Opinion article
Cultural Practices in Immigrant Populations and their Relevance to Dermatology
La influencia en dermatología de las prácticas culturales de la población inmigrante
Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, Spain
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Source: http://www.nelm.nhs.uk/en/NeLM-Area/News/2011---January/17/Marketing-authorisation-application-for-briakinumab-Ozespa-withdrawn- (last accessed January 30, 2012).<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a></p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. Puig" "autores" => array:1 [ 0 => array:2 [ "nombre" => "L." 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Albares, I. Belinchón" "autores" => array:2 [ 0 => array:4 [ "nombre" => "M.P." "apellidos" => "Albares" "email" => array:1 [ 0 => "pityalte@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Belinchón" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario de Alicante, Alicante, Spain" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La influencia en dermatología de las prácticas culturales de la población inmigrante" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The inequalities between different countries today are considerable; many countries in the world are involved in armed conflict and in many others a large part of the population lives below the poverty line.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> As a result, migration is increasing, as many people emigrate in search of a better quality of life. In Spain, we have witnessed exponential growth in immigration for more than a decade, although this trend appears to have slowed since 2011 as a result of the current economic crisis. Nevertheless, at the end of 2011, foreign residents in Spain (5 700 000) accounted for 12.2% of the country's population; 3 300 000 of these were economic migrants.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> This is a heterogeneous group made up of people from Latin America, eastern Europe, and Asia. Depending on their country of origin, these populations present distinctive characteristics that reflect their differing cultures and traditions, and these may sometimes affect the way they view health and disease and influence their attitudes when they are ill. Certain population groups also have specific cultural practices that can favor the appearance of certain skin diseases.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Importance of Dietary Habits in Health and Cultural Factors That Affect the Doctor-Patient Relationship</span><p id="par0010" class="elsevierStylePara elsevierViewall">The Islamic faith is strongly rooted among the Muslim population and may affect the behavior of this group. Most Muslims observe Ramadan, Islam's holy month of fasting. Ramadan begins on the first day of the ninth month of the Islamic lunar calendar. During the month of Ramadan, Muslims abstain from eating, drinking, smoking and engaging in sexual relations from sunrise until sunset to worship Allah and demonstrate their adherence to the doctrine revealed in the Quran of the prophet Muhammad. Some Muslims may choose not to take medication during the hours of fasting. Children, the sick, and women who are pregnant or breastfeeding are exempt from fasting.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> It is therefore important for health care workers to know whether patients are observing the month of Ramadan, as this period may lead to metabolic changes (increased levels of uric acid, cholesterol, and thyroid hormones in the blood, and hydrochloric acid in the stomach), nutritional changes (weight loss and dehydration), and mental changes (fatigue and reduced cognitive function); furthermore, diabetic patients may present more frequent episodes of hypoglycemia.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The Muslim population also presents several unique characteristics in terms of dietary habits. The foods permitted in the Muslim diet are called <span class="elsevierStyleItalic">halal</span> foods. For food to be considered <span class="elsevierStyleItalic">halal</span>, it must conform to the Islamic rules set out in the Quran, the traditions of the Prophet, and the teachings of Islamic lawgivers. According to these rules, the food must be free of any forbidden substance or ingredient or any component from a forbidden animal (pig, wild boar, carrion, animals that have been strangled or beaten to death, animals with claws or fangs, birds of prey or carrion birds, and harmful animals), and must not come into contact with any forbidden product while it is being prepared. Today, Muslim consumers prefer to eat <span class="elsevierStyleItalic">halal</span> products more for sociocultural reasons and reasons of identity than for religious reasons.