults with AD&#44; 57&#46;6&#37; had concomitant diseases&#44; in contrast with 40&#46;5&#37; of the adult controls &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The mean time elapsed since onset of disease was 5&#46;0 &#40;3&#46;4&#41; years for the children with AD and 2&#46;8 &#40;3&#46;5&#41; years for the pediatric control patients with benign tumors&#46; For adults the mean time elapsed since onset was 14&#46;9 &#40;11&#46;7&#41; years for the patients with AD and 6&#46;4 &#40;10&#46;4&#41; years for the control patients with tumors&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The mEASI scores showed improvement for the children with AD during the study&#44; as reflected by a mean reduction of 8&#46;6 points &#40;95&#37; confidence interval &#91;CI&#93;&#44; 6&#46;6-10&#46;6 points&#41; between baseline and the 3-month visit &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; and a mean reduction of 12&#46;3 points &#40;95&#37; CI&#44; 9&#46;9-14&#46;8 points&#41; at the 6-month visit&#46; Improvement was perceived by 64&#46;5&#37; of the patients between the baseline and 3-month visit and by 78&#46;7&#37; at 6 months&#46; The cDLQI showed a mean reduction of 3&#46;9 points &#40;95&#37; CI&#44; 2&#46;8-5&#46;0 points&#41; from baseline at 3 months and of 5&#46;5 points &#40;95&#37; CI&#44; 4&#46;0-7&#46;0 points&#41; at 6 months&#44; indicating that disease had come to exercise less impact on HRQOL over the course of the study&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In adults&#44; the mEASI demonstrated positive change in severity of AD during the study&#44; as the mean score fell by a mean of 8&#46;4 points &#40;95&#37; CI&#44; 6&#46;6-10&#46;2 points&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; below baseline at the 3-month visit and by 11&#46;0 points &#40;95&#37; CI&#44; 8&#46;9-13&#46;2&#41; at 6 months&#46; The patients also reported sensing improvement in their health at both follow-up visits&#46; At the 3-month visit&#44; 67&#46;0&#37; declared their health had improved over baseline and at 6 months 74&#46;0&#37; held this opinion&#46; A mean reduction of 3&#46;2 points &#40;95&#37; CI&#44; 2&#46;5-3&#46;9 points&#41; was detected in the DLQI at 3 months&#46; At 6 months&#44; the reduction was a mean of 4&#46;9 points &#40;95&#37; CI&#44; 3&#46;7-6&#46;0 points&#41; from baseline&#44; indicating improved HRQOL&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">ISS scores changed significantly at 3 months and at 6 months in comparison with baseline for both adults and children &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001 for both group comparisons&#41;&#46; In the children&#44; the ISS score fell by a mean of 2&#46;5 points &#40;95&#37; CI&#44; 1&#46;9-3&#46;0 points&#41; at 3 months from baseline and by 3&#46;5 points &#40;95&#37; CI&#44; 2&#46;8-4&#46;1 points&#41; at 6 months&#46; In the adults the ISS score fell by a mean of 3&#46;3 points &#40;95&#37; CI&#44; 2&#46;7-3&#46;9 points&#41; at 3 months and by 4&#46;8 points &#40;95&#37; CI&#44; 4&#46;0-5&#46;7 points&#41; at 6 months&#44; indicating that both children and adults experienced less pruritus&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Measurement Properties of the ISS in Pediatric Patients</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Feasibility</span><p id="par0125" class="elsevierStylePara elsevierViewall">The parents or guardians of 67&#46;6&#37; of the children with AD responded to all survey items&#46; The response rate exceeded 80&#46;0&#37; in all 3 pediatric groups&#44; indicating that the questionnaire can be considered feasible&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Validity</span><p id="par0130" class="elsevierStylePara elsevierViewall">Principal component analysis showed that a single component explained 68&#46;0&#37; of the variance&#44; confirming the unidimensionality of the Spanish ISS&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a> shows the correlation between this ISS version and the mEASI and cDLQI at baseline&#46; All correlations were positive&#44; moderate&#44; and statistically significant &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Sensitivity to Change</span><p id="par0135" class="elsevierStylePara elsevierViewall">The effect size between baseline and 3 months&#44; calculated to estimate sensitivity to change&#44; was 0&#46;988 &#40;large effect size&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The MID was 3 points &#40;ie&#44; a change of 3 points or more could be considered to reflect a significant change in HRQOL for the patient&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Reliability</span><p id="par0140" class="elsevierStylePara elsevierViewall">Good internal consistency was indicated by a Cronbach &#945; of 0&#46;840 &#40;superior to threshold of 0&#46;70&#41;&#46; Test-retest reliability&#44; estimated on the basis of scores at 3 and 6 months for patients with inactive lesions&#44; was reflected by ICCs between 0&#46;68 and 0&#46;73&#46; The ICCs were higher than 0&#46;7 in 2 out of 3 previously defined stability criteria&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Measurement properties of the Spanish ISS in children are summarized in <a class="elsevierStyleCrossRef" href="#tbl0040">Table 3</a>&#46;</p><elsevierMultimedia ident="tbl0040"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Measurement Properties of the ISS in Adult Patients</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Feasibility</span><p id="par0150" class="elsevierStylePara elsevierViewall">All ISS items were answered by 89&#46;0&#37; of the patients with AD and by 77&#46;5&#37; of the control patients&#46; The response rate was over 95&#37; for all ISS items in both AD patient groups and over 90&#37; in the control group&#46; Given that over 80&#37; of the items were answered&#44; the Spanish ISS can be considered feasible&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Validity</span><p id="par0155" class="elsevierStylePara elsevierViewall">Principal component analysis showed that a single component explained 61&#46;0&#37; of the variance&#44; confirming the unidimensionality of the Spanish ISS&#46; <a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a> shows the correlation between this ISS version and the mEASI and DLQI scores at baseline&#46; All correlations were positive&#44; moderate&#44; and statistically significant &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Sensitivity to Change</span><p id="par0160" class="elsevierStylePara elsevierViewall">The effect size&#44; estimating sensitivity to change&#44; was 1&#46;0 &#40;large effect size&#41; between the baseline and 3-month visits &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The MID was between 3 and 4 points at 3 months and between 3&#46;5 and 4&#46;5 points at 6 months&#46; Therefore a change of 4 points in the adult Spanish version of the ISS can be considered to reflect a significant change for the patient&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Reliability</span><p id="par0165" class="elsevierStylePara elsevierViewall">The good internal consistency of the scale was indicated by a Cronbach &#945; of 0&#46;825 &#40;higher than the stipulated value of 0&#46;7&#41;&#46; The test-retest reliability based on scores recorded for patients with inactive lesions at 3 and 6 months was reflected by an ICC between 0&#46;61 and 0&#46;66 &#40;<a class="elsevierStyleCrossRef" href="#tbl0040">Table 3</a>&#41;&#46;</p></span></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0170" class="elsevierStylePara elsevierViewall">This study demonstrates that the Spanish version of the ISS is valid for use in both its adult and pediatric versions and that its measurement properties are similar to those of the original version&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> ISS scores correlated moderately with those of both the pediatric and adult versions of the DLQI&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">No statistically significant differences in the sociodemographic characteristics of the AD patient and control groups were detected&#44; indicating that the 3 groups were homogeneous&#46; This similarity between the groups other than the finding of a greater frequency of diseases associated with AD than with benign tumors supports the robustness of the results we report&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">The pediatric ISS has proven feasible for use in a Spanish population &#40;response rate &#62;80&#37;&#41; as well as valid&#59; it is sensitive to change &#40;large effect size&#41; and has good internal consistency &#40;Cronbach &#945; more than 0&#46;7&#41;&#46; The properties of the pediatric version cannot be compared to those of the original ISS&#44; which did not have a version for use in children&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">The adult Spanish ISS also proved feasible and valid&#44; with good sensitivity to change and reliability in terms of internal consistency&#46; The correlations between ISS results on this version and scores on the mEASI and the DLQI at the baseline visit &#40;ranging from 0&#46;46 to 0&#46;72&#41; were higher than correlations found for the original version in relation to the DLQI &#40;which ranged from 0&#46;22-0&#46;55&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> In both cases&#44; however&#44; the correlations were moderate&#44; a finding that is not unusual in studies of the relation between clinical variables and HRQOL&#46; A moderate correlation indicates that higher ISS scores correspond to patients with more serious AD whose state of health is poorer&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Given that itch intensity has considerable impact on a patient&#39;s health and perception of HRQOL&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> it seems reasonable for the ISS score to be related to the patient&#39;s own sense of health&#46; In other words&#44; the patient&#39;s report of having less itching will be consistent with feeling healthier&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">The MIDs of the Spanish ISS allow us to assume that a patient will perceive improvement if there is a change of at least 4 points in the score&#46; In the study to validate the original version of the ISS&#44; the differences above which the instrument detected improvements was between 2&#46;2 and 5&#46;5 points&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">The levels of internal consistency of the Spanish version and the original version<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> were also similar and in both cases over 0&#46;7&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Test-retest reliability was found to lie between 0&#46;61 and 0&#46;66&#46; Thus&#44; this statistic did not reach or exceed the stipulated threshold of 0&#46;70 for the Spanish version and fell below the test-retest reliability of the original&#46; The failure to match this property is probably attributable to the difference in the timing of the first and second testing sessions in the 2 validation studies&#58; retesting of the original version took place at 2 weeks&#44; whereas retesting of the Spanish ISS took place after 3 months had passed&#46; It is to be expected that test-retest reliability would be higher for the shorter period of time&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">The subjective nature of itching might constitute a limitation of this study&#46; As this symptom cannot be measured objectively&#44; validity was assessed by comparing the Spanish ISS score to the same HRQOL questionnaire &#40;the DLQI&#41; that was used in validating the original version of the ISS&#46; Other studies have found HRQOL to be affected in the presence of pruritus in patients with chronic AD&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> as well as in patients with other skin conditions&#44; such as psoriasis<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a> or seborrheic dermatitis&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Given these results&#44; a dermatologist can use the Spanish ISS to monitor the degree or intensity of itching in patients as an indirect measure of the effectiveness of a treatment&#44; to help in setting a treatment regimen for an individual patient&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusions</span><p id="par0215" class="elsevierStylePara elsevierViewall">This study has demonstrated that&#44; like the original version of the ISS&#44; the Spanish instrument has good measurement properties in terms of feasibility&#44; validity&#44; sensitivity to change&#44; and internal consistency&#46; The Spanish ISS can be useful for evaluating the intensity of pruritus in patients with AD&#44; whether children or adults&#44; in routine practice&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Funding</span><p id="par0220" class="elsevierStylePara elsevierViewall">This study was funded by Astellas Pharma&#44; SA&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of Interest</span><p id="par0225" class="elsevierStylePara elsevierViewall">Dr E&#46; Daud&#233;n is or has been a member of advisory boards&#44; has received consulting fees and research grants&#44; has participated in clinical trials and received speaker&#39;s fees from the following companies&#58; Abbott&#44; Astellas&#44; Biogen&#44; Centocor Ortho Biotech Inc&#44; Galderma&#44; Glaxo&#44; Janssen-Cilag&#44; Leo Pharma&#44; Merck-Serono&#44; Pfizer&#44; Novartis&#44; Schering-Plough&#44; Stiefel&#44; Wyeth Pharmaceuticals&#44; 3<span class="elsevierStyleHsp" style=""></span>M&#44; and Celgene&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Dr J&#46; S&#225;nchez-P&#233;rez participates or has participated in clinical trials funded by the following pharmaceutical laboratories&#58; Abbott&#44; Astellas&#44; Biogen&#44; Galderma&#44; Pfizer&#44; Shering-Plough&#44; and Wyeth Pharmaceuticals&#46;</p></span></span>"
