array:24 [
  "pii" => "S0213911106715217"
  "issn" => "02139111"
  "doi" => "10.1157/13093203"
  "estado" => "S300"
  "fechaPublicacion" => "2006-09-01"
  "aid" => "71521"
  "copyright" => "Sociedad Española de Salud Pública y Administración Sanitaria"
  "copyrightAnyo" => "2006"
  "documento" => "article"
  "crossmark" => 0
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "fla"
  "cita" => "Gac Sanit. 2006;20:360-7"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 4809
    "formatos" => array:3 [
      "EPUB" => 124
      "HTML" => 4112
      "PDF" => 573
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S0213911106715229"
    "issn" => "02139111"
    "doi" => "10.1016/S0213-9111(06)71522-9"
    "estado" => "S300"
    "fechaPublicacion" => "2006-09-01"
    "aid" => "71522"
    "copyright" => "Sociedad Española de Salud Pública y Administración Sanitaria"
    "documento" => "article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Gac Sanit. 2006;20:368-73"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2430
      "formatos" => array:3 [
        "EPUB" => 137
        "HTML" => 1838
        "PDF" => 455
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Originales</span>"
      "titulo" => "Evaluation of the research methodology in genetic&#44; molecular and proteomic tests"
      "tienePdf" => "en"
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "368"
          "paginaFinal" => "373"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Valoraci&#243;n de la metodolog&#237;a de la investigaci&#243;n en pruebas de gen&#233;tica&#44; molecular y prote&#243;mica"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Blanca Lumbreras, Inmaculada Jarr&#237;n, Ildefonso Hern&#225;ndez Aguado"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Blanca"
              "apellidos" => "Lumbreras"
            ]
            1 => array:2 [
              "nombre" => "Inmaculada"
              "apellidos" => "Jarr&#237;n"
            ]
            2 => array:2 [
              "nombre" => "Ildefonso"
              "apellidos" => "Hern&#225;ndez Aguado"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213911106715229?idApp=WGSE"
    "url" => "/02139111/0000002000000005/v1_201301241603/S0213911106715229/v1_201301241603/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S0213911106715205"
    "issn" => "02139111"
    "doi" => "10.1157/13093202"
    "estado" => "S300"
    "fechaPublicacion" => "2006-09-01"
    "aid" => "71520"
    "copyright" => "Sociedad Espa&#241;ola de Salud P&#250;blica y Administraci&#243;n Sanitaria"
    "documento" => "article"
    "crossmark" => 0
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Gac Sanit. 2006;20:352-9"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2934
      "formatos" => array:3 [
        "EPUB" => 117
        "HTML" => 2381
        "PDF" => 436
      ]
    ]
    "es" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Originales</span>"
      "titulo" => "Asociaci&#243;n de los ingresos econ&#243;micos con la utilizaci&#243;n y la accesibilidad de los servicios sanitarios en Espa&#241;a al inicio del siglo XXI"
      "tienePdf" => "es"
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "352"
          "paginaFinal" => "359"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Association of income with use of and access to health services in Spain at the beginning of the XXI century"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Enrique Regidor, David Mart&#237;nez, Paloma Astasio, Paloma Ortega, Mar&#237;a Elisa Calle, Vicente Dom&#237;nguez"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Enrique"
              "apellidos" => "Regidor"
            ]
            1 => array:2 [
              "nombre" => "David"
              "apellidos" => "Mart&#237;nez"
            ]
            2 => array:2 [
              "nombre" => "Paloma"
              "apellidos" => "Astasio"
            ]
            3 => array:2 [
              "nombre" => "Paloma"
              "apellidos" => "Ortega"
            ]
            4 => array:2 [
              "nombre" => "Mar&#237;a"
              "apellidos" => "Elisa Calle"
            ]
            5 => array:2 [
              "nombre" => "Vicente"
              "apellidos" => "Dom&#237;nguez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213911106715205?idApp=WGSE"
    "url" => "/02139111/0000002000000005/v1_201301241603/S0213911106715205/v1_201301241603/es/main.assets"
  ]
  "es" => array:15 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Originales</span>"
    "titulo" => "El hambre en la Guerra Civil espa&#241;ola y la mortalidad por cardiopat&#237;a isqu&#233;mica&#58; una perspectiva desde la hip&#243;tesis de Barker"
    "tieneTextoCompleto" => 0
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "360"
        "paginaFinal" => "367"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Laura In&#233;s Gonz&#225;lez Zapata, Carlos Alvarez-Dardet D&#237;az, Andreu Nolasco Bonmat&#237;, Jos&#233; Aurelio Pina Romero, Mar&#237;a Jos&#233; Medrano"
        "autores" => array:5 [
          0 => array:4 [
            "nombre" => "Laura In&#233;s"
            "apellidos" => "Gonz&#225;lez Zapata"
            "email" => array:1 [
              0 => "laurag&#64;pijaos&#46;udea&#46;edu&#46;co"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff1"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">¿</span>"
                "identificador" => "cor1"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Carlos"
            "apellidos" => "Alvarez-Dardet D&#237;az"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff2"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Andreu"
            "apellidos" => "Nolasco Bonmat&#237;"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff3"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Jos&#233; Aurelio"
            "apellidos" => "Pina Romero"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff3"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Mar&#237;a"
            "apellidos" => "Jos&#233; Medrano"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff4"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:4 [
          0 => array:3 [
            "entidad" => "Escuela de Nutrici&#243;n y Diet&#233;tica&#44; Universidad de Antioquia&#44; Medell&#237;n-Colombia&#59; Departamento de Enfermer&#237;a Comunitaria&#44; Medicina Preventiva y Salud P&#250;blica e Historia de la Ciencia&#44; Universidad de Alicante&#44; Espa&#241;a"
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "aff1"
          ]
          1 => array:3 [
