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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">Aproximadamente un 20&#37; de los 208 millones de embarazos que anualmente ocurren en el mundo terminan en abortos voluntarios&#46; M&#225;s de la mitad se realizan en condiciones no seguras&#44; lo que provoca unas 47&#46;000 muertes<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; La incidencia de interrupciones voluntarias del embarazo es un indicador importante&#44; por un lado&#44; de los embarazos no deseados&#44; y por otro de las diferencias entre el funcionamiento de los servicios de contracepci&#243;n y la efectividad de su uso&#46; Su an&#225;lisis es esencial para monitorizar la situaci&#243;n de bienestar de las mujeres y las parejas<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">En el mundo hay distintas situaciones legales respecto al aborto&#46; Est&#225; permitido para salvar la vida de la madre&#44; por razones de salud f&#237;sica&#44; mental&#44; socioecon&#243;micas o sin restricciones<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; En Espa&#241;a&#44; el 5 de julio de 2010 entr&#243; en vigor la nueva ley de salud sexual y reproductiva&#44; que regula el aborto<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; En ella&#44; el aborto se ha convertido <span class="elsevierStyleItalic">de facto</span> en un derecho de la mujer&#46; Durante las primeras 14 semanas de gestaci&#243;n&#44; la mujer puede proceder&#44; libremente y sin supervisi&#243;n de terceros&#44; a la interrupci&#243;n voluntaria del embarazo&#44; y hasta la semana 22 siempre que haya un grave riesgo para la vida o la salud de la embarazada y as&#237; sea dictaminado por un m&#233;dico especialista distinto de quien practique la intervenci&#243;n<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La mayor&#237;a de las interrupciones voluntarias del embarazo son resultado de una concepci&#243;n no deseada&#44; pero las razones por las cuales se toma la decisi&#243;n de abortar&#44; una vez confirmado el embarazo no deseado&#44; son complejas y por muchos motivos&#46; Mientras la mejora en la contracepci&#243;n disminuye la incidencia de abortos&#44; hay un n&#250;mero dif&#237;cil de reducir m&#225;s relacionado con la libre decisi&#243;n de las mujeres sobre el control de sus vidas<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> y con circunstancias socioecon&#243;micas&#44; familiares&#44; etc&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">En este sentido&#44; es conocido que las inmigrantes residentes en Espa&#241;a tienen una proporci&#243;n de interrupciones voluntarias del embarazo respecto a la fertilidad m&#225;s alta que las espa&#241;olas<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a>&#46; Este fen&#243;meno&#44; complejo de analizar&#44; se da con similares caracter&#237;sticas en otros pa&#237;ses&#46; 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hay pocos trabajos que describan las variables m&#225;s relacionadas con la interrupci&#243;n voluntaria del embarazo y qu&#233; caracter&#237;sticas&#44; si las hay&#44; est&#225;n diferenciando los abortos voluntarios en la poblaci&#243;n inmigrante y en la aut&#243;ctona&#46; Este es el objetivo principal del trabajo&#46; Como el periodo de estudio coincide con la entrada en vigor de la nueva ley de salud sexual y reproductiva en Espa&#241;a&#44; se har&#225; menci&#243;n al impacto que haya podido tener en Andaluc&#237;a&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="par0030" class="elsevierStylePara elsevierViewall">Se ha realizado un estudio transversal de base poblacional&#46; La poblaci&#243;n est&#225; formada por todas las mujeres embarazadas residentes en Andaluc&#237;a entre 2007 y 2010 que han finalizado su embarazo en parto o en interrupci&#243;n voluntaria &#40;no se incluyeron los abortos espont&#225;neos&#41;&#46; Los datos de partos proceden del Bolet&#237;n Estad&#237;stico de Partos de las estad&#237;sticas oficiales del Movimiento Natural de la Poblaci&#243;n &#40;MNP&#41;&#44; publicado por el Instituto de Estad&#237;stica de Andaluc&#237;a&#44; y los datos de las interrupciones voluntarias del embarazo proceden del Registro Andaluz de Interrupci&#243;n