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                  "identificador" => "sec0070"
                  "titulo" => "Sensitivity to Change"
                ]
                3 => array:2 [
                  "identificador" => "sec0075"
                  "titulo" => "Reliability"
                ]
              ]
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0080"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0085"
          "titulo" => "Conclusions"
        ]
        9 => array:2 [
          "identificador" => "sec0090"
          "titulo" => "Funding"
        ]
        10 => array:2 [
          "identificador" => "sec0095"
          "titulo" => "Conflict of Interest"
        ]
        11 => array:2 [
          "identificador" => "xack35190"
          "titulo" => "Acknowledgments"
        ]
        12 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2011-01-20"
    "fechaAceptado" => "2011-03-20"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec82511"
          "palabras" => array:5 [
            0 => "Questionnaire"
            1 => "Pruritus"
            2 => "Health-related quality of life"
            3 => "Validation"
            4 => "Atopic dermatitis"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec82512"
          "palabras" => array:5 [
            0 => "Cuestionario"
            1 => "Prurito"
            2 => "Calidad de vida relacionada con la salud"
            3 => "Validaci&#243;n"
            4 => "Dermatitis at&#243;pica"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Background and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The Itch Severity Scale &#40;ISS&#41; facilitates objective assessment of the intensity of pruritus&#46; The aim of this study was to validate a Spanish version of the ISS in patients with atopic dermatitis&#46;</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A prospective epidemiological study was undertaken in patients diagnosed with atopic dermatitis at least 1 year previously and a control group without the disease&#46; Patients with atopic dermatitis were stratified according to the status of the lesions &#40;active or inactive&#41; and questionnaires were completed at baseline and 3-month and 6-month follow-up&#46; Data were collected on sociodemographic variables relating to atopic dermatitis &#40;including the modified Eczema Area and Severity Index &#91;mEASI&#93;&#41;&#44; concomitant disease&#44; and patient measures such as ISS&#44; Dermatology Life Quality Index &#40;DLQI&#41;&#44; and Children&#39;s DLQI &#40;cDLQI&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 207 children &#40;2-17 years&#41; were included&#58; 56 control subjects&#44; 103 patients with active lesions&#44; and 48 with inactive lesions&#46; The mean &#40;SD&#41; age of the participants in this age group was 8&#46;1 &#40;4&#46;0&#41; years&#46; A total of 261 adults &#40;&#8805; 18 years&#41; were included&#58; 89 control subjects&#44; 124 patients with active lesions&#44; and 48 with inactive lesions&#46; The mean age of the adult participants was 32&#46;3 &#40;13&#46;4&#41; years&#46; A response rate of &#62; 80&#37; was obtained on the pediatric ISS &#40;feasibility&#41; and the responses correlated with the mEASI and cDLQI at baseline &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; as an indicator of validity&#46; An effect size of 0&#46;988 was observed &#40;sensitivity to change&#41; along with a Chronbach &#945; of 0&#46;840 &#40;internal consistency&#41;&#46; A response rate of &#62;95&#37; was obtained on the adult ISS &#40;feasibility&#41; and the responses correlated with the mEASI and DLQI at baseline &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; as an indicator of validity&#46; An effect size of 1&#46;0 was observed &#40;sensitivity to change&#41; along with a Chronbach &#945; of 0&#46;825 &#40;internal consistency&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The Spanish version of the ISS is feasible&#44; valid&#44; sensitive to change&#44; and displays good reliability based on internal consistency in both children and adults&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El cuestionario <span class="elsevierStyleItalic">Itch Severity Scale</span> &#40;ISS&#41; permite evaluar objetivamente la intensidad del prurito&#46; El presente estudio pretende validar la versi&#243;n espa&#241;ola del cuestionario ISS en pacientes con dermatitis at&#243;pica &#40;DA&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Materiales y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio epidemiol&#243;gico prospectivo&#44; incluyendo pacientes con DA de m&#225;s de un a&#241;o de evoluci&#243;n y un grupo control sin DA&#46; Los pacientes con DA se estratificaron seg&#250;n actividad de las lesiones &#40;activas&#47;inactivas&#41;&#44; realizando una visita basal y dos de seguimiento &#40;3 y 6 meses&#41;&#46; Se recogieron variables sociodemogr&#225;ficas&#44; relacionadas con la DA &#40;incluyendo el <span class="elsevierStyleItalic">modified Eczema Area and Severity Index</span> o mEASI&#41;&#44; enfermedades concomitantes y medidas del paciente como ISS&#44; <span class="elsevierStyleItalic">Dermatology Life Quality Index</span> &#40;DLQI&#41; o <span class="elsevierStyleItalic">Children&#39;s DLQI</span> &#40;cDLQI&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 207 pacientes pedi&#225;tricos &#40;2-17 a&#241;os&#41;&#58; 56 controles&#44; 103 con lesiones activas y 48 inactivas&#44; con una edad media &#40;DE&#41; de 8&#44;1&#40;4&#44;0&#41; a&#241;os&#46; Los adultos fueron 261 pacientes &#40;&#8805; 18 a&#241;os&#41;&#58; 89 controles&#44; 124 con lesiones activas y 48 inactivas&#44; con una edad media &#40;DE&#41; de 32&#44;3 &#40;13&#44;4&#41; a&#241;os&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">ISS pedi&#225;tricos&#58; tasa de respuesta &#62; 80&#37; &#40;factibilidad&#41;&#44; correlacion&#225;ndose con mEASI y cDLQI en visita basal &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; &#40;validez&#41;&#44; <span class="elsevierStyleItalic">effect size</span> de 0&#44;988 &#40;sensibilidad al cambio&#41; y alpha de Cronbach de 0&#44;840 &#40;consistencia interna&#41;&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">ISS adultos&#58; tasa de respuesta fue &#62; 95&#37; &#40;factibilidad&#41;&#44; correlacion&#225;ndose con mEASI y DLQI en visita basal &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; &#40;validez&#41;&#44; <span class="elsevierStyleItalic">effect size</span> de 1&#44;0 &#40;sensibilidad al cambio&#41;&#44; alpha de Cronbach de 0&#44;825 &#40;consistencia interna&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La versi&#243;n espa&#241;ola del ISS se mostr&#243; factible&#44; v&#225;lida&#44; sensible al cambio y fiable en t&#233;rminos de consistencia interna&#44; tanto en ni&#241;os como en adultos&#46;</p>"
      ]
    ]
    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "a"
        "nota" => "<p class="elsevierStyleNotepara">The reader who wishes to use the questionnaire should seek permission from the original authors&#46;&#46;</p>"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Daud&#233;n E&#44; et al&#46; Validaci&#243;n de la versi&#243;n espa&#241;ola de la escla de intensidad del pico &#40;Cuestionario itch Severity Scale&#44; ISS&#41;&#46; Estudio PSEDA&#46; Actas Dermosifiliogr&#46; 2011&#59;102&#58;527-36&#46;</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0240" class="elsevierStylePara elsevierViewall">Las siguientes frases se refieren a lo que usted puede sentir sobre el picor que padece&#46;</p> <p id="par0245" class="elsevierStylePara elsevierViewall">Por favor&#44; lea detenidamente cada una de las preguntas y sus instrucciones para responderlas&#46; Se&#241;ale aquella opci&#243;n u opciones de respuesta que mejor describan lo que usted cree que le pasa&#46;</p> <p id="par0250" class="elsevierStylePara elsevierViewall">No hay respuestas correctas o incorrectas&#46; Simplemente estamos interesados en conocer lo que a usted le ocurre debido al picor que siente&#46;<span class="elsevierStyleVsp" style="height:0.5px"></span></p> <p id="par0255" class="elsevierStylePara elsevierViewall">1&#46; &#191;Con qu&#233; frecuencia siente picor en cada momento del d&#237;a&#63; &#40;por favor&#44; marque con una &#171;X&#187; la casilla que corresponda a su respuesta&#41;<elsevierMultimedia ident="tbl0005"></elsevierMultimedia></p> <p id="par0260" class="elsevierStylePara elsevierViewall">2&#46; &#191;Hasta qu&#233; punto los siguientes t&#233;rminos describen el picor que siente&#63; &#40;por favor&#44; marque con una &#171;X&#187; la casilla que corresponda a su respuesta&#41;<elsevierMultimedia ident="tbl0010"></elsevierMultimedia></p> <p id="par0265" class="elsevierStylePara elsevierViewall">3&#46; Por favor&#44; sombree las zonas donde suele sentir picor</p> <p id="par0270" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleInlineFigure"><elsevierMultimedia class="elsevierStyleLink" ident="fx1"></elsevierMultimedia></span></p> <p id="par0275" class="elsevierStylePara elsevierViewall">4&#46; Indique la intensidad del picor en cada uno de los siguientes casos &#40;por favor&#44; marque con una &#171;X&#187; la casilla que corresponda a su respuesta&#41;<elsevierMultimedia ident="tbl0015"></elsevierMultimedia></p> <p id="par0280" class="elsevierStylePara elsevierViewall">5&#46; &#191;Ha tenido cambios de humor debido al picor&#63; &#40;puede marcar m&#225;s de una respuesta&#41;</p> <p id="par0285" class="elsevierStylePara elsevierViewall">a&#46; Ning&#250;n cambio&#46;</p> <p id="par0290" class="elsevierStylePara elsevierViewall">b&#46; Deprimido&#47;a&#46;</p> <p id="par0295" class="elsevierStylePara elsevierViewall">c&#46; M&#225;s inquieto&#47;a&#46;</p> <p id="par0300" class="elsevierStylePara elsevierViewall">d&#46; Dificultad para concentrarse&#46;</p> <p id="par0305" class="elsevierStylePara elsevierViewall">e&#46; Angustiado&#47;a&#46;<span class="elsevierStyleVsp" style="height:0.5px"></span></p> <p id="par0310" class="elsevierStylePara elsevierViewall">NOTA&#58; La siguiente pregunta &#40;pregunta n&#176; 6&#41; no deber&#225; formularse en los pacientes menores de edad&#46; No ser&#225; tenida en cuenta para la puntuaci&#243;n final en este tipo de pacientes&#46;</p> <p id="par0315" class="elsevierStylePara elsevierViewall">6&#46; &#191;C&#243;mo le ha afectado el picor en lo siguiente&#63; &#40;por favor&#44; marque con una &#171;X&#187; la casilla que corresponda a su respuesta&#41;<elsevierMultimedia ident="tbl0020"></elsevierMultimedia></p> <p id="par0320" class="elsevierStylePara elsevierViewall">7&#46; Indique con qu&#233; frecuencia le ocurre cada una de las siguientes situaciones &#40;por favor&#44; marque con una &#171;X&#187;&#8221; la casilla que corresponda a su respuesta&#41;<elsevierMultimedia ident="tbl0025"></elsevierMultimedia></p> <p id="par0325" class="elsevierStylePara elsevierViewall">Si se quiere utilizar el cuestionario se debe solicitar autorizaci&#243;n</p> <p id="par0330" class="elsevierStylePara elsevierViewall">al autor del cuestionario original&#46;</p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Spanish Version of the Itch Severity Scale"
            "identificador" => "sec0100"
          ]
        ]
      ]
    ]
    "multimedia" => array:11 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2028
            "Ancho" => 3285