            "entidad" => "Observatorio de Pol&#237;ticas P&#250;blicas y Salud&#44; Departamento de Enfermer&#237;a Comunitaria&#44; Medicina Preventiva y Salud P&#250;blica e Historia de la Ciencia&#44; Universidad de Alicante&#44; Espa&#241;a"
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "aff2"
          ]
          2 => array:3 [
            "entidad" => "Unidad de Investigaci&#243;n de An&#225;lisis de la mortalidad y Estad&#237;sticas Sanitarias&#44; Departamento de Enfermer&#237;a Comunitaria&#44; Medicina Preventiva y Salud P&#250;blica e Historia de la Ciencia&#44; Universidad de Alicante&#44; Espa&#241;a"
            "etiqueta" => "<span class="elsevierStyleSup">c</span>"
            "identificador" => "aff3"
          ]
          3 => array:3 [
            "entidad" => "Centro Nacional de Epidemiolog&#237;a&#44; Instituto de Salud Carlos III&#44; Madrid&#44; Espa&#241;a"
            "etiqueta" => "<span class="elsevierStyleSup">d</span>"
            "identificador" => "aff4"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor1"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Correspondencia&#58; Dra&#46; Laura In&#233;s Gonz&#225;lez Zapata&#46; Escuela de Nutrici&#243;n y Diet&#233;tica&#46; Universidad de Antioquia&#46; Carrera 75&#44; 65-87 Bloque 44 Oficina 101&#46; Medell&#237;n-Colombia&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "en" => array:1 [
        "titulo" => "Famine in the Spanish civil war and mortality from coronary heart disease&#58; a perspective from Baker&#39;s hypothesis"
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2005-09-26"
    "fechaAceptado" => "2006-02-23"
    "PalabrasClave" => array:2 [
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec14150"
          "palabras" => array:5 [
            0 => "Hip&#243;tesis de Barker"
            1 => "An&#225;lisis de mortalidad"
            2 => "Modelos edad-per&#237;odo-cohorte"
            3 => "Cardiopat&#237;a isqu&#233;mica"
            4 => "Guerra Civil espa&#241;ola"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Key words"
          "identificador" => "xpalclavsec14149"
          "palabras" => array:5 [
            0 => "Barker&#39;s hypothesis"
            1 => "Mortality"
            2 => "Age-period-cohort models"
            3 => "Coronary heart diseases"
            4 => "Spanish civil war"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Analizar si el hambre durante la Guerra Civil espa&#241;ola y la inmediata posguerra influy&#243; sobre la mortalidad por cardiopat&#237;a isqu&#233;mica de las personas que nacieron en este per&#237;odo&#44; seg&#250;n lo planteado en la hip&#243;tesis de Barker acerca de la posible programaci&#243;n fetal de enfermedades de la edad adulta&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Con los datos de mortalidad por edad y sexo por cardiopat&#237;a isqu&#233;mica en el per&#237;odo 1990-2002&#44; se calcularon las tasas anuales de mortalidad espec&#237;ficas y las tasas ajustadas por edad&#44; por el m&#233;todo directo&#46; Mediante an&#225;lisis de regression de Poisson se analiz&#243; el efecto de la edad&#44; el per&#237;odo y la cohorte anual de nacimiento &#40;1918-1957&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Durante el per&#237;odo de estudio&#44; la mortalidad por cardiopat&#237;a isqu&#233;mica ha disminuido un promedio anual de &#8211;2&#44;3&#37; en ambos sexos y para todas las edades&#46; En el descenso de mortalidad est&#225;n presentes los efectos cohorte y per&#237;odo &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#59; se observa un incremento del riesgo para todas las edades y ambos sexos en las muertes correspondientes a personas nacidas durante los a&#241;os reconocidos como de mayor escasez alimentaria de la Guerra Civil y la inmediata posguerra &#40;1937&#44; 1940&#44; 1943 y 1945&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Los resultados obtenidos al estudiar anualmente la mortalidad por cardiopat&#237;a isqu&#233;mica son compatibles con la hip&#243;tesis de Barker sobre el efecto del estr&#233;s alimentario durante el embarazo en la g&#233;nesis de diversas enfermedades en el adulto&#46; La Guerra Civil espa&#241;ola&#44; adem&#225;s de costes humanos&#44; econ&#243;micos y pol&#237;ticos&#44; puede haber tenido consecuencias negativas para la salud de los nacidos en esas cohortes&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">To determine whether the famine experienced during the Spanish civil war and immediate postwar period influenced mortality from coronary heart disease &#40;CHD&#41; in persons born in this period&#44; following the lines of Barker&#39;s hypothesis on fetal programming of chronic diseases in adult life&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p class="elsevierStyleSimplePara elsevierViewall">Using CHD mortality data by age and sex for 1990-2002&#44; annual and age-adjusted rates were calculated by the direct method&#46; Poisson regressions were used to estimate period&#44; age and cohort effects by year of birth &#40;1918-1957&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">During the study period&#44; CHD mortality fell by a yearly average of &#8211;2&#46;3&#37; in both sexes and in all ages yearly&#46; This trend was influenced by both cohort and period effects &#40;p&#60; 0&#46;001&#41;&#59; an increased risk was observed for both sexes and in all ages in the deaths corresponding to persons born during the war and postwar years when the famine was most intense &#40;1937&#44;1940&#44; 1943 and 1945&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">The results obtained by studying yearly CHD mortality are compatible with those expected by Barker&#39;s hypothesis of the effect of nutritional stress during pregnancy&#46; In addition to its human&#44; economic and political costs&#44; the Spanish civil war could also have had negative consequences for the health of persons born in this period&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:34 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fetal origins of hyperphagia&#44; obesity&#44; and hypertension and postnatal amplification by hypercaloric nutrition"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Vickers"
                            1 => "B&#46;H&#46; Breier"
                            2 => "W&#46;S&#46; Cutfield"
                            3 => "P&#46;L&#46; Hofman"
                            4 => "P&#46;D&#46; Gluckman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Am J Physiol Endocrinol Metab"
                        "fecha" => "2000"
                        "volumen" => "279"
                        "paginaInicial" => "837"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fetal origins of coronary heart disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "D&#46;J&#46;P&#46; Barker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "1995"