Voluntaria del Embarazo de la Consejer&#237;a de Salud de la Junta de Andaluc&#237;a&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Del fichero de partos se incluyeron todas las mujeres que tuvieron un parto en el periodo estudiado o un aborto espont&#225;neo de m&#225;s de 28 semanas de gestaci&#243;n&#59; del fichero de interrupci&#243;n voluntaria del embarazo se tuvieron en cuenta las mujeres que hubieran abortado voluntariamente en cada uno de los a&#241;os estudiados&#46; S&#243;lo se contaron una vez las mujeres con m&#225;s de un aborto en un a&#241;o&#44; y tambi&#233;n se excluyeron las que tuvieron un hijo en el mismo a&#241;o que el aborto&#44; ya que estaban incluidas en el fichero de nacimientos<span class="elsevierStyleBold">&#46;</span> Con ello se construy&#243; un fichero &#250;nico con las variables comunes en ambos registros&#44; y se categorizaron para su posterior an&#225;lisis con regresi&#243;n log&#237;stica en&#58; <span class="elsevierStyleItalic">a&#41;</span> si el embarazo termin&#243; en interrupci&#243;n voluntaria o en parto&#59; <span class="elsevierStyleItalic">b&#41;</span> a&#241;o del evento &#40;parto o interrupci&#243;n voluntaria del embarazo&#41;&#59; <span class="elsevierStyleItalic">c&#41;</span> provincia de residencia&#59; <span class="elsevierStyleItalic">d&#41;</span> n&#250;mero de hijos previo&#44; categorizado en 0&#44; 1&#44; 2&#44; y 3 o m&#225;s&#59; <span class="elsevierStyleItalic">e&#41;</span> edad&#44; agrupada en menores de 25 a&#241;os&#44; entre 25 y 39 a&#241;os&#44; y 40 y m&#225;s a&#241;os de edad&#59; <span class="elsevierStyleItalic">f&#41;</span> nivel de instrucci&#243;n&#44; agrupado en sin estudios y primer grado&#44; segundo grado de primer y segundo ciclo&#44; y tercer grado&#44; siguiendo las recomendaciones de la Sociedad Espa&#241;ola de Epidemiolog&#237;a<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#59; <span class="elsevierStyleItalic">e&#41;</span> acompa&#241;ada&#44; variable construida con el estado civil y si convive en pareja del cuestionario de partos&#44; y con si tiene pareja de hecho del cuestionario de interrupci&#243;n voluntaria del embarazo&#59; y <span class="elsevierStyleItalic">f&#41;</span> pa&#237;s de origen&#44; agregado en Espa&#241;a&#44; Europa&#44; Am&#233;rica del Norte y Australia&#44; Pa&#237;ses del Este de Europa&#44; Magreb&#44; &#193;frica excepto Magreb&#44; Am&#233;rica del Sur y Asia&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Mediante un modelo de regresi&#243;n log&#237;stica binaria utilizando como variable dependiente el resultado del embarazo y como independientes el resto&#44; 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&#171;fecundidad&#187; al n&#250;mero de partos en la misma poblaci&#243;n&#44; e &#171;interrupci&#243;n voluntaria del embarazo&#187; al n&#250;mero de abortos voluntarios en la misma poblaci&#243;n&#46; Adem&#225;s&#44; se calcularon las tasas espec&#237;ficas por grupos de edad de las mujeres de las distintas zonas de procedencia&#44; y se realizaron las curvas por edad&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0050" class="elsevierStylePara elsevierViewall">De los 460&#46;716 embarazos en mujeres residentes en Andaluc&#237;a entre 2007 y 2010&#44; 383&#46;571 terminaron en parto y 77&#46;145 en interrupci&#243;n voluntaria&#44; lo que supone el 83&#37; y el 17&#37;&#44; respectivamente &#40;<a class="elsevierStyleCrossRef" href="#tbl1">tabla 1</a>&#41;&#46; Los porcentajes de partos e interrupciones voluntarias del embarazo fueron&#44; respectivamente&#44; de un 88&#37; y un 12&#37; en las espa&#241;olas&#44; y de un 67&#37; y un 33&#37; en las extranjeras&#46; Por a&#241;o&#44; en cuanto a embarazos destaca 2008&#44; en especial en las extranjeras&#46; Por provincias de residencia&#44; destaca Almer&#237;a con un 22&#37; del total de los embarazos en las extranjeras y s&#243;lo un 7&#37; en las espa&#241;olas&#46; M&#225;s de la mitad de las espa&#241;olas y un 46&#37; de las extranjeras embarazadas no ten&#237;an hijos&#46; El 75&#37; de los embarazos se produjeron en mujeres entre 25 y 39 a&#241;os de edad&#44; con una distribuci&#243;n diferente entre espa&#241;olas y extranjeras &#40;<a