            "Tamanyo" => 302704
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Correlation between the pediatric version of the Spanish Itch Severity Scale &#40;ISS&#41; and the modified Eczema Area and Severity &#40;mEASI&#41; &#40;left&#41; and between this ISS version and the Children&#39;s Dermatology Life Quality Index &#40;cDLQI&#41; &#40;right&#41;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1653
            "Ancho" => 3243
            "Tamanyo" => 229904
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Effect size of the Spanish Itch Severity Scale in terms of self-reported state of health 3 months after baseline in children and adults&#46; State of health was assessed by asking the patient for an opinion expressed in terms of the following possible answers&#58; very good&#44; fairly good&#44; somewhat good&#44; neither good nor bad&#44; fairly bad&#44; and very bad&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 2028
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            "Tamanyo" => 306839
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Correlation between the adult version of the Spanish Itch Severity Scale &#40;ISS&#41; and the modified Eczema Area and Severity &#40;mEASI&#41; &#40;left&#41; and between this ISS version and the Dermatology Life Quality Index &#40;DLQI&#41; &#40;right&#41;&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0030"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Patients With AD</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Controls&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Active Lesions&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Inactive Lesions&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">51 &#40;49&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">27 &#40;56&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">78 &#40;51&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sex</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
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \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" 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"><span class="elsevierStyleHsp" style=""></span>Male&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51 &#40;41&#46;1&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;41&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71 &#40;41&#46;3&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42 &#40;47&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73 &#40;58&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">101 &#40;58&#46;7&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;50&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Unknown&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">Age</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><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" 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"><span class="elsevierStyleHsp" style=""></span>18-30 y&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65 &#40;52&#46;3&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;64&#46;6&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96 &#40;55&#46;8&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;50&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>31-40 y&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;21&#46;0&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;20&#46;8&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36 &#40;20&#46;9&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;15&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>41-50 y&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;15&#46;3&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;8&#46;3&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;13&#46;4&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>51-60 y&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;5&#46;7&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#46;1&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;4&#46;7&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;16&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;61 y&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;5&#46;7&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;4&#46;2&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;5&#46;2&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;4&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">Education</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><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" 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"><span class="elsevierStyleHsp" style=""></span>No schooling&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;4&#46;0&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#46;1&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;3&#46;5&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Primary school&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;19&#46;4&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;16&#46;6&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;18&#46;6&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;12&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Secondary school&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48 &#40;38&#46;7&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \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" 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"><span class="elsevierStyleHsp" style=""></span>Correlation with the mEASI&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"><span class="elsevierStyleItalic">r</span> &#61; 0&#46;54874&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;54444&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Correlation with the cDLQI or DLQI&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"><span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;69165&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;72246&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">Sensitivity to Change</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></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Effect size&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&#46;988&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&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MID&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 points&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">4 points&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">Reliability</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></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Cronbach &#945;&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&#46;840&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&#46;825&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ICC&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&#46;68-0&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;61-0&#46;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Measurement Properties of the Itch Severity Scale in Pediatric and Adult Populations&#46;</p>"
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            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"><td 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" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Sin picor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Picor ocasional&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Picor frecuente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Picor constante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ma&#241;ana&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><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" 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">Mediod&#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="" 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><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" 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">Tarde&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><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" 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">Noche&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><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></tbody></table>
                  """
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      7 => array:5 [
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        "mostrarDisplay" => true
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">En absoluto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Un poco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Moderadamente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Mucho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urticante&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><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" 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">Punzante&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><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" 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">Ardiente&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><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" 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">Molesto&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><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" 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">Insoportable&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><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" 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">Preocupante&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><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></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab181795.png"
              ]
            ]
          ]
        ]
      ]
      8 => array:5 [
        "identificador" => "tbl0015"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Ninguno&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Moderado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Fuerte&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Muy fuerte&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Picor en su estado habitual&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><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" 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">Picor en su estado m&#225;ximo&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><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" 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">Picor en su estado m&#237;nimo&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><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></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab181799.png"
              ]
            ]
          ]
        ]
      ]
      9 => array:5 [
        "identificador" => "tbl0020"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Ning&#250;n cambio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Disminuci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Deseo sexual&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" 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">Funci&#243;n sexual&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></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab181798.png"
              ]
            ]
          ]
        ]
      ]
      10 => array:5 [
        "identificador" => "tbl0025"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Nunca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">A veces&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Casi siempre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tiene dificultad para conciliar el sue&#241;o debido al picor&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" 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">Se despierta debido al picor&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" 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">Toma somn&#237;feros&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></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab181796.png"
              ]
            ]
          ]
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
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Original Article
Validation of the Spanish Version of the Itch Severity Scale: The PSEDA Study
Validación de la versión española de la escala de intensidad del picor (Cuestionario Itch Severity Scale, ISS). Estudio PSEDA
E. Daudéna,
Autor para correspondencia
estebandauden@medynet.com

Corresponding author.
