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with a total of 213 diagnoses reached during the 1-year study period&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">3</span></a> Another study&#44; carried out in Granada in patients over 65 years of age&#44; found that basal cell carcinoma was the most frequent diagnosis&#44; followed by actinic keratosis&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">A recent analysis of the burden of skin disease in the United States found that 26&#46;9&#37; of the population was seen by a physician for a skin condition in 2013&#44; generating high direct and indirect costs&#44; comparable to those associated with conditions such as diabetes or cardiovascular disease&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">6</span></a> In view of the large number of patients seen in dermatology clinics each year&#44; accurate knowledge about the most prevalent diseases would make it possible to analyze the management of these diseases and the costs associated with their treatment&#44; and to distribute the available resources more efficiently in accordance with demand&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The diagnoses made by dermatologists in Spain have not previously been described by a prospective study of a representative sample of the country&#39;s dermatologists&#46; The aim of this study was to estimate the prevalence of the diagnoses reached by members of the Spanish Academy of Dermatology and Venereology &#40;AEDV&#41; at dermatology clinics in Spain as well as the volume of activity&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">Prevalence data were obtained in the DIADERM study through an anonymous survey of a representative random sample of dermatologists&#46; The project was coordinated by the AEDV&#39;s Spanish Group for Epidemiology and Health Promotion in Dermatology&#44; in collaboration with the academy&#39;s research unit&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">We selected a random sample of dermatologists drawn from the AEDV list &#40;which consisted of 2224 dermatologists as of November 2015&#41; and stratified by geographic area &#40;the AEDV is organized in sections that correspond approximately to Spain&#39;s autonomous communities&#44; although the smallest communities are grouped together&#41;&#46; The probability of selection was proportional to the number of dermatologists in each geographic area&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">To maximize the response rate&#44; the study was advertised through the AEDV&#39;s communication channels&#46; All selected dermatologists were personally contacted by the study&#39;s regional coordinators and were offered upfront compensation for their participation&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a> Several reminders were also sent before the starting date of the study&#46; After they agreed to participate&#44; the selected dermatologists received instructions on how to collect the data required&#46; Each participant recorded all diagnoses reached in the course of their clinical practice on 6 specified days &#40;January 19&#44; 20&#44; and 21 and May 18&#44; 19&#44; and 20&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">To estimate percentages of 5 per 1000 with a precision of &#177;2 per 1000 and a 95&#37; CI using a simple random sample&#44; data from 4778 consultations would be needed &#40;assuming 1 diagnosis per patient&#41;&#46; Since consultations were grouped by dermatologist and a certain degree of diagnostic correlation was possible&#44; it was important to consider the sampling method used &#40;design effect&#41;&#46; A design effect of approximately 2 was assumed&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">An earlier publication estimated that 97&#37; of dermatologists in Spain are AEDV members and that the mean number of daily consultations per dermatologist is 23&#46;6&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">8</span></a> If a dermatologist handles approximately 23 consultations per day&#44; the total number of patients seen in 6 days is 138&#46; Therefore&#44; 35 dermatologists would be needed in order to reach an adequate estimate using a simple random sample&#46; Taking the design effect into account&#44; a total of 70 dermatologists would be needed&#46; Assuming a 60&#37; response rate and with corrections for each geographic area&#44; we decided to contact 124 dermatologists&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">At each consultation&#44; the dermatologist collected the following data&#58; diagnosis &#40;free text&#41;&#44; whether or not the patient was under 18 years of age&#44; whether or not the consultation was done by teledermatology&#44; reason for consultation&#44; and any secondary diagnoses&#46; If multiple diagnoses were established for a single patient&#44; these diagnoses were marked as grouped&#46; Other variables considered were whether the consultation took place in a public or private health care setting &#40;a consultation was considered to have taken place in a public setting if the cost of medication was covered&#41;&#46; Since many dermatologists work in both public and private settings&#44; this aspect was associated not with the dermatologist but with the consultation&#46; The origin of the visit&#8212;direct access to the dermatologist without a filter appointment&#44; referral from primary care&#44; referral from another specialist&#44; or follow-up visit&#8212;was recorded&#46; The patient destination was also recorded&#58; discharge&#44; follow-up with the dermatologist &#40;including surgery&#41;&#44; or follow-up with another physician&#46; Neither personal data nor information about treatments were collected&#46; Diagnosis was the unit of analysis&#46; The dermatologists recorded diagnoses that corresponded to the reason for seeking care as well as any other diagnoses for which treatment&#8212;either medical or surgical&#8212;was prescribed&#46; The survey was anonymous and no information was collected about the characteristics of the participating dermatologists or about their hospitals or clinics&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The diagnoses were coded by a dermatologist &#40;AML&#41; expert in applying the International Classification of Diseases&#44; 10th revision &#40;ICD-10&#41;&#46; Textual descriptions of the diagnoses recorded in the survey and the corresponding codes were stored in a database&#46; Quality control of the data coding was performed using a random sample of surveys&#46; All diagnoses about which doubts existed were reviewed by 3 dermatologists with a particular interest in coding &#40;YG&#44; RT&#44; and IGD&#41;&#44; who belonged to the AEDV E-Dermatology and Imaging