class="elsevierStyleCrossRef" href="#tbl1">tabla 1</a>&#41;&#46; Las mujeres sin estudios o con estudios primarios son las que mayor n&#250;mero de embarazos tuvieron&#44; sobre todo las extranjeras&#46; El 80&#37; de los embarazos ocurri&#243; en mujeres con pareja&#44; un 82&#37; en las espa&#241;olas y un 77&#37; en las extranjeras&#46; El 83&#44;5&#37; de los embarazos fueron de espa&#241;olas&#44; y entre las extranjeras destacan las procedentes de Am&#233;rica del Sur&#44; con un 4&#44;8&#37; del total de los embarazos en mujeres extranjeras&#46;</p><elsevierMultimedia ident="tbl1"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">En la <a class="elsevierStyleCrossRef" href="#tbl2">tabla 2</a> puede verse que las razones entre partos y abortos voluntarios han descendido a partir de 2008&#44; debido a una disminuci&#243;n del n&#250;mero de partos y a un aumento de los abortos&#46; En 2009 se observ&#243; el mayor riesgo de aborto voluntario&#44; seguido de un descenso en 2010&#44; aunque todos los a&#241;os presentaron ORa mayores que en 2007&#46; La provincia de C&#225;diz fue la de mayor raz&#243;n entre partos y abortos&#44; y la de Huelva la menor&#59; esta &#250;ltima muestra un 46&#37; de m&#225;s riesgo de interrupci&#243;n voluntaria del embarazo que la media andaluza&#44; seguida de Granada con un 31&#37;&#44; y llama la atenci&#243;n el cambio de la ORc de Almer&#237;a cuando se ajusta por el resto de las variables&#46; Las mujeres con tres o m&#225;s hijos tuvieron un riesgo de interrupci&#243;n voluntaria del embarazo 23 veces mayor que aquellas sin hijos&#59; a su vez&#44; el n&#250;mero de hijos previos fue la variable que mayor influencia tuvo en las interrupciones voluntarias del embarazo&#46; Cuanto menor era la edad&#44; mayor el riesgo de aborto voluntario&#44; sobre todo en las menores de 25 a&#241;os&#44; con ORa de 19&#44;5&#46; Las mujeres con estudios secundarios fueron las que tuvieron OR m&#225;s altas&#44; en especial las ORc&#44; que se reducen cuando se ajustan&#46; No tener pareja casi iguala la raz&#243;n entre partos e interrupci&#243;n voluntaria del embarazo&#44; e incrementa diez veces el riesgo de interrupci&#243;n voluntaria del embarazo con respecto a las mujeres que viven acompa&#241;adas&#46; Las extranjeras tuvieron un riesgo de interrupci&#243;n voluntaria del embarazo cuatro veces superior al de las espa&#241;olas &#40;ORa<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;95&#41;&#44; y las mujeres de todas las zonas del mundo residentes en Andaluc&#237;a tuvieron un mayor riesgo que las aut&#243;ctonas&#44; destacando las africanas &#40;<a class="elsevierStyleCrossRef" href="#tbl2">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl2"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Las mismas variables influyen en el riesgo de interrupci&#243;n voluntaria del embarazo en las mujeres aut&#243;ctonas y en las extranjeras &#40;<a class="elsevierStyleCrossRef" href="#tbl3">tabla 3</a>&#41;&#44; con cambios en la magnitud entre ellas&#46; Las espa&#241;olas incrementaron su riesgo de interrupci&#243;n voluntaria del embarazo en un 56&#37; entre los a&#241;os 2007 y 2010&#44; mientras que las extranjeras s&#243;lo lo hicieron en un 16&#37;&#46; Las residentes en Huelva fueron las que mayor riesgo de aborto voluntario presentaron&#44; y las extranjeras m&#225;s de dos veces la media andaluza&#46; Las interrupciones voluntarias del embarazo en las menores de 25 a&#241;os extranjeras tuvieron una OR de 24&#44;4&#44; y en las espa&#241;olas de 17&#44;08&#44; en comparaci&#243;n con las mayores de 40 a&#241;os&#46;</p><elsevierMultimedia ident="tbl3"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">El primer resultado que llama la atenci&#243;n de las tasas &#40;<a class="elsevierStyleCrossRefs" href="#tbl4">tablas 4 y 5</a>&#44; y <a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41; es que el n&#250;mero de mujeres extranjeras de 10 a 54 a&#241;os de edad residentes en Andaluc&#237;a no llegaba al 8&#37;&#44; y el porcentaje de interrupciones voluntarias del embarazo fue superior al 15&#37;&#46; Las extranjeras tuvieron una tasa de abortos voluntarios casi seis veces superior a las aut&#243;ctonas&#44; mientras que la tasa de