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In general, Muslims do not drink alcohol, although this may not always be the case among communities living outside of or marginalized from Muslim populations.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Muslims tend to see disease as an imbalance between body and soul and believe that it may be the result of failure to comply with the rules governing religious precepts, a belief that makes the individual responsible for the illness.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> It is important to understand the specific characteristics of this population when prescribing treatment: Muslim women do not accept injectable treatments during menstruation; nor should we prescribe syrups, tonics or antiseptics containing alcohol to Muslim patients.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">With regard to physical examinations, it should be noted that Muslim women, like Hindu and Buddhist women, are reticent about undressing and about undergoing vaginal examinations, particularly if they are unaccompanied and the physician is a man.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Muslims also tend to be reluctant to accept organ donations, transplants, transfusions, or autopsies.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The Chinese population is the community with the strongest tendency to maintain its own social and family structures and cultural activities and make relatively little contact with local and national social activities in the host country. The family is an essential component in the social life of the Chinese community. For young people, respect for parents, elders, and authority figures such as teachers and masters is very important.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Chinese women have traditionally been seen as submissive and committed to marriage and family life, but Mao Zedong's cultural revolution and the later westernization of life in China have changed this situation. Equality between men and women has become apparent in practically all aspects of life in modern China.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The Chinese view health as a question of balance between the forces of <span class="elsevierStyleItalic">yin</span> and <span class="elsevierStyleItalic">yang</span>. Yin represents darkness, the moon, femininity, passiveness, and yielding, whereas yang represents light, the sun, masculinity, activity, and resisting. These principles are not opposing or contrary but complementary and interdependent. Yin and yang are of equal importance, as one cannot exist without the other: light is not the opposite of shadow and that which yields is not the opposite of that which resists. Any deficit or excess in the circulation of this energy produces an imbalance that results in disease.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In terms of nutrition, there is a belief that some foods are heat-inducing while others are cooling—yin and yang again. For example, pregnancy is considered a <span class="elsevierStyleItalic">hot</span> state and it is therefore considered advisable to reduce the consumption of heat-inducing foods (red meat and fats in general) and increase the intake of cooling foods (fruit and vegetables).<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> It is common to see the family members of Chinese patients who have been admitted to hospital bring them the foods that, according to traditional Chinese medicine, are most appropriate for their illness.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Chinese immigrants tend to use medical and social services much less than immigrants from other regions. This may be because Chinese patients are, in general, prepared to suffer more and because they trust in self-administered natural remedies. They also tend to work 12<span class="elsevierStyleHsp" style=""></span>hours a day and thus have little time to visit the doctor, a difficulty that is further compounded by the language barrier.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Chinese patients consider drips to be a cure-all in the treatment of any illness and prefer drugs that are administered parenterally. In general, they do not accept enemas or suppositories, and are reluctant to have blood taken, as they believe that this weakens their health. They tend to see the loss of teeth as an inevitable consequence of age and rarely visit the dentist.