                        "volumen" => "311"
                        "paginaInicial" => "171"
                        "paginaFinal" => "174"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7613432"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nutrici&#243;n temprana y enfermedades en la edad adulta&#58; acerca de la &#171;hip&#243;tesis de Barker&#187;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "P&#46; Dur&#225;n"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arch Argent Pediatr"
                        "fecha" => "2004"
                        "volumen" => "102"
                        "paginaInicial" => "26"
                        "paginaFinal" => "34"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obesity at the age of 50y in men and women exposed to famine prenatally"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Ravelli"
                            1 => "M&#46; Van Der"
                            2 => "C&#46; Osmond"
                            3 => "D&#46;J&#46;P&#46; Barker"
                            4 => "O&#46; Bleker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Clin Nutr"
                        "fecha" => "1999"
                        "volumen" => "70"
                        "paginaInicial" => "811"
                        "paginaFinal" => "816"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10539740"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Is blood pressure inversely related to birth weight&#63; The strength of evidence from a systematic review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46;M&#46; Low"
                            1 => "A&#46;W&#46; Shield"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Hypertens"
                        "fecha" => "1996"
                        "volumen" => "14"
                        "paginaInicial" => "935"
                        "paginaFinal" => "941"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8884547"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fetal and infant growth and cardiovascular risk factors in women"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46;H&#46;D&#46; Fall"
                            1 => "C&#46; Osmond"
                            2 => "D&#46;J&#46;P&#46; Barker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "1995"
                        "volumen" => "310"
                        "paginaInicial" => "428"
                        "paginaFinal" => "432"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7873947"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The thrifty phenotype hypothesis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46;N&#46; Hales"
                            1 => "D&#46;J&#46;P&#46; Barker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br Med Bull"
                        "fecha" => "2001"
                        "volumen" => "60"
                        "paginaInicial" => "5"
                        "paginaFinal" => "20"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11809615"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Growth in utero&#44; blood pressure in childhood and adult life&#44; and mortality from cardiovascular disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46;J&#46;P&#46; Barker"
                            1 => "C&#46; Osmond"
                            2 => "J&#46; Goldings"
                            3 => "D&#46; Kuh"
                            4 => "M&#46;E&#46; Wadsworth"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "1989"
                        "volumen" => "298"
                        "paginaInicial" => "564"
                        "paginaFinal" => "567"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2495113"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Birht weight and adult hypertension&#44; diabetes mellitus&#44; and obesity in US men"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "G&#46;C&#46; Curhan"
                            1 => "W&#46;C&#46; Willet"
                            2 => "E&#46;B&#46; Rimm"
                            3 => "D&#46; Spielgelman"
                            4 => "A&#46;L&#46; Ascherio"
                            5 => "M&#46;J&#46; Stampfer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Circulation"
                        "fecha" => "1996"
                        "volumen" => "94"
                        "paginaInicial" => "3246"
                        "paginaFinal" => "3250"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8989136"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Observations throwing light on the high mortality in the county of Finmark&#46; Is the high mortality today a late effect of very poor living conditions in childhood and adolescense&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46; Forsdahl"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Epidemiol"
                        "fecha" => "2002"
                        "volumen" => "31"
                        "paginaInicial" => "302"
                        "paginaFinal" => "308"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11980784"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Familiar patterns of ischemic hearth disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "G&#46; Rose"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Prev Soc Med"
                        "fecha" => "1964"
                        "volumen" => "18"
                        "paginaInicial" => "75"
                        "paginaFinal" => "80"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14150877"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Are poor living conditions in childhood and adolescence an important risk factor for arterioesclerotic hearth disease&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46; Forsdahl"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Prev Soc Med"
                        "fecha" => "1977"
                        "volumen" => "31"
                        "paginaInicial" => "91"
                        "paginaFinal" => "95"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/884401"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The intrauterine and early postnatal origins of cardiovascular disease and chronic bronchitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;J&#46;P&#46; Barker"
                            1 => "C&#46; Osmond"
                            2 => "C&#46;M&#46; Law"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Epidemiol Community Health"
                        "fecha" => "1989"