fertilidad era un poco menos del doble&#46; Las mujeres europeas&#44; norteamericanas y australianas ten&#237;an indicadores muy parecidos a las andaluzas&#44; y entre el resto de las extranjeras destacan las africanas con las mayores tasas de interrupci&#243;n voluntaria del embarazo&#44; aunque representan un porcentaje muy peque&#241;o de la poblaci&#243;n&#46; A partir del a&#241;o 2008 se produce un descenso continuado de las tasas de interrupci&#243;n voluntaria del embarazo en el conjunto de la poblaci&#243;n extranjera&#44; mientras que las espa&#241;olas experimentaron un ligero ascenso&#44; y en ambas descendi&#243; la fecundidad&#46; Por grupos de edad&#44; destacan las africanas con las tasas m&#225;s altas y un pico en el grupo de 20 a 24 a&#241;os de edad&#44; y en el otro extremo las espa&#241;olas y las europeas&#44; aunque las mayores tasas coinciden en el mismo grupo de edad&#46;</p><elsevierMultimedia ident="tbl4"></elsevierMultimedia><elsevierMultimedia ident="tbl5"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0070" class="elsevierStylePara elsevierViewall">Las mujeres en edad f&#233;rtil residentes en Andaluc&#237;a&#44; independientemente del pa&#237;s de origen&#44; presentan caracter&#237;sticas comunes en cuanto a las variables que determinan que un embarazo termine con su interrupci&#243;n voluntaria&#46; Estas caracter&#237;sticas son el n&#250;mero de hijos previo al embarazo&#44; la edad y tener o no pareja&#59; el resto de las variables estudiadas tiene una importancia relativa menor&#46; Se ha producido un ligero incremento del riesgo y de la incidencia de las interrupciones voluntarias del embarazo en el a&#241;o de la entrada en vigor de la nueva ley de salud sexual y reproductiva que regula el aborto&#44; debido a las mujeres aut&#243;ctonas y en menor medida a las extranjeras&#46; El perfil de la mujer con mayor riesgo de abortar voluntariamente en Andaluc&#237;a podr&#237;a definirse como una mujer joven&#44; extranjera&#44; con hijos&#44; sin pareja&#44; con estudios y residente en Huelva&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">El riesgo de abortos voluntarios es inversamente proporcional a la edad de la mujer&#58; cuanto m&#225;s joven es la mujer&#44; mayor es el riesgo de que un embarazo termine en interrupci&#243;n voluntaria&#46; En el caso de las menores de 15 a&#241;os&#44; en Andaluc&#237;a&#44; se produjeron m&#225;s abortos que partos&#59; sin embargo&#44; cuando se mide la incidencia&#44; el grupo de 20 a 24 a&#241;os es el que tiene mayores tasas&#46; Esta distribuci&#243;n no coincide con la publicada en otros pa&#237;ses<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#44; donde la mayor incidencia se da en edades mayores&#44; y por estudios realizados en otros lugares<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> se sabe que la intencionalidad de la mujer a la hora de realizar un aborto es diferente seg&#250;n la edad&#58; en las j&#243;venes es posponer la maternidad&#44; y en las mayores es no tener m&#225;s hijos&#46; En ambas situaciones&#44; la interrupci&#243;n voluntaria del embarazo supone un fracaso de las medidas anticonceptivas&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">En otros trabajos se ha descrito una incidencia de abortos en mujeres que viven solas mayor que en las que viven acompa&#241;adas<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a>&#59; esta situaci&#243;n puede ser especialmente determinante en Andaluc&#237;a&#44; donde la maternidad de mujeres solas est&#225; en torno al 17&#37; de la fecundidad total<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#44; todav&#237;a baja en comparaci&#243;n con los pa&#237;ses del centro y del norte de Europa<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46; En este sentido&#44; nuestro trabajo no ha utilizado s&#243;lo el estado civil recogido en los registros de partos y abortos&#44; sino que se ha construido una variable a&#241;adiendo la informaci&#243;n de si vive o no en pareja&#44; ya que el estado civil no recoge las situaciones actuales de pareja&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">La variable con mayor peso a la hora de interrumpir voluntariamente un embarazo en Andaluc&#237;a es