Group&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The statistical analysis took into account the data collection design and was carried out using the survey module of the Stata software package&#44;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">9</span></a> which incorporates standard error correction for correlated data&#46; A finite population correction was not necessary because the real number of dermatologists yielded values close to 1 for each AEDV section&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The study was classified by the Spanish Agency of Medicines and Medical Devices as a non-postauthorization study and was approved by the research ethics committee of Granada province &#40;October 8&#44; 2014&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">Of the 124 randomly selected dermatologists&#44; 80 &#40;65&#37;&#41; participated in the first phase of the study and 73 &#40;59&#37;&#41; in the second&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Over the 6-day study period&#44; 11 223 diagnoses were recorded&#44; but 224 were excluded because they were procedures and therefore could not be coded&#46; A total of 10 999 diagnoses in 8953 patients were ultimately obtained&#44; representing an estimated total of 208 141 diagnoses reached in 169 517 patients by all AEDV dermatologists&#46; Hereinafter we will refer to the estimated data based on the total number of AEDV dermatologists&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">As for the data coding quality control&#44; a minimal error percentage &#40;0&#46;16&#37;&#41; was found in a sample of 621 diagnoses &#40;5&#37; of the total&#41;&#46; In addition&#44; all 764 diagnoses about which coding-related doubts existed &#40;7&#37; of the total&#41; and an additional random sample of 1231 diagnoses &#40;11&#37; of the total&#41; were reviewed by a group of dermatologists with a particular interest in coding&#44; who belonged to the AEDV E-Dermatology and Imaging Group&#46; Errors were found in 79 &#40;4&#37;&#41; of these 1995 diagnoses&#46;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Estimated Incidence of Consultations</span><p id="par0085" class="elsevierStylePara elsevierViewall">Extrapolating the 6-day study period to the 22 working days in a month&#44; an estimated 621 562 patients &#40;95&#37; CI&#44; 368 130-874 995&#41; are seen by a dermatologist in Spain each month&#44; the equivalent of 28&#46;2 &#40;95&#37; CI&#44; 25&#46;2-31&#46;2&#41; patients per day per clinic&#46; The consultations were distributed geographically as shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Central Spain and Valencia were the geographic areas with the most consultations per month&#44; each accounting for more than 100 000 patients &#40;more than 16&#37; of the total&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Consultation Characteristics</span><p id="par0090" class="elsevierStylePara elsevierViewall">During the 6-day study period&#44; an estimated 208 141 diagnoses &#40;122 342-293 939&#41; were made by AEDV dermatologists&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the distribution of the diagnoses by chapter of the ICD-10&#46; The most common diagnoses&#44; logically&#44; were diseases of the skin&#44; followed by neoplasms and certain infectious and parasitic diseases&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">However&#44; when the estimated diagnoses are classified by a more detailed breakdown of ICD-10 categories &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#44; we find that the most frequent diagnosis was skin changes &#40;L57&#41;&#44; particularly actinic keratoses&#46; An estimated 16 972 such cases &#40;95&#37; CI&#44; 10 434-23 511&#41; were diagnosed over the 6-day study period&#46; Nonmelanoma skin cancers &#40;C44&#41;&#44; particularly basal cell carcinoma&#44; were the second most frequent diagnosis&#44; with an estimated 16 756 cases &#40;95&#37; CI&#44; 8776-24 735&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows the 10 most frequent categories&#44; as well as atopic dermatitis and urticaria&#44; which were the 11th and 28th most frequent categories&#44; respectively&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Consultation Types</span><p id="par0105" class="elsevierStylePara elsevierViewall">The consultations took place at a clinic in 99&#37; of cases &#40;95&#37; CI&#44; 97&#37;-99&#46;7&#37;&#41; and teledermatology was used in 1&#37; of diagnoses &#40;95&#37; CI&#44; 0&#46;3&#37;-3&#46;0&#37;&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Reasons for Seeking Care</span><p id="par0110" class="elsevierStylePara elsevierViewall">The principal diagnosis reached during the consultation was the main reason for seeking care in 82&#37; of cases &#40;95&#37; CI&#44; 80&#46;7&#37;-84&#46;7&#37;&#41;&#46; Of the diagnoses that required some sort of treatment&#44; 17&#46;2&#37; &#40;15&#46;3&#37;-19&#46;3&#37;&#41; were reached as a consequence of a secondary consultation with the dermatologist&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Percentage of Patients Under 18 Years of Age</span><p id="par0115" class="elsevierStylePara elsevierViewall">Although patient age was not included in the survey&#44; the dermatologists did record whether or not patients were under 18 years of age&#46; Patients were under 18 years of age in 11&#46;7&#37; of cases &#40;95&#37; CI&#44; 9&#46;1&#37;-14&#46;9&#37;&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the estimated number of diagnoses in patients under 18 years of age&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Public or Private Health Care Settings</span><p id="par0120" class="elsevierStylePara elsevierViewall">Another important variable recorded was whether the consultation took place in a public or private health care setting&#46; Consultations took place in public settings in 68&#46;3&#37; of cases &#40;95&#37; CI&#44; 55&#46;7&#37;-78&#46;7&#37;&#41; and in private settings in 31&#46;7&#37; of cases &#40;95&#37; CI&#44; 21&#46;3&#37;-44&#46;3&#37;&#41;&#46; The diagnoses reached most frequently in private settings were similar to those reached in public settings&#44; with the 5 most common diagnoses being seborrheic keratosis&#44; other benign neoplasms of the skin&#44; melanocytic nevi&#44; other disorders of pigmentation &#40;solar lentigo&#47;chloasma&#41;&#44; and skin changes &#40;actinic keratosis&#41;&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Patient Origins</span><p id="par0125" class="elsevierStylePara elsevierViewall">The top half of <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> shows the estimated percentages for patient origin before consultation with the dermatologist&#46; The figures reveal differences between public and private