                        "volumen" => "43"
                        "paginaInicial" => "237"
                        "paginaFinal" => "240"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2607302"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "La mortalidad en la Guerra Civil espa&#241;ola"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46; D&#237;ez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Bol Asoc Demogr Hist"
                        "fecha" => "1985"
                        "volumen" => "3"
                        "paginaInicial" => "41"
                        "paginaFinal" => "55"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12266715"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "La mortalidad infantil espa&#241;ola en el siglo XX Centro de Investigaciones Sociol&#243;gicas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46; G&#243;mez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "1992"
                        "editorial" => "Siglo XXI"
                        "editorialLocalizacion" => "Madrid"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "La mortalidad en Espa&#241;a&#44; I&#46; La mortalidad infantil en Espa&#241;a 1900-1976"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Bolumar"
                            1 => "G&#46; Garrucho"
                            2 => "M&#46;J&#46; Meg&#237;a"
                            3 => "A&#46; Mu&#241;oz"
                            4 => "A&#46; Valverde"
                            5 => "F&#46; P&#233;rez Berm&#250;dez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev San Hig Pub"
                        "fecha" => "1981"
                        "volumen" => "55"
                        "paginaInicial" => "1205"
                        "paginaFinal" => "1219"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Los estudios sobre alimentaci&#243;n en la guerra&#46; En&#58; Problemas epidemiol&#243;gicos&#44; m&#233;dicos y sociales del latirismo en Espa&#241;a &#91;tesis doctoral&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46;I&#46; Del Cura"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2004"
                        "editorial" => "Universidad Aut&#243;noma de Madrid"
                        "editorialLocalizacion" => "Madrid"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "La alimentaci&#243;n de la poblaci&#243;n en Espa&#241;a desde la posguerra hasta los a&#241;os ochenta&#58; una revision cr&#237;tica de las encuestas de nutrici&#243;n"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46; Villalbi"
                            1 => "R&#46; Maldonado"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;"
                        "fecha" => "1988"
                        "volumen" => "90"
                        "paginaInicial" => "127"
                        "paginaFinal" => "130"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An evaluation of the nutritional status of a population group in Madrid&#46; Spain during the summer of 1941"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "W&#46; Robinson"
                            1 => "J&#46; Janney"
                            2 => "F&#46; Grande-Covian"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Nutr"
                        "fecha" => "1942"
                        "volumen" => "24"
                        "paginaInicial" => "557"
                        "paginaFinal" => "584"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patr&#243;n de mortalidad en Espa&#241;a&#44;1998"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46; Regidor"
                            1 => "J&#46;L&#46; Guti&#233;rrez-Fisac"
                            2 => "M&#46;E&#46; Calle"
                            3 => "A&#46; Otero"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Clin &#40;Barc&#41;"
                        "fecha" => "2002"
                        "volumen" => "118"
                        "paginaInicial" => "13"
                        "paginaFinal" => "15"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Actualizaci&#243;n de la mortalidad por enfermedades cardiovasculares arterioscler&#243;ticas&#58; enfermedad cerebrovascular y enfermedad isqu&#233;mica del coraz&#243;n"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46; Boix"
                            1 => "M&#46;J&#46; Medrano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Bolet&#237;n Epidemiol&#243;gico Semanal"
                        "fecha" => "2000"
                        "volumen" => "8"
                        "paginaInicial" => "77"
                        "paginaFinal" => "80"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22&#46;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Plan Integral de Cardiopat&#237;a Isqu&#233;mica 2004-2007&#46; Madrid&#58; Ministerio de Sanidad y Consumo&#59; 2003&#46;"
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Infant mortality&#44; childhood nutrition&#44; and ischaemic hearth disease in England and Wales"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;J&#46;P&#46; Barker"
                            1 => "C&#46; Osmond"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "1986"
                        "numero" => "I"
                        "paginaInicial" => "1077"
                        "paginaFinal" => "1081"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiolog&#237;a de la cardiopat&#237;a isqu&#233;mica en Espa&#241;a&#58; estimaci&#243;n del n&#250;mero de casos y las tendencias entre 1997 y 2005"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Marrugat"
                            1 => "R&#46; Elos&#250;a"
                            2 => "H&#46; Mart&#237;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Cardiol"
                        "fecha" => "2002"
                        "volumen" => "55"
                        "paginaInicial" => "337"
                        "paginaFinal" => "346"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11975899"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25&#46;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Instituto Nacional de Estad&#237;stica&#44; Espa&#241;a&#46; Demograf&#237;a y Poblaci&#243;n&#46; Proyecciones de Poblaci&#243;n &#91;citado 1 Jun 2005&#93;&#46; Disponible en&#58; <a class="elsevierStyleInterRef" href="http://www.ine.es/">http&#58;&#47;&#47;www&#46;ine&#46;es</a>"
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Age&#44; period and cohort models&#58; review of knowledge and implementation in GLIM"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Decarli"
                            1 => "C&#46; La Vecchia"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Stat App"