, J. Sánchez-Pereza, M. Prietob, M. Rosetc
a Servicio de Dermatología, Hospital Universitario La Princesa, Madrid
b Departamento Médico, Astellas Pharma S.A., Madrid
c Director of Statistics, Health Economics & Outcomes Research, IMS Health, Barcelona
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the Spanish study group on Itch Severity in Patients With Atopic Dermatitis &#40;PSEDA&#44; the Spanish acronym&#41; sought to produce a culturally adapted version of the ISS for use in both children and adults with AD&#46; We present an analysis of the measurement properties of the Spanish version of the scale&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Material and Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">This naturalistic&#44; prospective&#44; epidemiologic&#44; multicenter study was carried out in Spain between October 2007 and November 2008&#46; A total of 115 dermatologists from hospitals all over the country participated&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The dermatologists selected subjects for 3 study groups&#58; patients with AD who had clinically unstable or active lesions&#44; patients with AD who had stable or inactive lesions&#44; and a control group of patients who had benign skin tumors&#46; Enrolled patients had been diagnosed at least 1 year earlier with AD &#40;according to the criteria of Hanifin and Rajka<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#41; or with a benign tumor&#46; All pediatric patients were older than 2 years and younger than 18 years of age&#46; Adults were aged 18 years or older&#46; Patients with AD were seen at baseline and at 3 and 6 months&#59; patients with tumors &#40;control group&#41; were seen only at baseline&#46; Written informed consent was obtained from all patients &#40;or from the parent or legal guardian of the children&#41;&#46; The clinical research ethics committee of Hospital Universitario de La Princesa in Madrid approved the study&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The baseline visit was used to record sociodemographic variables &#40;age&#44; sex and education&#44; and in adults&#44; occupational status&#41; and clinical variables related to AD &#40;time since onset and severity&#41;&#44; and concomitant diseases&#46; Changes in AD severity were noted during both follow-up visits&#46; Patient-centered information &#40;self- or parent-reported&#41; was collected at all visits by means of the ISS<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and the Dermatology Life Quality Index &#40;DLQI&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> or the Children&#39;s Dermatology Life Quality Index &#40;cDLQI&#41; in the case of the pediatric AD group&#46; The patient&#39;s own health assessment was also noted&#46; The pediatric questionnaire was completed by the parent or legal guardian&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">AD severity was assessed on the modified Eczema Area and Severity Index &#40;mEASI&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> which gives an overall score between 0 &#40;no disease&#41; and 90 &#40;maximum severity of disease&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The cDLQI and the DLQI are generic dermatologic HRQOL inventories&#46; Each has 10 items and gives a score between 0 &#40;minimal impact on HRQOL&#47;good HRQOL&#41; and 30 &#40;maximum impact on HRQOL&#47;poor HRQOL&#41;&#46; The patients&#8217; perception of their health status was assessed with a questionnaire with 7 categorical responses from &#8220;very good&#8221; to &#8220;very bad&#46;&#8221;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The ISS<a class="elsevierStyleCrossRef" href="#fn0005"><span class="elsevierStyleSup">a</span></a> is a specific instrument for assessing and quantifying the intensity of pruritus&#46; To develop the Spanish ISS&#44; the original version<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> was translated and culturally adapted for use in Spain following standard methods&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a> In the definitive Spanish version finally developed &#40;<a class="elsevierStyleCrossRef" href="#sec0100">Appendix A</a>&#41;&#44; items are scored exactly as in the original version&#46; The ISS contains 7 items and provides a global score between 0 &#40;no itching&#41; and 21 &#40;very severe itching&#41;&#46; Item 6&#44; which refers to sexual desire and function is omitted from the pediatric version&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Statistical Analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">Descriptive statistics for the baseline sociodemographic variables were compiled by patient group &#40;patients with active AD lesions&#44; patients with inactive AD lesions&#44; and control patients with benign tumors&#41; and by age group &#40;children and adults&#41;&#46; Continuous variables were described as mean &#40;SD&#41;&#46; Categorical variables were summarized by number of cases and percentage&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">To validate the Spanish version of the ISS&#44; we studied its measurement properties &#40;feasibility&#44; validity&#44; sensitivity to change&#44; and reliability&#41;&#46; Feasibility was reflected by the number of test items and the percentage of items patients answered&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">To analyze the structural validity and confirm the unidimensionality of the ISS&#44; we carried out principal component analysis&#44; calculated Pearson correlation coefficients&#44; and performed analysis of variance &#40;ANOVA&#41;&#46; To estimate the correlation between the ISS score and the mEASI&#44; cDLQI&#44; and DLQI scores at baseline we used the Pearson or Spearman correlation coefficient&#44; depending on the nature of the variable&#46; Weak correlation was indicated by a coefficient of 0&#46;3 or less&#44; moderate correlation by a coefficient over 0&#46;3 and less than 0&#46;5&#44; and strong correlation by a coefficient of 0&#46;5 or more&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">To analyze sensitivity to change&#44; the change in ISS score from baseline to each follow-up visit in relation to changes in the patient&#39;s own perception of state of health at that time was subjected to repeated-measures ANOVA&#46; The effect size was calculated for each category&#46; Change was recorded as improvement &#40;positive change in category&#41;&#44; no change &#40;same category&#41;&#44; or worsening &#40;negative change in category&#41;&#46; We also calculated the minimal important difference &#40;MID&#41;&#44; defined as the difference in ISS score associated with the patients&#8217; perception of an important change in health&#46; For that purpose&#44; we selected patients who showed improvement in 2 categories between the baseline and 3-month visits as well as a change in DLQI of 2 to 5 points in the same period&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Reliability was reflected by internal consistency &#40;Cronbach &#945;&#41;&#46; Test-retest reliability was assessed based on scores recorded during the 3-month and 6-month follow-up visits&#44; for patients whose condition remained stable&#46; An intraclass correlation coefficient &#40;ICC&#41; of 0&#46;7 or higher was considered to indicate acceptable reliability&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Statistics were compiled using the SAS software package&#44; version 9&#46;1 for Windows&#46; In all statistical tests the level of significance was set at a value of <span class="elsevierStyleItalic">P</span> less than &#46;05&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Study Population Characteristics</span><p id="par0085" class="elsevierStylePara elsevierViewall">We recruited 468 patients with AD or benign tumors detected at least 1 year earlier&#59; 207 were pediatric patients &#40;aged 2-17 years&#41; and 207 were adults &#40;&#8805;18 years old&#41;&#46; Among the pediatric participants&#44; 103 and 48 had active and inactive AD lesions&#44; respectively&#44; and 56 had tumors &#40;controls&#41;&#46; Among the adult patients&#44; 124 and 48 had active and inactive AD lesions&#44; respectively&#44; and 89 had tumors&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The mean age of children with AD was 8&#46;1 &#40;4&#46;0&#41; years&#44; while the mean age of the pediatric control patients was 9&#46;4 &#40;4&#46;5&#41; years &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0030">Table 1</a> shows the sociodemographic characteristics for all 3 pediatric groups&#46; The adults with AD had a mean age of 32&#46;3 &#40;13&#46;4&#41; years&#44; while the mean age for the adult controls was 35&#46;2 &#40;14&#46;7&#41; years &#40;<a class="elsevierStyleCrossRef" href="#tbl0035">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0030"></elsevierMultimedia><elsevierMultimedia ident="tbl0035"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Congenital melanocytic nevus &#40;50&#46;0&#37;&#41; and intradermal melanocytic nevus &#40;53&#46;9&#37;&#41; were the most common tumor types in the pediatric and adult control groups&#44; respectively&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Concomitant diseases were noted in 43&#46;7&#37; of the pediatric patients with AD&#44; whereas only 17&#46;9&#37; of the pediatric controls had comorbidity &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46; In the group of adults with AD&#44; 57&#46;6&#37; had concomitant diseases&#44; in contrast with 40&#46;5&#37; of the adult controls &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;01&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The mean time elapsed since onset of disease was 5&#46;0 &#40;3&#46;4&#41; years for the children with AD and 2&#46;8 &#40;3&#46;5&#41; years for the pediatric control patients with benign tumors&#46; For adults the mean time elapsed since onset was 14&#46;9 &#40;11&#46;7&#41; years for the patients with AD and 6&#46;4 &#40;10&#46;4&#41; years for the control patients with tumors&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The