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Continuous consumption of <span class="elsevierStyleItalic">chapati</span> (a type of wholemeal bread) in Asian communities interferes with the absorption of calcium in the intestines and eventually leads to neonatal hypocalcemia, rickets, and osteoporosis. Chewing betel leaves is also a widespread habit among Asians. Betel is the leaf of a vine grown in South and Southeast Asia. It has somewhat minty flavor, stains the teeth and mucosa a characteristic red color, and can cause kidney stones and mouth ulcers, which occasionally turn malignant.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Hindus are not allowed to eat beef and those who are vegetarians consume <span class="elsevierStyleItalic">karela</span> or bitter melon, a plant of the cucurbitaceae family that can cause hypoglycemia.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">In Latin-American culture, the concept of disease is closely linked to the body and much importance is placed on physical examinations, additional testing, and the use of technology to diagnose the disease. In contrast to this, Africans sometimes refuse to have blood taken because of the link they have experienced between blood and different practices of witchcraft and black magic.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">It is important to know that, for some immigrant populations, alternative medicines, which are traditional in their country of origin, may continue to play an important role in our country. The use of witch doctors ceases to be important when these populations (particularly Latin Americans) come to Spain, owing to the ease of access to health care. Once in Spain, these populations associate the use of witch doctors with the lack of money and with the culture of their country. Africans are less willing to talk about traditional healing practices and it is possible that they continue to believe in their power and may even continue to use them in Spain.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Dermatoses Caused by Cultural Practices</span><p id="par0075" class="elsevierStylePara elsevierViewall">The cultural practices of certain immigrant groups can lead to skin abnormalities or the appearance of certain skin diseases. These include coining, cupping, and moxibustion, practices that are usually carried out by Asians.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Understanding these traditional practices will help us to avoid social and legal conflicts that may arise from mistaken diagnoses of abuse, particularly in children.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The application of coins (coining) is used to treat febrile diseases in children, headaches, and myalgia. The practice consists of rubbing a coin, usually made of copper or silver, over the skin of the chest or back until the skin becomes reddened or purple.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The coin is immersed in wine, water, or aromatic oils before being applied.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The application of suction cups (cupping) is a technique used widely in Asian countries, but also in Eastern Europe. It has been used for different purposes: eliminating toxins from the body, improving illness by transferring the pain to other parts of the body, and in the treatment of pneumonia, asthma, and nephritis.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Currently the most common use is to treat chronic pain such as lower back pain or headaches.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> The procedure is performed by lighting alcohol-soaked cotton wool and placing it in a cup-shaped receptacle, which is then applied to the skin. As the alcohol burns a vacuum is created, which sucks on the skin. This suction damages the surface blood vessels of the papillary dermis and produces circular areas of erythema, ecchymosis, purpura, or blood-filled blisters. The most common areas of application are the back, chest, abdomen, and buttocks.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Moxibustion is a common practice among Asians. The aim of the practice is to balance the forces of yin and yang. It consists of burning cones of wood from the <span class="elsevierStyleItalic">Artemisia vulgaris</span> plant close to or on the skin.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> The practice causes circular burns that usually present on the navel, chest, wrists, ankles, and scalp.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Scarring is another cultural practice used in some African societies. It consists of producing scars on the skin by means of cuts or burns. It is used for both decorative and medicinal purposes.