                        "fecha" => "1987"
                        "volumen" => "20"
                        "paginaInicial" => "397"
                        "paginaFinal" => "409"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27&#46;"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "The Comprehensive R Archive Network &#91;citado 27 Jun 2005&#93;&#46; Disponible en&#58; <a class="elsevierStyleInterRef" href="http://cran.es.r-project.org/">http&#58;&#47;&#47;cran&#46;es&#46;r-project&#46;org</a>"
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Time trends&#44; cohorts effects&#44; and geographic patterns in stroke mortality&#58; United States"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46; Feinleib"
                            1 => "L&#46; Ingster"
                            2 => "H&#46; Rosenberg"
                            3 => "J&#46; Maurer"
                            4 => "G&#46; Singh"
                            5 => "K&#46; Kochanek"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Epidemiol"
                        "fecha" => "1993"
                        "volumen" => "3"
                        "paginaInicial" => "458"
                        "paginaFinal" => "465"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8167818"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tendencias en la mortalidad por cardiopat&#237;a isqu&#233;mica en 50 provincias espa&#241;olas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Boix"
                            1 => "N&#46; Aragon&#233;s"
                            2 => "M&#46;J&#46; Medrano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Cardiol"
                        "fecha" => "2003"
                        "volumen" => "56"
                        "paginaInicial" => "850"
                        "paginaFinal" => "856"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14519271"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Tendencias de la mortalidad en Espa&#241;a&#44; 1952-1996&#46; Efecto de la edad&#44; de la cohorte de nacimiento y del per&#237;odo de muerte"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; L&#243;pez-Abente"
                            1 => "M&#46; Poll&#225;n"
                            2 => "N&#46; Aragon&#233;s"
                            3 => "B&#46; P&#233;rez"
                            4 => "A&#46; Ll&#225;cer"
                            5 => "J&#46; P&#233;rez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2002"
                        "editorial" => "Instituto de Salud Carlos III"
                        "editorialLocalizacion" => "Madrid"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effects of prenatal exposure to the Dutch famine on adult disease in later life&#58; an overview"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "T&#46;J&#46; Roseboom"
                            1 => "J&#46;H&#46;P&#46; Van der Meulen"
                            2 => "A&#46; Ravelli"
                            3 => "C&#46; Osmond"
                            4 => "D&#46;J&#46;P&#46; Barker"
                            5 => "O&#46;P&#46; Bleker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Mol Cell Endocrinol"
                        "fecha" => "2001"
                        "volumen" => "185"
                        "paginaInicial" => "93"
                        "paginaFinal" => "98"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11738798"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib32"
              "etiqueta" => "32&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Algunos aspectos metodol&#243;gicos sobre los modelos edad-per&#237;odo-cohorte&#46; Aplicaci&#243;n a las tendencias de mortalidad por c&#225;ncer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;R&#46; Gonz&#225;lez"
                            1 => "F&#46;J&#46; Llorca"
                            2 => "V&#46; Moreno"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gac Sanit"
                        "fecha" => "2002"
                        "volumen" => "16"
                        "paginaInicial" => "267"
                        "paginaFinal" => "273"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12057184"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib33"
              "etiqueta" => "33&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estados de salud y descenso de la mortalidad&#58; un espacio para la interdisciplinariedad"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46; Bernabeu-Mestre"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Berceo"
                        "fecha" => "1999"
                        "volumen" => "137"
                        "paginaInicial" => "25"
                        "paginaFinal" => "33"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib34"
              "etiqueta" => "34&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early growth&#44; adult income&#44; and risk of stroke"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;G&#46; Eriksson"
                            1 => "T&#46; Forsen"
                            2 => "J&#46; Tuomilehto"
                            3 => "C&#46; Osmond"
                            4 => "D&#46;J&#46;P&#46; Barker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Stroke"
                        "fecha" => "2000"
                        "volumen" => "31"
                        "paginaInicial" => "869"
                        "paginaFinal" => "874"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10753990"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "es"
  "url" => "/02139111/0000002000000005/v1_201301241603/S0213911106715217/v1_201301241603/es/main.assets"
  "Apartado" => array:4 [
    "identificador" => "764"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Originales"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/02139111/0000002000000005/v1_201301241603/S0213911106715217/v1_201301241603/es/main.pdf?idApp=WGSE&text.app=https://gacetasanitaria.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213911106715217?idApp=WGSE"
]
Compartir
Publique en esta revista
Información de la revista
Vol. 20. Núm. 5.
Páginas 360-367 (septiembre - octubre 2006)
Respuestas rápidas
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 20. Núm. 5.
Páginas 360-367 (septiembre - octubre 2006)
Originales
Open Access
El hambre en la Guerra Civil española y la mortalidad por cardiopatía isquémica: una perspectiva desde la hipótesis de Barker
Famine in the Spanish civil war and mortality from coronary heart disease: a perspective from Baker's hypothesis
Visitas
1001
Laura Inés González Zapataa,
Autor para correspondencia
laurag@pijaos.udea.edu.co