health care settings&#46; The most common patient origin in public settings was a primary health care consultation &#40;42&#46;3&#37;&#41;&#46; In private settings&#44; the most common patient origin was direct access to the specialist without a filter appointment &#40;74&#46;7&#37;&#41;&#46; Follow-up was the patient origin in 42&#37; of cases in public settings and 15&#46;7&#37; in private settings&#46; <a class="elsevierStyleCrossRef" href="#tbl0030">Table 6</a> analyzes the diagnoses as a function of whether the patient was seeking care for the first time or attending a follow-up visit&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><elsevierMultimedia ident="tbl0030"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Patient Destinations After Consultation</span><p id="par0130" class="elsevierStylePara elsevierViewall">The bottom half of <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a> shows the estimated percentages for patient destination after consultation with the dermatologist&#46; The most common patient destination&#44; occurring in nearly 66&#37; of cases &#40;including follow-up appointments&#41;&#44; was a new appointment with the dermatologist&#46; Patients were discharged in nearly 30&#37; of cases&#46; The destination was consultation with another specialist in just 2&#37; of cases and referral to a primary care physician in 5&#37; of cases&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0135" class="elsevierStylePara elsevierViewall">We estimate that more than 600 000 patients are seen by AEDV dermatologists each month in Spain&#44; with an average of 28 patients seen per day per clinic&#46; The most frequent diagnosis was actinic keratosis&#44; followed by basal cell carcinoma and melanocytic nevus&#46; The vast majority of visits took place at clinics and less than 1&#37; of patients were assessed using teledermatology&#46; In one third of cases&#44; the consultation took place in a private health care setting and the dermatologist was the patient&#39;s origin as well as destination&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Our findings show that a large number of patients are seen by AEDV dermatologists in Spain each month&#46; Our figures are somewhat higher than those published by the Spanish Ministry of Health in 2014 &#40;the most recent data on real activity currently available&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">10</span></a> which indicate an annual total of 5 177 878 dermatology consultations in public and private health care facilities &#40;hospitals and outpatient clinics&#41;&#46; According to the ministry&#39;s report&#44; 910 624 consultations &#40;17&#46;5&#37;&#41; took place in private health care settings&#44; a lower percentage than that found in our study &#40;31&#46;7&#37;&#41;&#46; One possible explanation for this difference is that some private dermatology clinics are not included in the ministry&#39;s information collection systems&#46; In fact&#44; the ministry&#39;s statistics on specialized care centers are based on information provided by the centers listed in the national catalogue of hospitals&#44; which omits many private dermatology clinics&#46; According to the ministry&#39;s data&#44; dermatology consultations accounted for 4&#46;7&#37; of all consultations&#44; behind higher-volume specialties such as ophthalmology&#44; traumatology&#44; and gynecology but ahead of all others&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">10</span></a> The mean number of daily consultations in our study&#8212;28&#46;2 patients per day per dermatologist&#8212;was higher than the figure of 23&#46;6 obtained in a previous study&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">8</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">The most frequent diagnosis in the DIADERM study was actinic keratosis&#44; accounting for an estimated 8&#46;2&#37; of diagnoses&#44; followed by basal cell carcinoma &#40;8&#46;1&#37;&#41; and melanocytic nevi &#40;7&#46;5&#37;&#41;&#46; In a multicenter survey conducted in 2013 and 2014&#44; the prevalence of actinic keratosis in the dermatology outpatient population over the age of 45 years was 28&#46;6&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">11</span></a> In one local study conducted in Majorca&#44; the most frequent diagnosis was melanocytic nevi&#44; followed by seborrheic keratosis and verruca vulgaris&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">3</span></a> In a study of patients from Granada over 65 years of age&#44; the most frequent diagnosis was basal cell carcinoma&#44; followed by actinic keratosis and seborrheic keratosis&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a> In a 2006 study carried out in Barcelona&#44; the most frequent diagnoses were seborrheic keratosis and melanocytic nevi&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">12</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">In all these studies&#44; tumors or premalignant disease were the most frequent reasons for seeking care&#46; This may be due to the growing incidence of skin cancer<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a> or to patients&#8217; motivation to obtain an early diagnosis as a consequence of the AEDV&#39;s awareness-raising campaigns&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a> Probably as a result of these secondary prevention strategies&#44; we observed that diagnoses of actinic keratosis and basal cell carcinoma were more frequent in follow-up patients than in first-time patients&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">In public health care settings&#44; the most common origin for patients seen by a dermatologist was a referral by a primary care physician or by another specialist &#40;accounting for 47&#46;8&#37; of visits&#41;&#59; in private settings&#44; the most common origin was personal initiative &#40;74&#46;7&#37;&#41;&#46; In both public and private health care settings&#44; follow-up was the patient destination in more than 60&#37; of cases&#46; Given that single-visit care is becoming increasingly common&#8212;especially in public settings&#8212;this percentage is rather high&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">This study had various limitations&#46; First&#44; although the participation rate &#40;greater than 60&#37;&#41; was quite high for surveys of this type&#44; the number of dermatologists taking part decreased in the second phase of the study&#46; Because the sample was random and representative and a total of 10<span class="elsevierStyleHsp" style=""></span>999 diagnoses were obtained&#44; we consider that our findings reflect the reality of clinical practice in Spain quite well&#44; despite the fact that data were collected over just 6 days&#46; Second&#44; surveys