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,14</span></a> There is also a custom among the women of some African societies of tattooing their gums for esthetic purposes or as a mark of tribal identity and this should lead us to include racial pigmentation, metal poisoning, tattoos using amalgams, etc. in the differential diagnosis.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The application of certain products to the hair may lead to the development of certain skin diseases. Mudi-chood is a lichenoid dermatitis that appears on the neck and back of Indian women from the state of Kerala. It is associated with the application of oils to the hair, in combination with the conditions of heat and humidity that obtain in that part of the world.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> There are also differences between the hair of black and white populations. In black people, the curvature of the hair follicles is greater, hairs are flatter and elliptical in shape, making them more fragile, and have fewer elastic fibers; the roots contains more melanosomes and the melanin granules in the shaft are more numerous.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The biological differences in the hair, together with certain traditional hairstyling practices used among black people (particularly women)—such as hot combs, hair-straightening products, creams, rollers, and extensions—favor the development of alopecia. Two forms of alopecia have been described in this setting: frontal and temporal alopecia<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and central centrifugal cicatricial alopecia on the crown.<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17–19</span></a> The application of hair creams by patients with black skin has also been linked to acne.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Of note among Latin-American patients are dermatitis due to capsaicin and prayer nodules. Chili peppers are a commonly used condiment in several Latin-American countries. People who manipulate them may present erythema, edema, and pain in the skin of the hands. The capsaicin in the peppers depolarizes the nerve endings, leading to vasodilation, smooth-muscle stimulation and activation of the sensory nerves. It is important to prevent this condition by using gloves. When symptoms appear, the hands should be washed with abundant soap and water and submerged in vegetable oil for an hour; corticosteroids and topical anesthetics may also be used.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Prayer nodules are calluses caused by pressure on certain points of the body while praying. These nodules have become less frequent since the Catholic Church removed the obligation to kneel during mass, but they are still seen in highly religious individuals—usually elderly Latin-American women—who continue this practice while praying, sometimes for hours.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> These lesions are also characteristic in the Muslim population; Muslims often pray 5 times a day and may present lesions on the forehead, knees, ankles, and dorsa of the feet.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Another practice found among Muslim women is tattooing with henna or <span class="elsevierStyleItalic">haarqus</span> for social occasions. Allergic contact dermatitis has been described in association with this practice, in most cases due to the presence of paraphenylenediamine in the dye.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23,24</span></a> Similarly, some Indian women develop allergic contact dermatitis caused by certain components of the <span class="elsevierStyleItalic">bindi</span>, the pigment they apply to their foreheads in certain ceremonies.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">The change in Spain's demographic composition has changed the profile of the patients we see in our clinics. As we have seen, the cultural practices and customs of immigrant populations may favor the appearance of certain skin diseases or modify their form of presentation. Understanding of and respect for the different cultures we live with may be of great help in our routine daily practice.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Importance of Dietary Habits in Health and Cultural Factors That Affect the Doctor-Patient Relationship" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Dermatoses Caused by Cultural Practices" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Albares MP, Belinchón I. La influencia en dermatología de las prácticas culturales de la población inmigrante. Actas Dermosifiliogr. 2012;103:849–52.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:25 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inmigración y salud" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. López-Vélez" 1 => "H. Huerga" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2002" "editorial" => "PBM, SL" "editorialLocalizacion" => "Madrid" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "INE.es, Instituto Nacional de Estadística (sede web). Madrid: INE.es; [consultado 1/2/2012]. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 17 | 15 | 32 |