Correspondencia: Dra. Laura Inés González Zapata. Escuela de Nutrición y Dietética. Universidad de Antioquia. Carrera 75, 65-87 Bloque 44 Oficina 101. Medellín-Colombia.
, Carlos Alvarez-Dardet Díazb, Andreu Nolasco Bonmatíc, José Aurelio Pina Romeroc, María José Medranod
a Escuela de Nutrición y Dietética, Universidad de Antioquia, Medellín-Colombia; Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Universidad de Alicante, España
b Observatorio de Políticas Públicas y Salud, Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Universidad de Alicante, España
c Unidad de Investigación de Análisis de la mortalidad y Estadísticas Sanitarias, Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la Ciencia, Universidad de Alicante, España
d Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, España
Este artículo ha recibido

Under a Creative Commons license
Información del artículo
Resumen
Objetivo

Analizar si el hambre durante la Guerra Civil española y la inmediata posguerra influyó sobre la mortalidad por cardiopatía isquémica de las personas que nacieron en este período, según lo planteado en la hipótesis de Barker acerca de la posible programación fetal de enfermedades de la edad adulta.

Métodos

Con los datos de mortalidad por edad y sexo por cardiopatía isquémica en el período 1990-2002, se calcularon las tasas anuales de mortalidad específicas y las tasas ajustadas por edad, por el método directo. Mediante análisis de regression de Poisson se analizó el efecto de la edad, el período y la cohorte anual de nacimiento (1918-1957).

Resultados

Durante el período de estudio, la mortalidad por cardiopatía isquémica ha disminuido un promedio anual de –2,3% en ambos sexos y para todas las edades. En el descenso de mortalidad están presentes los efectos cohorte y período (p<0,001); se observa un incremento del riesgo para todas las edades y ambos sexos en las muertes correspondientes a personas nacidas durante los años reconocidos como de mayor escasez alimentaria de la Guerra Civil y la inmediata posguerra (1937, 1940, 1943 y 1945).