mEASI scores showed improvement for the children with AD during the study&#44; as reflected by a mean reduction of 8&#46;6 points &#40;95&#37; confidence interval &#91;CI&#93;&#44; 6&#46;6-10&#46;6 points&#41; between baseline and the 3-month visit &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; and a mean reduction of 12&#46;3 points &#40;95&#37; CI&#44; 9&#46;9-14&#46;8 points&#41; at the 6-month visit&#46; Improvement was perceived by 64&#46;5&#37; of the patients between the baseline and 3-month visit and by 78&#46;7&#37; at 6 months&#46; The cDLQI showed a mean reduction of 3&#46;9 points &#40;95&#37; CI&#44; 2&#46;8-5&#46;0 points&#41; from baseline at 3 months and of 5&#46;5 points &#40;95&#37; CI&#44; 4&#46;0-7&#46;0 points&#41; at 6 months&#44; indicating that disease had come to exercise less impact on HRQOL over the course of the study&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">In adults&#44; the mEASI demonstrated positive change in severity of AD during the study&#44; as the mean score fell by a mean of 8&#46;4 points &#40;95&#37; CI&#44; 6&#46;6-10&#46;2 points&#41; &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; below baseline at the 3-month visit and by 11&#46;0 points &#40;95&#37; CI&#44; 8&#46;9-13&#46;2&#41; at 6 months&#46; The patients also reported sensing improvement in their health at both follow-up visits&#46; At the 3-month visit&#44; 67&#46;0&#37; declared their health had improved over baseline and at 6 months 74&#46;0&#37; held this opinion&#46; A mean reduction of 3&#46;2 points &#40;95&#37; CI&#44; 2&#46;5-3&#46;9 points&#41; was detected in the DLQI at 3 months&#46; At 6 months&#44; the reduction was a mean of 4&#46;9 points &#40;95&#37; CI&#44; 3&#46;7-6&#46;0 points&#41; from baseline&#44; indicating improved HRQOL&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">ISS scores changed significantly at 3 months and at 6 months in comparison with baseline for both adults and children &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001 for both group comparisons&#41;&#46; In the children&#44; the ISS score fell by a mean of 2&#46;5 points &#40;95&#37; CI&#44; 1&#46;9-3&#46;0 points&#41; at 3 months from baseline and by 3&#46;5 points &#40;95&#37; CI&#44; 2&#46;8-4&#46;1 points&#41; at 6 months&#46; In the adults the ISS score fell by a mean of 3&#46;3 points &#40;95&#37; CI&#44; 2&#46;7-3&#46;9 points&#41; at 3 months and by 4&#46;8 points &#40;95&#37; CI&#44; 4&#46;0-5&#46;7 points&#41; at 6 months&#44; indicating that both children and adults experienced less pruritus&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Measurement Properties of the ISS in Pediatric Patients</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Feasibility</span><p id="par0125" class="elsevierStylePara elsevierViewall">The parents or guardians of 67&#46;6&#37; of the children with AD responded to all survey items&#46; The response rate exceeded 80&#46;0&#37; in all 3 pediatric groups&#44; indicating that the questionnaire can be considered feasible&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Validity</span><p id="par0130" class="elsevierStylePara elsevierViewall">Principal component analysis showed that a single component explained 68&#46;0&#37; of the variance&#44; confirming the unidimensionality of the Spanish ISS&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a> shows the correlation between this ISS version and the mEASI and cDLQI at baseline&#46; All correlations were positive&#44; moderate&#44; and statistically significant &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Sensitivity to Change</span><p id="par0135" class="elsevierStylePara elsevierViewall">The effect size between baseline and 3 months&#44; calculated to estimate sensitivity to change&#44; was 0&#46;988 &#40;large effect size&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The MID was 3 points &#40;ie&#44; a change of 3 points or more could be considered to reflect a significant change in HRQOL for the patient&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Reliability</span><p id="par0140" class="elsevierStylePara elsevierViewall">Good internal consistency was indicated by a Cronbach &#945; of 0&#46;840 &#40;superior to threshold of 0&#46;70&#41;&#46; Test-retest reliability&#44; estimated on the basis of scores at 3 and 6 months for patients with inactive lesions&#44; was reflected by ICCs between 0&#46;68 and 0&#46;73&#46; The ICCs were higher than 0&#46;7 in 2 out of 3 previously defined stability criteria&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Measurement properties of the Spanish ISS in children are summarized in <a class="elsevierStyleCrossRef" href="#tbl0040">Table 3</a>&#46;</p><elsevierMultimedia ident="tbl0040"></elsevierMultimedia></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Measurement Properties of the ISS in Adult Patients</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Feasibility</span><p id="par0150" class="elsevierStylePara elsevierViewall">All ISS items were answered by 89&#46;0&#37; of the patients with AD and by 77&#46;5&#37; of the control patients&#46; The response rate was over 95&#37; for all ISS items in both AD patient groups and over 90&#37; in the control group&#46; Given that over 80&#37; of the items were answered&#44; the Spanish ISS can be considered feasible&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Validity</span><p id="par0155" class="elsevierStylePara elsevierViewall">Principal component analysis showed that a single component explained 61&#46;0&#37; of the variance&#44; confirming the unidimensionality of the Spanish ISS&#46; <a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a> shows the correlation between this ISS version and the mEASI and DLQI scores at baseline&#46; All correlations were positive&#44; moderate&#44; and statistically significant &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Sensitivity to Change</span><p id="par0160" class="elsevierStylePara elsevierViewall">The effect size&#44; estimating sensitivity to change&#44; was 1&#46;0 &#40;large effect size&#41; between the baseline and 3-month visits &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The MID was between 3 and 4 points at 3 months and between 3&#46;5 and 4&#46;5 points at 6 months&#46; Therefore a change of 4 points in the adult Spanish version of the ISS can be considered to reflect a significant change for the patient&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Reliability</span><p id="par0165" class="elsevierStylePara elsevierViewall">The good internal consistency of the scale was indicated by a Cronbach &#945; of 0&#46;825 &#40;higher than the stipulated value of 0&#46;7&#41;&#46; The test-retest reliability based on scores recorded for patients with inactive lesions at 3 and 6 months was reflected by an ICC between 0&#46;61 and 0&#46;66 &#40;<a class="elsevierStyleCrossRef" href="#tbl0040">Table 3</a>&#41;&#46;</p></span></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0170" class="elsevierStylePara elsevierViewall">This study demonstrates that the Spanish version of the ISS is valid for use in both its adult and pediatric versions and that its measurement properties are similar to those of the original version&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> ISS scores correlated moderately with those of both the pediatric and adult versions of the DLQI&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">No statistically significant differences in the sociodemographic characteristics of the AD patient and control groups were detected&#44; indicating that the 3 groups were homogeneous&#46; This similarity between the groups other than the finding of a greater frequency of diseases associated with AD than with benign tumors supports the robustness of the results we report&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">The pediatric ISS has proven feasible for use in a Spanish population &#40;response rate &#62;80&#37;&#41; as well as valid&#59; it is sensitive to change &#40;large effect size&#41; and has good internal consistency &#40;Cronbach &#945; more than 0&#46;7&#41;&#46; The properties of the pediatric version cannot be compared to those of the original ISS&#44; which did not have a version for use in children&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">The adult Spanish ISS also proved feasible and valid&#44; with good sensitivity to change and reliability in terms of internal consistency&#46; The correlations between ISS results on this version and scores on the mEASI and the DLQI at the baseline visit &#40;ranging from 0&#46;46 to 0&#46;72&#41; were higher than correlations found for the original version in relation to the DLQI &#40;which ranged from 0&#46;22-0&#46;55&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> In both cases&#44; however&#44; the correlations were moderate&#44; a finding that is not unusual in studies of the relation between clinical variables and HRQOL&#46; A moderate correlation indicates that higher ISS scores correspond to patients with more serious AD whose state of health is poorer&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Given that itch intensity has considerable impact on a patient&#39;s health and perception of HRQOL&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> it seems reasonable for the ISS score to be related to the patient&#39;s own sense of health&#46; In other words&#44; the patient&#39;s report of having less itching will be consistent with feeling healthier&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">The MIDs of the Spanish ISS allow us to assume that a patient will perceive improvement if there is a change of at least 4 points in the score&#46; In the study to validate the original version of the ISS&#44; the differences above which the instrument detected improvements was between 2&#46;2 and 5&#46;5 points&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0200" class="elsevierStylePara elsevierViewall">The levels of internal consistency of the Spanish version and the original