tend to have a certain degree of coding error&#44; especially if double data entry is not used&#46; In our study&#44; however&#44; a group of experts conducted a review and found that the data quality was good&#44; with an error rate of less than 5&#37;&#46; Finally&#44; personal details such as age and sex were not collected in our survey&#46; Although these details would have provided interesting information&#44; their collection would made the study procedure more complicated&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">In conclusion&#44; this is the first nationwide study in Spain to analyze the diagnoses reached in dermatology clinics by AEDV members&#46; Our findings show a high volume of activity&#44; with the most frequent diagnoses being actinic keratosis&#44; basal cell carcinoma&#44; and melanocytic nevi&#46; This information will be useful for guiding health care planning&#44; resource use&#44; and future studies&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Funding</span><p id="par0170" class="elsevierStylePara elsevierViewall">The DIADERM study was promoted by the AEDV&#39;s Fundaci&#243;n Piel Sana&#44; which has received financial assistance from Novartis&#46; The pharmaceutical company did not participate in data collection&#44; data analysis&#44; or the interpretation of the results&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Conflicts of Interest</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Dermatologists perform most of their work in outpatient or private clinics&#46; Data on the diagnoses made by dermatologists in these settings are lacking&#44; however&#44; as outpatient activity&#44; unlike hospital activity&#44; is difficult to code&#46; The aim of this study was to analyze the diagnoses made by members of the Spanish Academy of Dermatology and Venereology &#40;AEDV&#41; at dermatology clinics in Spain&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We selected a random sample of AEDV dermatologists drawn from the AEDV list and stratified by geographic area&#46; The selected dermatologists received instructions on how to collect the data required&#46; Each participant recorded the diagnosis reached and other data for patients seen during 2 specified periods&#58; 3 days in January and 3 days in May&#46; The diagnoses were subsequently coded by a dermatologist expert in applying the International Classification of Diseases &#40;10th revision&#41;&#46; In view of the complex nature of the sample&#44; data were analyzed with standard error and finite population corrections&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The sample consisted of 124 dermatologists&#46; Of these&#44; 65&#37; participated in the first phase of the study and 59&#37; in the second&#46; An estimated 621 562 patients &#40;95&#37; CI&#44; 368 130-874 995&#41; visit the dermatologist every month in Spain&#46; This is the equivalent of 28 &#40;25-31&#41; patients per day per clinic&#46; The most common diagnosis recorded was actinic keratosis&#44; followed by basal cell carcinoma and melanocytic nevus&#46; The vast majority of visits took place at the clinic&#44; but 1&#37; of patients &#40;0&#46;3&#37;-3&#37;&#41; were assessed using teledermatology&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">This is the first study in Spain to analyze diagnoses made by AEDV members at outpatient dermatology clinics&#46; Our findings show a high volume of activity and will be useful for guiding health care planning&#44; resource use&#44; and future studies&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La actividad principal realizada por dermat&#243;logos tiene lugar en la consulta externa hospitalaria o en los centros privados&#46; A diferencia de la actividad hospitalaria&#44; que es f&#225;cilmente codificada&#44; no existen datos globales sobre los diagn&#243;sticos realizados por los dermat&#243;logos en estos niveles&#46; El objetivo de este estudio es analizar los diagn&#243;sticos realizados en las consultas de dermatolog&#237;a de los miembros de la Academia Espa&#241;ola de Dermatolog&#237;a y Venereolog&#237;a &#40;AEDV&#41; en Espa&#241;a&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Metodolog&#237;a</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A partir del listado de dermat&#243;logos de la AEDV se obtuvo una muestra aleatoria estratificada por secciones territoriales de la AEDV&#46; A los dermat&#243;logos participantes se les instruy&#243; en la forma de recoger los datos&#46; Cada participante recogi&#243; los diagn&#243;sticos y otros datos de los pacientes atendidos durante 6 d&#237;as de consulta en 2 fases &#40;3 d&#237;as en enero y 3 d&#237;as en mayo&#41;&#46; Posteriormente la codificaci&#243;n de los diagn&#243;sticos la realiz&#243; un dermat&#243;logo experto empleando la CIE-10&#46; El an&#225;lisis se realiz&#243; considerando el dise&#241;o muestral complejo empleado para corregir los errores est&#225;ndar y el ajuste para poblaciones finitas&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se muestrearon 124 dermat&#243;logos&#46; Finalmente participaron en el estudio el 65&#37; de los dermat&#243;logos muestreados en la primera fase y el 59&#37; en la segunda&#46; El n&#250;mero de pacientes estimados que consultan al dermat&#243;logo en toda Espa&#241;a por mes ser&#237;a de 621&#46;562 &#40;IC 95&#37;&#58; 368&#44;130-874&#44;995&#41;&#44; con un promedio de 28 &#40;25-31&#41; pacientes por d&#237;a de consulta&#46; El diagn&#243;stico m&#225;s frecuente fue el de queratosis act&#237;nica&#44; seguido de carcinoma basocelular y nevus melanoc&#237;tico&#46; La forma habitual de evaluar a los pacientes es mediante visita presencial y en el 1&#37; &#40;0&#44;3&#37;-3&#37;&#41; de los casos se realiza teledermatolog&#237;a&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se trata del primer estudio de &#225;mbito nacional que analiza diagn&#243;sticos hechos en las consultas de dermatolog&#237;a de los miembros de la AEDV&#44; mostrando una alta carga asistencial&#46; Dicha informaci&#243;n adem&#225;s ser&#225; de utilidad para realizar una correcta planificaci&#243;n sanitaria&#44; aprovechamiento de los recursos y planificar futuros estudios&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Metodolog&#237;a"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Buend&#237;a-Eisman A&#44; Arias-Santiago S&#44; Molina-Leyva A&#44; Gilaberte Y&#44; Fern&#225;ndez-Crehuet P&#44; Husein-ElAhmed H&#44; et al&#46; An&#225;lisis de los diagn&#243;sticos realizados en la actividad ambulatoria dermatol&#243;gica en Espa&#241;a&#58; muestreo aleatorio nacional DIADERM&#46; Actas Dermosifiliogr&#46; 2018&#59;109&#58;416&#8211;423&#46;</p>"
      ]
    ]
    "multimedia" => array:6 [