el n&#250;mero de hijos previos&#46; Esta variable puede estar relacionada con unos recursos econ&#243;micos insuficientes para planificar y decidir el tama&#241;o familiar&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> En otros pa&#237;ses se ha encontrado una asociaci&#243;n entre el n&#250;mero de hijos previos y los embarazos no deseados&#44; y por lo tanto la mayor probabilidad de abortar&#46; Esta relaci&#243;n aumentaba a medida que era mayor el n&#250;mero de hijos&#44; y se suger&#237;a una posible desconexi&#243;n entre la salud maternoinfantil y los servicios de planificaci&#243;n familiar<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#44;20</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Cabr&#237;a esperar que las caracter&#237;sticas sociodemogr&#225;ficas respecto a las interrupciones voluntarias del embarazo en las mujeres inmigrantes fueran diferentes a las de las aut&#243;ctonas&#44; como lo son los patrones reproductivos<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a>&#59; sin embargo&#44; como muestran los resultados&#44; son parecidas en ambas poblaciones&#44; y hay un mayor riesgo de interrupci&#243;n voluntaria del embarazo en toda la poblaci&#243;n extranjera con independencia del pa&#237;s de procedencia&#46; Esto ocurre hasta en las mujeres de pa&#237;ses con niveles de renta superiores a la media andaluza&#44; lo cual hace plantearse que el hecho de la inmigraci&#243;n en s&#237; influye en el riesgo de abortar voluntariamente&#44; puesto de manifiesto en otros trabajos<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;13</span></a>&#46; En general&#44; hay problemas de acceso a los m&#233;todos anticonceptivos y a la interrupci&#243;n voluntaria del embarazo<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#8211;25</span></a>&#44; teniendo que ver con la formaci&#243;n de los profesionales&#44; y la organizaci&#243;n y la financiaci&#243;n de los servicios que limitan la oferta&#46; Adem&#225;s&#44; en el caso de la poblaci&#243;n inmigrante se a&#241;aden problemas ling&#252;&#237;sticos y culturales&#44; que no s&#243;lo est&#225;n produciendo un mayor n&#250;mero de abortos sino que a veces retrasan las semanas de gestaci&#243;n con que se realizan<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">El nivel de estudios de las mujeres embarazadas del registro de partos e interrupciones voluntarias del embarazo no muestra el gradiente de las desigualdades sociales&#44; ni en la poblaci&#243;n aut&#243;ctona ni en la inmigrante&#44; que s&#237; aparecen en los resultados de otros trabajos<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">27&#44;28</span></a>&#46; Son las mujeres con estudios medios las que mayor riesgo de interrupci&#243;n voluntaria del embarazo tienen&#46; Puede significar&#44; por un lado&#44; que las mujeres que est&#225;n en periodo de formaci&#243;n o en integraci&#243;n en el mercado laboral quieran retrasar el nacimiento de su primer hijo&#44; y por otro que el propio hecho de utilizar los recursos existentes para la interrupci&#243;n voluntaria del embarazo requiere una formaci&#243;n y una informaci&#243;n m&#225;s f&#225;ciles de encontrar con unos niveles de estudios y culturales medios que sin estudios&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Llama la atenci&#243;n el alto riesgo y las tasas de interrupci&#243;n voluntaria del embarazo de las inmigrantes procedentes del continente africano&#44; que posiblemente est&#233; relacionado con colectivos con escasos recursos&#44; tanto culturales como materiales&#44; y tendr&#237;an que ser una prioridad en los programas y las actividades encaminadas a mejorar la salud reproductiva&#44; ya que no s&#243;lo tienen altas tasas de abortos y fecundidad&#44; sino que son las que mayores tasas de partos por ces&#225;reas presentan<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a>&#46; En sentido opuesto&#44; las mujeres procedentes de los antiguos pa&#237;ses de la Uni&#243;n Sovi&#233;tica tuvieron comparativamente menos interrupciones voluntarias del embarazo de lo que se esperar&#237;a por sus zonas de procedencia<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&#59; esto no coincide con lo publicado en la ciudad de