version<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> were also similar and in both cases over 0&#46;7&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Test-retest reliability was found to lie between 0&#46;61 and 0&#46;66&#46; Thus&#44; this statistic did not reach or exceed the stipulated threshold of 0&#46;70 for the Spanish version and fell below the test-retest reliability of the original&#46; The failure to match this property is probably attributable to the difference in the timing of the first and second testing sessions in the 2 validation studies&#58; retesting of the original version took place at 2 weeks&#44; whereas retesting of the Spanish ISS took place after 3 months had passed&#46; It is to be expected that test-retest reliability would be higher for the shorter period of time&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">The subjective nature of itching might constitute a limitation of this study&#46; As this symptom cannot be measured objectively&#44; validity was assessed by comparing the Spanish ISS score to the same HRQOL questionnaire &#40;the DLQI&#41; that was used in validating the original version of the ISS&#46; Other studies have found HRQOL to be affected in the presence of pruritus in patients with chronic AD&#44;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> as well as in patients with other skin conditions&#44; such as psoriasis<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a> or seborrheic dermatitis&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Given these results&#44; a dermatologist can use the Spanish ISS to monitor the degree or intensity of itching in patients as an indirect measure of the effectiveness of a treatment&#44; to help in setting a treatment regimen for an individual patient&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusions</span><p id="par0215" class="elsevierStylePara elsevierViewall">This study has demonstrated that&#44; like the original version of the ISS&#44; the Spanish instrument has good measurement properties in terms of feasibility&#44; validity&#44; sensitivity to change&#44; and internal consistency&#46; The Spanish ISS can be useful for evaluating the intensity of pruritus in patients with AD&#44; whether children or adults&#44; in routine practice&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Funding</span><p id="par0220" class="elsevierStylePara elsevierViewall">This study was funded by Astellas Pharma&#44; SA&#46;</p></span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of Interest</span><p id="par0225" class="elsevierStylePara elsevierViewall">Dr E&#46; Daud&#233;n is or has been a member of advisory boards&#44; has received consulting fees and research grants&#44; has participated in clinical trials and received speaker&#39;s fees from the following companies&#58; Abbott&#44; Astellas&#44; Biogen&#44; Centocor Ortho Biotech Inc&#44; Galderma&#44; Glaxo&#44; Janssen-Cilag&#44; Leo Pharma&#44; Merck-Serono&#44; Pfizer&#44; Novartis&#44; Schering-Plough&#44; Stiefel&#44; Wyeth Pharmaceuticals&#44; 3<span class="elsevierStyleHsp" style=""></span>M&#44; and Celgene&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">Dr J&#46; S&#225;nchez-P&#233;rez participates or has participated in clinical trials funded by the following pharmaceutical laboratories&#58; Abbott&#44; Astellas&#44; Biogen&#44; Galderma&#44; Pfizer&#44; Shering-Plough&#44; and Wyeth Pharmaceuticals&#46;</p></span></span>"
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                  "identificador" => "sec0070"
                  "titulo" => "Sensitivity to Change"
                ]
                3 => array:2 [
                  "identificador" => "sec0075"
                  "titulo" => "Reliability"
                ]
              ]
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0080"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0085"
          "titulo" => "Conclusions"
        ]
        9 => array:2 [
          "identificador" => "sec0090"
          "titulo" => "Funding"
        ]
        10 => array:2 [
          "identificador" => "sec0095"
          "titulo" => "Conflict of Interest"
        ]
        11 => array:2 [
          "identificador" => "xack35190"
          "titulo" => "Acknowledgments"
        ]
        12 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2011-01-20"
    "fechaAceptado" => "2011-03-20"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec82511"
          "palabras" => array:5 [
            0 => "Questionnaire"
            1 => "Pruritus"
            2 => "Health-related quality of life"
            3 => "Validation"
            4 => "Atopic dermatitis"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec82512"
          "palabras" => array:5 [
            0 => "Cuestionario"
            1 => "Prurito"
            2 => "Calidad de vida relacionada con la salud"
            3 => "Validaci&#243;n"
            4 => "Dermatitis at&#243;pica"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Background and objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The Itch Severity Scale &#40;ISS&#41; facilitates objective assessment of the intensity of pruritus&#46; The aim of this study was to validate a Spanish version of the ISS in patients with atopic dermatitis&#46;</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A prospective epidemiological study was undertaken in patients diagnosed with atopic dermatitis at least 1 year previously and a control group without the disease&#46; Patients with atopic dermatitis were stratified according to the status of the lesions &#40;active or inactive&#41; and questionnaires were completed at baseline and 3-month and 6-month follow-up&#46; Data were collected on sociodemographic variables relating to atopic dermatitis &#40;including the modified Eczema Area and Severity Index &#91;mEASI&#93;&#41;&#44; concomitant disease&#44; and patient measures such as ISS&#44; Dermatology Life Quality Index &#40;DLQI&#41;&#44; and Children&#39;s DLQI &#40;cDLQI&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 207 children &#40;2-17 years&#41; were included&#58; 56 control subjects&#44; 103 patients with active lesions&#44; and 48 with inactive lesions&#46; The mean &#40;SD&#41; age of the participants in this age group was 8&#46;1 &#40;4&#46;0&#41; years&#46; A total of 261 adults &#40;&#8805; 18 years&#41; were included&#58; 89 control subjects&#44; 124 patients with active lesions&#44; and 48 with inactive lesions&#46; The mean age of the adult participants was 32&#46;3 &#40;13&#46;4&#41; years&#46; A response rate of &#62; 80&#37; was obtained on the pediatric ISS &#40;feasibility&#41; and the responses correlated with the mEASI and cDLQI at baseline &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; as an indicator of validity&#46; An effect size of 0&#46;988 was observed &#40;sensitivity to change&#41; along with a Chronbach &#945; of 0&#46;840 &#40;internal consistency&#41;&#46; A response rate of &#62;95&#37; was obtained on the adult ISS &#40;feasibility&#41; and the responses correlated with the mEASI and DLQI at baseline &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&#41; as an indicator of validity&#46; An effect size of 1&#46;0 was observed &#40;sensitivity to change&#41; along with a Chronbach &#945; of 0&#46;825 &#40;internal consistency&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The Spanish version of the ISS is feasible&#44; valid&#44; sensitive to change&#44; and displays good reliability based on internal consistency in both children and adults&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El cuestionario <span class="elsevierStyleItalic">Itch Severity Scale</span> &#40;ISS&#41; permite evaluar objetivamente la intensidad del prurito&#46; El presente estudio pretende validar la versi&#243;n espa&#241;ola del cuestionario ISS en pacientes con dermatitis at&#243;pica &#40;DA&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Materiales y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio epidemiol&#243;gico prospectivo&#44; incluyendo pacientes con DA de m&#225;s de un a&#241;o de evoluci&#243;n y un grupo control sin DA&#46; Los pacientes con DA se estratificaron seg&#250;n actividad de las lesiones &#40;activas&#47;inactivas&#41;&#44; realizando una visita basal y dos de seguimiento &#40;3 y 6 meses&#41;&#46; Se recogieron variables sociodemogr&#225;ficas&#44; relacionadas con la DA &#40;incluyendo el <span class="elsevierStyleItalic">modified Eczema Area and Severity Index</span> o mEASI&#41;&#44; enfermedades concomitantes y medidas del paciente como ISS&#44; <span class="elsevierStyleItalic">Dermatology Life Quality Index</span> &#40;DLQI&#41; o <span class="elsevierStyleItalic">Children&#39;s DLQI</span> &#40;cDLQI&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 207 pacientes pedi&#225;tricos &#40;2-17 a&#241;os&#41;&#58; 56 controles&#44; 103 con lesiones activas y 48 inactivas&#44; con una edad media &#40;DE&#41; de 8&#44;1&#40;4&#44;0&#41; a&#241;os&#46; Los adultos fueron 261 pacientes &#40;&#8805; 18 a&#241;os&#41;&#58; 89 controles&#44; 124 con lesiones activas y 48 inactivas&#44; con una edad media &#40;DE&#41; de 32&#44;3 &#40;13&#44;4&#41; a&#241;os&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">ISS pedi&#225;tricos&#58; tasa de respuesta &#62; 80&#37; &#40;factibilidad&#41;&#44; correlacion&#225;ndose con mEASI y cDLQI en visita basal &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; &#40;validez&#41;&#44; <span class="elsevierStyleItalic">effect size</span> de 0&#44;988 &#40;sensibilidad al cambio&#41; y alpha de Cronbach de 0&#44;840 &#40;consistencia interna&#41;&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">ISS adultos&#58; tasa de respuesta fue &#62; 95&#37; &#40;factibilidad&#41;&#44; correlacion&#225;ndose con mEASI y DLQI en visita basal &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; &#40;validez&#41;&#44; <span class="elsevierStyleItalic">effect size</span> de 1&#44;0 &#40;sensibilidad al cambio&#41;&#44; alpha de Cronbach de 0&#44;825 &#40;consistencia interna&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">La versi&#243;n espa&#241;ola del ISS se mostr&#243; factible&#44; v&#225;lida&#44; sensible al cambio y fiable en t&#233;rminos de consistencia interna&#44; tanto en ni&#241;os como en adultos&#46;</p>"