      0 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Abbreviation&#58; AEDV&#44; Spanish Academy of Dermatology and Venereology&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Geographic Area &#40;AEDV Section&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage of Consultations in Spain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Estimated Monthly Consultations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Asturias&#44; Cantabria&#44; and Castile-Le&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52 928&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Andalusia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">93 966&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Balearic Islands&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 611&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Canary Islands&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34 892&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Catalonia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">85 360&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Central Spain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">104 933&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Galicia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">62 073&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Murcia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5236&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Basque Country&#44; Navarre&#44; Arag&#243;n&#44; and La Rioja&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68 284&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Valencia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100 280&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">621 562&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Distribution of Estimated Monthly Dermatology Consultations by Geographic Area&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Abbreviation&#58; ICD-10&#44; International Classification of Diseases&#44; 10th revision&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ICD-10 Chapter&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; of Diagnoses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lower Limit of 95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Upper Limit of 95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diseases of the skin and subcutaneous tissue &#40;L00-L99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">123 621&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74 166&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">173 076&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Neoplasms &#40;C00-D49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">52 766&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 054&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74 477&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Certain infectious and parasitic diseases &#40;A00-B99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 407&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 553&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29 260&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diseases of the digestive system &#40;K00-K95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1034&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2978&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diseases of the circulatory system &#40;I00-I99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1985&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1109&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2861&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Congenital malformations&#46;&#46;&#46; &#40;Q00-Q99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1772&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">905&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2640&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Not elsewhere classified &#40;R00-R99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1321&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">761&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1880&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Injury&#46;&#46;&#46; &#40;S00-T88&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1178&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">655&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1700&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diseases of the musculoskeletal system&#46;&#46;&#46; &#40;M00-M99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">725&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">301&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1149&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diseases of the genitourinary system &#40;N00-N99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">721&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">209&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1233&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Endocrine diseases&#46;&#46;&#46; &#40;E00-E89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">522&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">323&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">722&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diseases of the blood&#46;&#46;&#46; &#40;D50-D89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">378&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">715&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diseases of the ear&#46;&#46;&#46; &#40;H60-H95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">286&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">123&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">450&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Diseases of the eye &#40;H00-H59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">283&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">468&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mental and behavioral disorders &#40;F01-F99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">114&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">209&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pregnancy&#44; childbirth&#44; and the puerperium &#40;O00-O9A&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">121&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">208 141&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">122 342&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">293 939&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Abbreviation&#58; ICD-10&#44; International Classification of Diseases&#44; 10th revision&#46;</p>"
          "tablatextoimagen" => array:1 [