Conclusiones

Los resultados obtenidos al estudiar anualmente la mortalidad por cardiopatía isquémica son compatibles con la hipótesis de Barker sobre el efecto del estrés alimentario durante el embarazo en la génesis de diversas enfermedades en el adulto. La Guerra Civil española, además de costes humanos, económicos y políticos, puede haber tenido consecuencias negativas para la salud de los nacidos en esas cohortes.

Palabras clave:
Hipótesis de Barker
Análisis de mortalidad
Modelos edad-período-cohorte
Cardiopatía isquémica
Guerra Civil española
Abstract
Objective

To determine whether the famine experienced during the Spanish civil war and immediate postwar period influenced mortality from coronary heart disease (CHD) in persons born in this period, following the lines of Barker's hypothesis on fetal programming of chronic diseases in adult life.

Methods

Using CHD mortality data by age and sex for 1990-2002, annual and age-adjusted rates were calculated by the direct method. Poisson regressions were used to estimate period, age and cohort effects by year of birth (1918-1957).

Results

During the study period, CHD mortality fell by a yearly average of –2.3% in both sexes and in all ages yearly. This trend was influenced by both cohort and period effects (p< 0.001); an increased risk was observed for both sexes and in all ages in the deaths corresponding to persons born during the war and postwar years when the famine was most intense (1937,1940, 1943 and 1945).

Conclusions

The results obtained by studying yearly CHD mortality are compatible with those expected by Barker's hypothesis of the effect of nutritional stress during pregnancy. In addition to its human, economic and political costs, the Spanish civil war could also have had negative consequences for the health of persons born in this period.