      ]
    ]
    "NotaPie" => array:2 [
      0 => array:2 [
        "etiqueta" => "a"
        "nota" => "<p class="elsevierStyleNotepara">The reader who wishes to use the questionnaire should seek permission from the original authors&#46;&#46;</p>"
      ]
      1 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Daud&#233;n E&#44; et al&#46; Validaci&#243;n de la versi&#243;n espa&#241;ola de la escla de intensidad del pico &#40;Cuestionario itch Severity Scale&#44; ISS&#41;&#46; Estudio PSEDA&#46; Actas Dermosifiliogr&#46; 2011&#59;102&#58;527-36&#46;</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0240" class="elsevierStylePara elsevierViewall">Las siguientes frases se refieren a lo que usted puede sentir sobre el picor que padece&#46;</p> <p id="par0245" class="elsevierStylePara elsevierViewall">Por favor&#44; lea detenidamente cada una de las preguntas y sus instrucciones para responderlas&#46; Se&#241;ale aquella opci&#243;n u opciones de respuesta que mejor describan lo que usted cree que le pasa&#46;</p> <p id="par0250" class="elsevierStylePara elsevierViewall">No hay respuestas correctas o incorrectas&#46; Simplemente estamos interesados en conocer lo que a usted le ocurre debido al picor que siente&#46;<span class="elsevierStyleVsp" style="height:0.5px"></span></p> <p id="par0255" class="elsevierStylePara elsevierViewall">1&#46; &#191;Con qu&#233; frecuencia siente picor en cada momento del d&#237;a&#63; &#40;por favor&#44; marque con una &#171;X&#187; la casilla que corresponda a su respuesta&#41;<elsevierMultimedia ident="tbl0005"></elsevierMultimedia></p> <p id="par0260" class="elsevierStylePara elsevierViewall">2&#46; &#191;Hasta qu&#233; punto los siguientes t&#233;rminos describen el picor que siente&#63; &#40;por favor&#44; marque con una &#171;X&#187; la casilla que corresponda a su respuesta&#41;<elsevierMultimedia ident="tbl0010"></elsevierMultimedia></p> <p id="par0265" class="elsevierStylePara elsevierViewall">3&#46; Por favor&#44; sombree las zonas donde suele sentir picor</p> <p id="par0270" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleInlineFigure"><elsevierMultimedia class="elsevierStyleLink" ident="fx1"></elsevierMultimedia></span></p> <p id="par0275" class="elsevierStylePara elsevierViewall">4&#46; Indique la intensidad del picor en cada uno de los siguientes casos &#40;por favor&#44; marque con una &#171;X&#187; la casilla que corresponda a su respuesta&#41;<elsevierMultimedia ident="tbl0015"></elsevierMultimedia></p> <p id="par0280" class="elsevierStylePara elsevierViewall">5&#46; &#191;Ha tenido cambios de humor debido al picor&#63; &#40;puede marcar m&#225;s de una respuesta&#41;</p> <p id="par0285" class="elsevierStylePara elsevierViewall">a&#46; Ning&#250;n cambio&#46;</p> <p id="par0290" class="elsevierStylePara elsevierViewall">b&#46; Deprimido&#47;a&#46;</p> <p id="par0295" class="elsevierStylePara elsevierViewall">c&#46; M&#225;s inquieto&#47;a&#46;</p> <p id="par0300" class="elsevierStylePara elsevierViewall">d&#46; Dificultad para concentrarse&#46;</p> <p id="par0305" class="elsevierStylePara elsevierViewall">e&#46; Angustiado&#47;a&#46;<span class="elsevierStyleVsp" style="height:0.5px"></span></p> <p id="par0310" class="elsevierStylePara elsevierViewall">NOTA&#58; La siguiente pregunta &#40;pregunta n&#176; 6&#41; no deber&#225; formularse en los pacientes menores de edad&#46; No ser&#225; tenida en cuenta para la puntuaci&#243;n final en este tipo de pacientes&#46;</p> <p id="par0315" class="elsevierStylePara elsevierViewall">6&#46; &#191;C&#243;mo le ha afectado el picor en lo siguiente&#63; &#40;por favor&#44; marque con una &#171;X&#187; la casilla que corresponda a su respuesta&#41;<elsevierMultimedia ident="tbl0020"></elsevierMultimedia></p> <p id="par0320" class="elsevierStylePara elsevierViewall">7&#46; Indique con qu&#233; frecuencia le ocurre cada una de las siguientes situaciones &#40;por favor&#44; marque con una &#171;X&#187;&#8221; la casilla que corresponda a su respuesta&#41;<elsevierMultimedia ident="tbl0025"></elsevierMultimedia></p> <p id="par0325" class="elsevierStylePara elsevierViewall">Si se quiere utilizar el cuestionario se debe solicitar autorizaci&#243;n</p> <p id="par0330" class="elsevierStylePara elsevierViewall">al autor del cuestionario original&#46;</p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Spanish Version of the Itch Severity Scale"
            "identificador" => "sec0100"
          ]
        ]
      ]
    ]
    "multimedia" => array:11 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2028
            "Ancho" => 3285
            "Tamanyo" => 302704
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Correlation between the pediatric version of the Spanish Itch Severity Scale &#40;ISS&#41; and the modified Eczema Area and Severity &#40;mEASI&#41; &#40;left&#41; and between this ISS version and the Children&#39;s Dermatology Life Quality Index &#40;cDLQI&#41; &#40;right&#41;&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1653
            "Ancho" => 3243
            "Tamanyo" => 229904
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Effect size of the Spanish Itch Severity Scale in terms of self-reported state of health 3 months after baseline in children and adults&#46; State of health was assessed by asking the patient for an opinion expressed in terms of the following possible answers&#58; very good&#44; fairly good&#44; somewhat good&#44; neither good nor bad&#44; fairly bad&#44; and very bad&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 2028
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            "Tamanyo" => 306839
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Correlation between the adult version of the Spanish Itch Severity Scale &#40;ISS&#41; and the modified Eczema Area and Severity &#40;mEASI&#41; &#40;left&#41; and between this ISS version and the Dermatology Life Quality Index &#40;DLQI&#41; &#40;right&#41;&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0030"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Patients With AD</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Controls&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Active Lesions&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Inactive Lesions&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">51 &#40;49&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">27 &#40;56&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">78 &#40;51&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sex</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
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \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" 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"><span class="elsevierStyleHsp" style=""></span>Male&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51 &#40;41&#46;1&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;41&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71 &#40;41&#46;3&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42 &#40;47&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73 &#40;58&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">101 &#40;58&#46;7&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;50&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Unknown&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;2&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">Age</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><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" 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"><span class="elsevierStyleHsp" style=""></span>18-30 y&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65 &#40;52&#46;3&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;64&#46;6&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96 &#40;55&#46;8&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45 &#40;50&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>31-40 y&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26 &#40;21&#46;0&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;20&#46;8&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36 &#40;20&#46;9&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;15&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>41-50 y&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19 &#40;15&#46;3&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;8&#46;3&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;13&#46;4&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>51-60 y&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;5&#46;7&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#46;1&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;4&#46;7&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;16&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;61 y&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;5&#46;7&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;4&#46;2&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;5&#46;2&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;4&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">Education</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><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" 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"><span class="elsevierStyleHsp" style=""></span>No schooling&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;4&#46;0&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;2&#46;1&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;3&#46;5&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Primary school&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;19&#46;4&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 &#40;16&#46;6&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">32 &#40;18&#46;6&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;12&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Secondary school&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="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">48 &#40;38&#46;7&#37;&#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="char" valign="\n