Barcelona&#44; donde este colectivo presentaba las tasas m&#225;s altas<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Los datos de poblaci&#243;n de mujeres embarazadas en el periodo estudiado no son exhaustivos porque faltan los abortos espont&#225;neos&#44; por otro lado inexistentes de manera sistem&#225;tica&#46; Para el an&#225;lisis se han unido dos fuentes diferentes en cuanto a sus objetivos&#44; los registros de partos e interrupciones voluntarias del embarazo&#44; que no siempre coinciden en el a&#241;o en que se produjo la fecundaci&#243;n&#44; es decir&#44; los partos se producen tras 9 meses de embarazo y los abortos en gran parte antes del tercer mes&#59; si se hacen corresponder con el a&#241;o en que ocurri&#243; el evento&#44; puede haber diferencias que en parte se han obviado agregando en 4 a&#241;os&#46; Esto&#44; que puede ser una limitaci&#243;n del trabajo&#44; en general es una buena aproximaci&#243;n a la fertilidad del colectivo de las mujeres residentes en Andaluc&#237;a&#46; As&#237;&#44; podemos ver qu&#233; importancia relativa tienen las interrupciones voluntarias del embarazo sobre los patrones de fecundidad&#44; es decir&#44; como m&#233;todo contraceptivo y regulador de la fecundidad&#44; que sit&#250;a a Andaluc&#237;a en una zona con baja incidencia<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;32</span></a>&#46; Otra limitaci&#243;n es no disponer de informaci&#243;n respecto a si el embarazo fue deseado o no&#46; En el caso de los que terminan en interrupci&#243;n voluntaria se presupone que fue no deseado&#44; pero del resto no se tiene esta informaci&#243;n con la cual podr&#237;an haberse caracterizado los partos de una manera m&#225;s adecuada&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Tras la entrada en vigor de la nueva ley&#44; las interrupciones voluntarias del embarazo han aumentado en un porcentaje peque&#241;o&#44; por un incremento en las mujeres aut&#243;ctonas m&#225;s que en las extranjeras&#46; La tendencia descendente en el n&#250;mero de embarazos&#44; iniciada en 2009&#44; puede estar relacionada con la crisis econ&#243;mica que empez&#243; a frenar el flujo migratorio en 2008&#44; y que sobre todo repercute en la fecundidad de las inmigrantes&#44; aunque el riesgo de abortos voluntarios ha seguido aumentando ligeramente en este grupo&#46; An&#225;lisis posteriores deber&#225;n dilucidar si&#44; adem&#225;s del efecto demogr&#225;fico&#44; la bater&#237;a de medidas impulsada por la nueva ley para mejorar la informaci&#243;n sexual de los ciudadanos ha tenido el efecto beneficioso de reducir el n&#250;mero de embarazos no deseados y&#44; por tanto&#44; de mujeres que optan por el aborto voluntario&#46;<elsevierMultimedia ident="tb0005"></elsevierMultimedia></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Contribuciones de autor&#237;a</span><p id="par0125" class="elsevierStylePara elsevierViewall">M&#46; Ruiz-Ramos ha participado en el dise&#241;o del trabajo&#44; ha adaptado las bases de datos de partos y nacimientos&#44; ha realizado los c&#225;lculos que se presentan en los resultados y ha colaborado en la redacci&#243;n&#46; L&#46; Iva&#241;ez ha participado desde el principio en el dise&#241;o del trabajo&#44; facilitando las bases de datos de interrupci&#243;n voluntaria del embarazo&#44; ha colaborado en los c&#225;lculos y la redacci&#243;n de los apartados de material y m&#233;todos&#44; resultados y discusi&#243;n&#46; J&#46; Garc&#237;a Le&#243;n ha estado directamente relacionado con la elaboraci&#243;n de todas las partes del trabajo y ha participado de una manera m&#225;s activa en la b&#250;squeda bibliogr&#225;fica&#44; la introducci&#243;n y sobre todo la discusi&#243;n de los resultados&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Financiaci&#243;n</span><p id="par0140" class="elsevierStylePara elsevierViewall">Ninguna&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflictos de intereses</span><p id="par0135" class="elsevierStylePara elsevierViewall">Ninguno&#46;</p></span></span>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Describir las variables asociadas con la interrupci&#243;n voluntaria del embarazo en Andaluc&#237;a y las diferencias entre poblaci&#243;n