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| 2024 Septiembre | 78 | 38 | 116 |
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| 2023 Noviembre | 49 | 32 | 81 |
| 2023 Octubre | 35 | 31 | 66 |
| 2023 Septiembre | 55 | 28 | 83 |
| 2023 Agosto | 33 | 24 | 57 |
| 2023 Julio | 35 | 44 | 79 |
| 2023 Junio | 53 | 25 | 78 |
| 2023 Mayo | 48 | 31 | 79 |
| 2023 Abril | 48 | 28 | 76 |
| 2023 Marzo | 49 | 25 | 74 |
| 2023 Febrero | 40 | 19 | 59 |
| 2023 Enero | 28 | 29 | 57 |
| 2022 Diciembre | 68 | 48 | 116 |
| 2022 Noviembre | 36 | 35 | 71 |
| 2022 Octubre | 24 | 21 | 45 |
| 2022 Septiembre | 22 | 42 | 64 |
| 2022 Agosto | 34 | 42 | 76 |
| 2022 Julio | 35 | 48 | 83 |
| 2022 Junio | 32 | 23 | 55 |
| 2022 Mayo | 57 | 44 | 101 |
| 2022 Abril | 63 | 38 | 101 |
| 2022 Marzo | 62 | 68 | 130 |
| 2022 Febrero | 63 | 44 | 107 |
| 2022 Enero | 64 | 35 | 99 |
| 2021 Diciembre | 38 | 42 | 80 |
| 2021 Noviembre | 36 | 46 | 82 |
| 2021 Octubre | 40 | 53 | 93 |
| 2021 Septiembre | 37 | 42 | 79 |
| 2021 Agosto | 39 | 30 | 69 |
| 2021 Julio | 29 | 27 | 56 |
| 2021 Junio | 27 | 29 | 56 |
| 2021 Mayo | 33 | 33 | 66 |
| 2021 Abril | 49 | 69 | 118 |
| 2021 Marzo | 54 | 25 | 79 |
| 2021 Febrero | 57 | 22 | 79 |
| 2021 Enero | 25 | 15 | 40 |
| 2020 Diciembre | 26 | 25 | 51 |
| 2020 Noviembre | 28 | 17 | 45 |
| 2020 Octubre | 20 | 13 | 33 |
| 2020 Septiembre | 33 | 11 | 44 |
| 2020 Agosto | 20 | 17 | 37 |
| 2020 Julio | 15 | 14 | 29 |
| 2020 Junio | 32 | 22 | 54 |
| 2020 Mayo | 21 | 30 | 51 |
| 2020 Abril | 24 | 15 | 39 |
| 2020 Marzo | 26 | 17 | 43 |
| 2020 Febrero | 5 | 3 | 8 |
| 2020 Enero | 4 | 3 | 7 |
| 2019 Diciembre | 4 | 2 | 6 |
| 2019 Noviembre | 4 | 3 | 7 |
| 2019 Octubre | 0 | 1 | 1 |
| 2019 Septiembre | 4 | 1 | 5 |
| 2019 Agosto | 4 | 0 | 4 |
| 2019 Julio | 4 | 2 | 6 |
| 2019 Junio | 4 | 3 | 7 |
| 2019 Mayo | 4 | 13 | 17 |
| 2019 Abril | 2 | 1 | 3 |
| 2019 Marzo | 0 | 9 | 9 |
| 2019 Febrero | 2 | 0 | 2 |
| 2019 Enero | 1 | 0 | 1 |
| 2018 Diciembre | 4 | 0 | 4 |
| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Octubre | 1 | 0 | 1 |
| 2018 Septiembre | 4 | 0 | 4 |
| 2018 Marzo | 3 | 0 | 3 |
| 2018 Febrero | 29 | 3 | 32 |
| 2018 Enero | 32 | 7 | 39 |
| 2017 Diciembre | 53 | 11 | 64 |
| 2017 Noviembre | 25 | 6 | 31 |
| 2017 Octubre | 39 | 6 | 45 |
| 2017 Septiembre | 31 | 11 | 42 |
| 2017 Agosto | 30 | 14 | 44 |
| 2017 Julio | 28 | 6 | 34 |
| 2017 Junio | 34 | 21 | 55 |
| 2017 Mayo | 41 | 13 | 54 |
| 2017 Abril | 28 | 9 | 37 |
| 2017 Marzo | 33 | 13 | 46 |
| 2017 Febrero | 26 | 11 | 37 |
| 2017 Enero | 21 | 20 | 41 |
| 2016 Diciembre | 36 | 4 | 40 |
| 2016 Noviembre | 39 | 4 | 43 |
| 2016 Octubre | 44 | 28 | 72 |
| 2016 Septiembre | 41 | 14 | 55 |
| 2016 Agosto | 62 | 18 | 80 |
| 2016 Julio | 33 | 11 | 44 |
| 2016 Junio | 12 | 16 | 28 |
| 2016 Mayo | 5 | 17 | 22 |
| 2016 Abril | 7 | 7 | 14 |
| 2016 Marzo | 17 | 7 | 24 |
| 2016 Febrero | 7 | 8 | 15 |
| 2016 Enero | 5 | 10 | 15 |
| 2015 Diciembre | 10 | 4 | 14 |
| 2015 Noviembre | 10 | 8 | 18 |
| 2015 Octubre | 11 | 8 | 19 |
| 2015 Septiembre | 11 | 7 | 18 |
| 2015 Agosto | 14 | 7 | 21 |
| 2015 Julio | 52 | 4 | 56 |
| 2015 Junio | 32 | 13 | 45 |
| 2015 Mayo | 41 | 11 | 52 |
| 2015 Abril | 59 | 10 | 69 |
| 2015 Marzo | 42 | 15 | 57 |
| 2015 Febrero | 49 | 11 | 60 |
| 2015 Enero | 23 | 16 | 39 |
| 2014 Diciembre | 50 | 13 | 63 |
| 2014 Noviembre | 13 | 8 | 21 |
| 2014 Octubre | 22 | 8 | 30 |
| 2014 Septiembre | 5 | 6 | 11 |
| 2014 Agosto | 17 | 10 | 27 |
| 2014 Julio | 8 | 7 | 15 |
| 2014 Junio | 27 | 4 | 31 |
| 2014 Mayo | 38 | 8 | 46 |
| 2014 Abril | 28 | 2 | 30 |
| 2014 Marzo | 33 | 11 | 44 |
| 2014 Febrero | 17 | 5 | 22 |
| 2014 Enero | 10 | 3 | 13 |
| 2013 Diciembre | 14 | 6 | 20 |
| 2013 Noviembre | 16 | 6 | 22 |
| 2013 Octubre | 8 | 6 | 14 |
| 2013 Septiembre | 15 | 2 | 17 |
| 2013 Agosto | 15 | 11 | 26 |
| 2013 Julio | 12 | 9 | 21 |
| 2013 Junio | 13 | 16 | 29 |
| 2013 Mayo | 13 | 6 | 19 |
| 2013 Abril | 14 | 15 | 29 |
| 2013 Marzo | 16 | 9 | 25 |
| 2013 Febrero | 30 | 5 | 35 |
| 2013 Enero | 32 | 6 | 38 |
| 2012 Diciembre | 22 | 6 | 28 |
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