                  \t\t\t\t\ttop\n
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                  \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" 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"><span class="elsevierStyleHsp" style=""></span>Correlation with the mEASI&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"><span class="elsevierStyleItalic">r</span> &#61; 0&#46;54874&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;54444&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Correlation with the cDLQI or DLQI&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"><span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;69165&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;72246&#42;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">Sensitivity to Change</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></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Effect size&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&#46;988&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&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MID&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 points&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">4 points&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><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"><span class="elsevierStyleItalic">Reliability</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></tr><tr title="table-row"><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"><span class="elsevierStyleHsp" style=""></span>Cronbach &#945;&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&#46;840&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&#46;825&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>ICC&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&#46;68-0&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;61-0&#46;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Measurement Properties of the Itch Severity Scale in Pediatric and Adult Populations&#46;</p>"
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            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"><td 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" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Sin picor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Picor ocasional&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Picor frecuente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Picor constante&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ma&#241;ana&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><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" 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">Mediod&#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="" 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><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" 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">Tarde&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><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" 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">Noche&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><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></tbody></table>
                  """
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      7 => array:5 [
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        "mostrarDisplay" => true
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">En absoluto&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Un poco&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Moderadamente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Mucho&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Urticante&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><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" 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">Punzante&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><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" 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">Ardiente&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><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" 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">Molesto&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><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" 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">Insoportable&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><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" 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">Preocupante&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><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></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab181795.png"
              ]
            ]
          ]
        ]
      ]
      8 => array:5 [
        "identificador" => "tbl0015"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Ninguno&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Leve&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Moderado&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Fuerte&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Muy fuerte&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Picor en su estado habitual&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><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" 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">Picor en su estado m&#225;ximo&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><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" 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">Picor en su estado m&#237;nimo&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><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></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab181799.png"
              ]
            ]
          ]
        ]
      ]
      9 => array:5 [
        "identificador" => "tbl0020"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Ning&#250;n cambio&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Disminuci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Deseo sexual&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" 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">Funci&#243;n sexual&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></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab181798.png"
              ]
            ]
          ]
        ]
      ]
      10 => array:5 [
        "identificador" => "tbl0025"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td 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" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Nunca&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">A veces&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Casi siempre&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tiene dificultad para conciliar el sue&#241;o debido al picor&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" 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">Se despierta debido al picor&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" 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">Toma somn&#237;feros&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></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab181796.png"
              ]
            ]
          ]
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
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2022 Noviembre 26 34 60
2022 Octubre 30 23 53
2022 Septiembre 27 46 73
2022 Agosto 26 44 70
2022 Julio 31 53 84
2022 Junio 34 36 70
2022 Mayo 86 49 135
2022 Abril 64 54 118
2022 Marzo 73 74 147
2022 Febrero 65 43 108
2022 Enero 95 52 147
2021 Diciembre 64 52 116
2021 Noviembre 72 48 120
2021 Octubre 75 60 135
2021 Septiembre 71 36 107
2021 Agosto 69 32 101
2021 Julio 54 37 91
2021 Junio 64 50 114
2021 Mayo 60 40 100
2021 Abril 154 92 246
2021 Marzo 131 42 173
2021 Febrero 78 30 108
2021 Enero 80 34 114
2020 Diciembre 60 21 81
2020 Noviembre 56 26 82
2020 Octubre 44 13 57
2020 Septiembre 46 12 58
2020 Agosto 53 34 87
2020 Julio 55 13 68
2020 Junio 55 31 86
2020 Mayo 61 28 89
2020 Abril 38 17 55
2020 Marzo 44 20 64
2020 Febrero 5 0 5
2020 Enero 0 1 1
2019 Diciembre 4 4 8
2019 Noviembre 0 3 3
2019 Septiembre 11 1 12
2019 Julio 0 7 7
2019 Junio 2 17 19
2019 Mayo 0 29 29
2019 Abril 0 63 63
2019 Marzo 2 3 5
2019 Enero 2 0 2
2018 Noviembre 1 0 1
2018 Octubre 1 0 1
2018 Septiembre 2 0 2
2018 Marzo 2 0 2
2018 Febrero 37 2 39
2018 Enero 45 7 52
2017 Diciembre 51 6 57
2017 Noviembre 45 4 49
2017 Octubre 30 4 34
2017 Septiembre 43 4 47
2017 Agosto 53 10 63
2017 Julio 50 4 54
2017 Junio 68 4 72
2017 Mayo 58 5 63
2017 Abril 55 8 63
2017 Marzo 50 23 73
2017 Febrero 40 5 45
2017 Enero 31 9 40
2016 Diciembre 49 11 60
2016 Noviembre 62 8 70
2016 Octubre 65 10 75
2016 Septiembre 100 22 122
2016 Agosto 63 11 74
2016 Julio 39 10 49
2016 Junio 15 8 23
2016 Mayo 12 7 19
2016 Abril 5 26 31
2016 Marzo 12 10 22
2016 Febrero 12 9 21
2016 Enero 12 12 24
2015 Diciembre 13 6 19
2015 Noviembre 14 10 24
2015 Octubre 21 1 22
2015 Septiembre 12 5 17
2015 Agosto 19 4 23
2015 Julio 62 13 75
2015 Junio 54 7 61
2015 Mayo 103 11 114
2015 Abril 68 11 79
2015 Marzo 51 10 61
2015 Febrero 66 8 74
2015 Enero 37 9 46
2014 Diciembre 56 13 69
2014 Noviembre 41 9 50
2014 Octubre 64 14 78
2014 Septiembre 62 11 73
2014 Agosto 51 16 67
2014 Julio 74 16 90
2014 Junio 79 10 89
2014 Mayo 82 23 105
2014 Abril 55 12 67
2014 Marzo 68 24 92
2014 Febrero 40 23 63
2014 Enero 55 29 84
2013 Diciembre 54 15 69
2013 Noviembre 43 24 67
2013 Octubre 55 24 79
2013 Septiembre 39 31 70
2013 Agosto 5 30 35
2013 Julio 8 50 58
2013 Junio 5 26 31
2013 Mayo 14 32 46
2013 Abril 15 25 40
2013 Marzo 11 13 24
2013 Febrero 25 8 33
2013 Enero 13 5 18
2012 Diciembre 14 3 17
2012 Octubre 0 4 4
2012 Septiembre 2 0 2
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