aut&#243;ctona y extranjera&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio poblacional transversal&#46; Se ha unido el fichero de partos con el de interrupci&#243;n voluntaria del embarazo y se ha creado un fichero &#250;nico del periodo 2007-2010&#46; Mediante modelos de regresi&#243;n log&#237;stica binaria&#44; utilizando como variable dependiente si el embarazo termin&#243; en parto o aborto voluntario y como independientes el a&#241;o&#44; la provincia de residencia&#44; el n&#250;mero de hijos previo&#44; el nivel de instrucci&#243;n&#44; la convivencia y la nacionalidad&#44; se han calculado las <span class="elsevierStyleItalic">odds ratios</span> crudas y ajustadas con sus intervalos de confianza del 95&#37;&#44; para mujeres aut&#243;ctonas y extranjeras&#46; Con las poblaciones del padr&#243;n se calcularon las tasas correspondientes&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se produjeron 460&#46;715 embarazos&#44; de los cuales un 17&#37; termin&#243; en aborto voluntario y un 83&#37; en parto&#46; Las variables que m&#225;s influyeron en el riesgo de abortos voluntarios en las mujeres aut&#243;ctonas y extranjeras fueron tener tres o m&#225;s hijos &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#44;06&#41;&#44; ser menor de 25 a&#241;os &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&#44;53&#41;&#44; vivir sola &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#44;04&#41; y ser extranjera &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;95&#41;&#44; en especial africana&#46; Las tasas de abortos voluntarios&#44; de fecundidad y de fertilidad fueron mayores en las extranjeras que en las andaluzas&#44; con un aumento de los abortos y un descenso de la fertilidad y de la fecundidad&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">El mayor riesgo de abortar voluntariamente en Andaluc&#237;a lo presentan mujeres j&#243;venes&#44; con hijos&#44; que no conviven en pareja&#44; con estudios secundarios y extranjeras&#44; en especial procedentes de &#193;frica subsahariana y con residencia en la provincia de Huelva&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To describe the variables associated with induced abortions in Andalusia &#40;Spain&#41; and the differences between native and foreign populations&#46;</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional population-based study was carried out&#46; The files on deliveries and induced abortions were combined to create a single file for the period 2007-2010&#46; A binary logistic regression model was employed&#46; The dependent variable was whether the pregnancy ended in delivery or induced abortion&#46; The independent variables were the year&#44; province of residence&#44; number of previous children&#44; schooling&#44; cohabitation and nationality&#46; The raw and adjusted odds ratios and the 95&#37; confidence intervals were calculated for native and foreign women&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Of 460&#44;716 pregnancies&#44; 17&#37; ended in an induced abortion and 83&#37; in delivery&#46; The variables most closely associated with the risk of an induced abortion among native and foreign women in Andalusia were having three or more previous children &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>23&#46;06&#41;&#44; being under 25 years old &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>19&#46;53&#41;&#44; living alone &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>10&#46;04&#41; and being an immigrant &#40;OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#46;95&#41;&#44; especially in African women&#46; The rates of abortions&#44; fecundity and fertility were higher in foreigners than in native women&#44; with an increase in abortions and a decrease in fertility and fecundity&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The women at greatest risk of having an abortion in Andalusia are young foreign women&#44; especially those from Africa&#44; who live alone&#44; have previous children and secondary education and reside in the province of Huelva&#46;</p>"
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Tasas espec&#237;ficas por edad&#44; de abortos por 1000 mujeres en edad f&#233;rtil y seg&#250;n zona de origen&#46; Andaluc&#237;a&#44; 2007-2010&#46;</p>"