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ICD-10 Category&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; of Diagnoses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lower Limit of 95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Upper Limit of 95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L57&#58; Skin changes &#40;actinic keratosis&#44; etc&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 972&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 434&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23 511&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">C44&#58; Nonmelanoma skin cancer &#40;basal cell carcinoma&#44; etc&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 756&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8776&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 735&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D22&#58; Melanocytic nevi&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 668&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9246&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 091&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L82&#58; Seborrheic keratosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 224&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9253&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 195&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D23&#58; Other benign neoplasms of skin &#40;nevus not otherwise specified&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 991&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7512&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18 471&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L40&#58; Psoriasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 344&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6260&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 428&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L70&#58; Acne&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 209&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5996&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 423&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">B07&#58; Viral warts &#40;verruca vulgaris&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8970&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4940&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L81&#58; Other disorders of pigmentation &#40;solar lentigo&#47;chloasma&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8211&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4410&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L30&#58; Other or unspecified dermatitis &#40;eczema not otherwise specified&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7215&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 418&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L20&#58; Atopic dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5170&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2660&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7681&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L50&#58; Urticaria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1653&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">910&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2396&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">78 758&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47 933&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">109 577&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">208 141&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">122 342&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">293 939&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Abbreviation&#58; ICD-10&#44; International Classification of Diseases&#44; 10th revision&#46;</p>"
          "tablatextoimagen" => array:1 [
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ICD-10 Category&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; of Diagnoses&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Lower Limit of 95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Upper Limit of 95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L70&#58; Acne&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3680&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5350&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L20&#58; Atopic dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2824&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1501&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4148&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D22&#58; Melanocytic nevi&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2514&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1280&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3748&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">B07&#58; Viral warts &#40;verruca vulgaris&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2511&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1232&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3791&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">B08&#58; Other viral infections&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1304&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">587&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2021&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D23&#58; Other benign neoplasms of skin &#40;nevus not otherwise specified&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1164&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">433&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1894&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L30&#58; Other or unspecified dermatitis &#40;eczema not otherwise specified&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">814&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">264&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1364&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L21&#58; Seborrheic dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">622&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">221&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1024&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D18&#58; Hemangioma and lymphangioma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">569&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">167&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">972&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L81&#58; Other disorders of pigmentation &#40;solar lentigo&#47;chloasma&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">525&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1205&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L40&#58; Psoriasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">489&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">196&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">782&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L82&#58; Seborrheic keratosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">337&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">929&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L57&#58; Skin changes &#40;actinic keratosis&#44; etc&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">219&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">447&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">C44&#58; Other malignant neoplasms of skin &#40;basal cell carcinoma&#44; etc&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">186&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">456&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L50&#58; Urticaria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">154&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">337&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6342&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2301&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 383&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 254&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 193&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38 851&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Distribution of Estimated Diagnoses in Spain by ICD-10 Category in Patients Under Age 18 Years During 6-Day Survey&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient Origin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage of Total Diagnoses in Public and Private Health Care Settings &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage of Total Diagnoses in Public Health Care Settings &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage of Total Diagnoses in Private Health Care Settings &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Direct access without filter appointment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30&#46;7 &#40;22&#46;1-41&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10&#46;2 &#40;7-14&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">74&#46;7 &#40;66&#46;5-81&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Primary care consultation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31&#46;2 &#40;25&#46;1-37&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42&#46;3 &#40;37&#46;2-47&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46;7 &#40;2&#46;8-15&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Consultation with another specialist&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;7 &#40;3&#46;9-5&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5&#46;5 &#40;4&#46;2-7&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;9 &#40;1&#46;7-4&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dermatologist &#40;including follow-up&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">33&#46;5 &#40;29-38&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42 &#40;37&#46;4-46&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15&#46;7 &#40;10&#46;7-22&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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            1 => array:2 [
              "tabla" => array:1 [
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Patient Destination&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage of Total Diagnoses in Public and Private Health Care Settings &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage of Total Diagnoses in Public Health Care Settings &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Percentage of Total Diagnoses in Private Health Care Settings &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Discharge&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#46;6 &#40;23-32&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27&#46;1 &#40;23-31&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28&#46;6 &#40;20-39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Primary care consultation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#46;7 &#40;2&#46;9-7&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6&#46;4 &#40;4&#46;3-9&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;2 &#40;0&#46;3-4&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Consultation with another specialist&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;1&#46;5-2&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#46;2 &#40;1&#46;8-2&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#46;6 &#40;0&#46;8-3&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Dermatologist &#40;including follow-up&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65&#46;6 &#40;59&#46;3-71&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">64&#46;2 &#40;58&#46;1-69&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">68&#46;6 &#40;57&#46;4-78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">Abbreviation&#58; ICD-10&#44; International Classification of Diseases&#44; 10th revision&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">ICD-10 Category&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Follow-up Patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">First-Time Patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">C44&#58; Nonmelanoma skin cancer &#40;basal cell carcinoma&#44; etc&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 716&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5040&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L57&#58; Skin changes &#40;actinic keratosis&#44; etc&#46;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 711&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6262&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">D22&#58; Melanocytic nevi&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7539&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8129&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L40&#58; Psoriasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6472&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3872&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L70&#58; Acne&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6037&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4172&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">L82&#58; Seborrheic keratosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5614&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9610&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Most Frequent Diagnoses in First-Time and Follow-up Patients&#46;</p>"
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    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:14 [
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