Key words:
Barker's hypothesis
Mortality
Age-period-cohort models
Coronary heart diseases
Spanish civil war
El Texto completo está disponible en PDF
Bibliografía
[1.]
M. Vickers, B.H. Breier, W.S. Cutfield, P.L. Hofman, P.D. Gluckman.
Fetal origins of hyperphagia, obesity, and hypertension and postnatal amplification by hypercaloric nutrition.
Am J Physiol Endocrinol Metab, 279 (2000), pp. 837
[2.]
D.J.P. Barker.
Fetal origins of coronary heart disease.
BMJ, 311 (1995), pp. 171-174
[3.]
P. Durán.
Nutrición temprana y enfermedades en la edad adulta: acerca de la «hipótesis de Barker».
Arch Argent Pediatr, 102 (2004), pp. 26-34
[4.]
A. Ravelli, M. Van Der, C. Osmond, D.J.P. Barker, O. Bleker.
Obesity at the age of 50y in men and women exposed to famine prenatally.
Am J Clin Nutr, 70 (1999), pp. 811-816
[5.]
C.M. Low, A.W. Shield.
Is blood pressure inversely related to birth weight? The strength of evidence from a systematic review of the literature.
J Hypertens, 14 (1996), pp. 935-941
[6.]
C.H.D. Fall, C. Osmond, D.J.P. Barker.
Fetal and infant growth and cardiovascular risk factors in women.
BMJ, 310 (1995), pp. 428-432
[7.]
C.N. Hales, D.J.P. Barker.
The thrifty phenotype hypothesis.
Br Med Bull, 60 (2001), pp. 5-20
[8.]
D.J.P. Barker, C. Osmond, J. Goldings, D. Kuh, M.E. Wadsworth.
Growth in utero, blood pressure in childhood and adult life, and mortality from cardiovascular disease.
BMJ, 298 (1989), pp. 564-567
[9.]
G.C. Curhan, W.C. Willet, E.B. Rimm, D. Spielgelman, A.L. Ascherio, M.J. Stampfer.
Birht weight and adult hypertension, diabetes mellitus, and obesity in US men.
Circulation, 94 (1996), pp. 3246-3250
[10.]
A. Forsdahl.
Observations throwing light on the high mortality in the county of Finmark. Is the high mortality today a late effect of very poor living conditions in childhood and adolescense?.
Int J Epidemiol, 31 (2002), pp. 302-308
[11.]
G. Rose.
Familiar patterns of ischemic hearth disease.
Br J Prev Soc Med, 18 (1964), pp. 75-80
[12.]
A. Forsdahl.
Are poor living conditions in childhood and adolescence an important risk factor for arterioesclerotic hearth disease?.
Br J Prev Soc Med, 31 (1977), pp. 91-95
[13.]
D.J.P. Barker, C. Osmond, C.M. Law.
The intrauterine and early postnatal origins of cardiovascular disease and chronic bronchitis.
J Epidemiol Community Health, 43 (1989), pp. 237-240
[14.]
J. Díez.
La mortalidad en la Guerra Civil española.
Bol Asoc Demogr Hist, 3 (1985), pp. 41-55
[15.]
R. Gómez.
La mortalidad infantil española en el siglo XX Centro de Investigaciones Sociológicas.
Siglo XXI, (1992),
[16.]
F. Bolumar, G. Garrucho, M.J. Megía, A. Muñoz, A. Valverde, F. Pérez Bermúdez, et al.
La mortalidad en España, I. La mortalidad infantil en España 1900-1976.
Rev San Hig Pub, 55 (1981), pp. 1205-1219
[17.]
M.I. Del Cura.
Los estudios sobre alimentación en la guerra. En: Problemas epidemiológicos, médicos y sociales del latirismo en España [tesis doctoral].
Universidad Autónoma de Madrid, (2004),
[18.]
J. Villalbi, R. Maldonado.
La alimentación de la población en España desde la posguerra hasta los años ochenta: una revision crítica de las encuestas de nutrición.
Med Clin (Barc), 90 (1988), pp. 127-130
[19.]
W. Robinson, J. Janney, F. Grande-Covian.
An evaluation of the nutritional status of a population group in Madrid. Spain during the summer of 1941.
J Nutr, 24 (1942), pp. 557-584
[20.]
E. Regidor, J.L. Gutiérrez-Fisac, M.E. Calle, A. Otero.
Patrón de mortalidad en España,1998.
Med Clin (Barc), 118 (2002), pp. 13-15
[21.]
R. Boix, M.J. Medrano.
Actualización de la mortalidad por enfermedades cardiovasculares arterioscleróticas: enfermedad cerebrovascular y enfermedad isquémica del corazón.
Boletín Epidemiológico Semanal, 8 (2000), pp. 77-80
[22.]
Plan Integral de Cardiopatía Isquémica 2004-2007. Madrid: Ministerio de Sanidad y Consumo; 2003.
[23.]
D.J.P. Barker, C. Osmond.
Infant mortality, childhood nutrition, and ischaemic hearth disease in England and Wales.
Lancet, (1986), pp. 1077-1081
[24.]
J. Marrugat, R. Elosúa, H. Martí.
Epidemiología de la cardiopatía isquémica en España: estimación del número de casos y las tendencias entre 1997 y 2005.
Rev Esp Cardiol, 55 (2002), pp. 337-346
[25.]
Instituto Nacional de Estadística, España. Demografía y Población. Proyecciones de Población [citado 1 Jun 2005]. Disponible en: http://www.ine.es
[26.]
A. Decarli, C. La Vecchia.
Age, period and cohort models: review of knowledge and implementation in GLIM.
Rev Stat App, 20 (1987), pp. 397-409
[27.]
The Comprehensive R Archive Network [citado 27 Jun 2005]. Disponible en: http://cran.es.r-project.org
[28.]
M. Feinleib, L. Ingster, H. Rosenberg, J. Maurer, G. Singh, K. Kochanek.
Time trends, cohorts effects, and geographic patterns in stroke mortality: United States.
Ann Epidemiol, 3 (1993), pp. 458-465
[29.]
R. Boix, N. Aragonés, M.J. Medrano.
Tendencias en la mortalidad por cardiopatía isquémica en 50 provincias españolas.
Rev Esp Cardiol, 56 (2003), pp. 850-856
[30.]
G. López-Abente, M. Pollán, N. Aragonés, B. Pérez, A. Llácer, J. Pérez, et al.
Tendencias de la mortalidad en España, 1952-1996. Efecto de la edad, de la cohorte de nacimiento y del período de muerte.
Instituto de Salud Carlos III, (2002),
[31.]
T.J. Roseboom, J.H.P. Van der Meulen, A. Ravelli, C. Osmond, D.J.P. Barker, O.P. Bleker.
Effects of prenatal exposure to the Dutch famine on adult disease in later life: an overview.
Mol Cell Endocrinol, 185 (2001), pp. 93-98
[32.]
J.R. González, F.J. Llorca, V. Moreno.
Algunos aspectos metodológicos sobre los modelos edad-período-cohorte. Aplicación a las tendencias de mortalidad por cáncer.
Gac Sanit, 16 (2002), pp. 267-273
[33.]
J. Bernabeu-Mestre.
Estados de salud y descenso de la mortalidad: un espacio para la interdisciplinariedad.
Berceo, 137 (1999), pp. 25-33
[34.]
J.G. Eriksson, T. Forsen, J. Tuomilehto, C. Osmond, D.J.P. Barker.
Early growth, adult income, and risk of stroke.
Stroke, 31 (2000), pp. 869-874
Copyright © 2006. Sociedad Española de Salud Pública y Administración Sanitaria
Descargar PDF
Idiomas
Gaceta Sanitaria
Opciones de artículo
Herramientas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?