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Residentes</td><td class="td" title="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">337&#46;253&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;87&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&#46;308&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;67&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Aborto voluntario</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">47&#46;573&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&#40;12&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">460&#46;716&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">384&#46;826&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">68&#46;930&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">116&#46;776&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;25&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">94&#46;777&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;24&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15&#46;048&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;21&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">2008</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">120&#46;483&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;26&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">101&#46;608&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;26&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18&#46;872&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">2009</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">113&#46;629&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">&#40;24&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Menos de 25 a&#241;os</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Vive en pareja</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t">68&#46;930&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="7" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Nacionalidad</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Espa&#241;ola</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Europa&#44; Norteam&#233;rica&#44; Australia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Europa del Este&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;25&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Magreb&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;23&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#193;frica sin Magreb&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;0&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;944&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;4&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Am&#233;rica del Sur&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">22&#46;161&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;4&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">22&#46;161&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;32&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Asia&nbsp;\t\t\t\t\t\t\n
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                  """
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                  \t\t\t\t"><span class="elsevierStyleBold">Vive en pareja</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>40 y m&#225;s a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>25 a 39 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;4&#44;30-5&#44;12&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Menos 25 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;16&#44;12-18&#44;11&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#40;22&#44;08-27&#44;05&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Nivel de instrucci&#243;n</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tercer grado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">Segundo</span> grado&#44; 1&#176; y 2&#176; ciclo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sin estudios&#44;1&#176; grado&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Vive en pareja</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>S&#237;&nbsp;\t\t\t\t\t\t\n
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