was read the article
array:23 [ "pii" => "S2173574317300692" "issn" => "21735743" "doi" => "10.1016/j.reumae.2017.04.002" "estado" => "S300" "fechaPublicacion" => "2017-07-01" "aid" => "1058" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "copyrightAnyo" => "2017" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Reumatol Clin. 2017;13:185-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 636 "formatos" => array:3 [ "EPUB" => 38 "HTML" => 423 "PDF" => 175 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1699258X17301031" "issn" => "1699258X" "doi" => "10.1016/j.reuma.2017.04.012" "estado" => "S300" "fechaPublicacion" => "2017-07-01" "aid" => "1058" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Reumatol Clin. 2017;13:185-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2865 "formatos" => array:3 [ "EPUB" => 155 "HTML" => 2144 "PDF" => 566 ] ] "es" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Impactos probables de la reforma migratoria estadounidense: algunos escenarios para la reumatología mexicana" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "185" "paginaFinal" => "188" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Probable impacts of United States immigration reform: Some scenarios for Mexican rheumatology" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carlos Pineda, Hugo Sandoval" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Carlos" "apellidos" => "Pineda" ] 1 => array:2 [ "nombre" => "Hugo" "apellidos" => "Sandoval" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2173574317300692" "doi" => "10.1016/j.reumae.2017.04.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574317300692?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X17301031?idApp=UINPBA00004M" "url" => "/1699258X/0000001300000004/v1_201706290122/S1699258X17301031/v1_201706290122/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2173574317300618" "issn" => "21735743" "doi" => "10.1016/j.reumae.2016.04.013" "estado" => "S300" "fechaPublicacion" => "2017-07-01" "aid" => "928" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Reumatol Clin. 2017;13:189-96" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 590 "formatos" => array:3 [ "EPUB" => 43 "HTML" => 398 "PDF" => 149 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Evaluation of the Implementation of an Integrated Program for Musculoskeletal System Care" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "189" "paginaFinal" => "196" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evaluación de la implementación de un programa integrado de atención a las enfermedades del aparato locomotor" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2143 "Ancho" => 3337 "Tamanyo" => 235434 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Conceptual model.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Igor Larrañaga, Myriam Soto-Gordoa, Arantzazu Arrospide, María Luz Jauregi, Jesús Millas, Ricardo San Vicente, Jabier Aguirrebeña, Javier Mar" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Igor" "apellidos" => "Larrañaga" ] 1 => array:2 [ "nombre" => "Myriam" "apellidos" => "Soto-Gordoa" ] 2 => array:2 [ "nombre" => "Arantzazu" "apellidos" => "Arrospide" ] 3 => array:2 [ "nombre" => "María Luz" "apellidos" => "Jauregi" ] 4 => array:2 [ "nombre" => "Jesús" "apellidos" => "Millas" ] 5 => array:2 [ "nombre" => "Ricardo" "apellidos" => "San Vicente" ] 6 => array:2 [ "nombre" => "Jabier" "apellidos" => "Aguirrebeña" ] 7 => array:2 [ "nombre" => "Javier" "apellidos" => "Mar" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X16300444" "doi" => "10.1016/j.reuma.2016.04.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X16300444?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574317300618?idApp=UINPBA00004M" "url" => "/21735743/0000001300000004/v1_201707050008/S2173574317300618/v1_201707050008/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Probable Impacts of United States Immigration Reform: Some Scenarios for Mexican Rheumatology" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "185" "paginaFinal" => "188" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Carlos Pineda, Hugo Sandoval" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Carlos" "apellidos" => "Pineda" "email" => array:1 [ 0 => "carpineda@yahoo.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Hugo" "apellidos" => "Sandoval" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Dirección de Investigación, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Unidad de Vigilancia Epidemiológica Hospitalaria-Investigación Sociomédica, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Impactos probables de la reforma migratoria estadounidense: algunos escenarios para la reumatología mexicana" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">For more than 50 years, hospitals and specialized medical centers, organizations for basic and clinical research, the drug industry, high-tech health-related firms and institutions for higher education that, together, constitute the biomedical research sector of the United States (U.S.),<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a> have benefited from the immigration of skilled students, scientists and academics from the entire world. Making use of this source of immigrant talent is unquestionable. In 2016 alone,<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">1</span></a> of a total of 897,783 registered practicing physicians in the U.S., 206,030 (22.95%) graduated from a medical school from outside the territory of the U.S. or Canada<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">2</span></a>; nearly 30,000 medical residents were registered to be trained in that country<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">2</span></a> and more than 50% of the positions of residents in internal medicine were occupied by an international resident.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">1,3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Given that around half of the growth of the entire U.S. economy can be explained by the motor represented by the constant innovation in science and engineering,<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">4</span></a> the sustained increase in the scientific and technological knowledge of the U.S., for more than half a century, has counted on the valuable participation of millions of immigrants. The recent toughening of the U.S. immigration policy<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">5</span></a> has the potential of provoking a disruption in this global trend, that has permitted that 5% of all of the current students in the U.S. are foreigners.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">There is, for example, the latent proposal concerning the possibility of a massive deportation of undocumented immigrants contemplated in the program Deferred Action for Childhood Arrivals (DACA). Under this initiative, it is estimated that 5400 physicians would no longer be eligible for introduction into the U.S. health care system over the next few decades.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The current immigration policy has also risked the health of certain seriously ill patients, since the temporary prohibition of accepting refugees could mean denying hospital admission for 800 persons who urgently need medical care and treatment. It has been calculated that, prior to the prohibitions, an average of around 200 refugees with different medical conditions, were being resettled in the U.S. every month.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The fear of being deported can likewise provoke an increase in the costs of health care services by means of extra out-of-pocket expenses. Since there is no universal health coverage in the U.S., payments of this type can, on occasion, represent a catastrophic volume of expenses associated with the impoverishment of both families and individuals.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The lack of alternatives for vulnerable groups also signifies that a growing number of immigrant patients are turning to the services offered by certain chains of pharmacies and retailers in the U.S. that run medical clinics attended to by nursing professionals and certified medical assistants, referred to as retail clinics.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">It is expected that establishments of this type will undergo an annual growth of 14% in 2017, numbering more than 2800 clinics, and will represent more than the levels registered in 2014, when there were approximately 1914 retail clinics.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">9</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Concomitantly, the U.S. government has announced stricter requirements for applying for a visa, as well as additional security controls in airports, international flights and customs.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In the hypothetical case of massive deportation of undocumented immigrants, it should be considered that the population returned to Mexico may need some supplementary type of medical care over the short term. An excess in the demand could saturate the capacity to respond of the Mexican health care system.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Likewise, the incidence of different common mental disorders,<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">10</span></a> as well as infectious diseases found in certain immigrant groups, could require the implementation of additional health services to reduce the burden of diseases of this type along the border and prevent a possible health crisis.<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">11,12</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">All these changes and threats, in combination with deportations and restrictions for the entry of refugees, are actions that can affect supply and demand of U.S. and Mexican medical care, as is shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. For these reasons, a stricter immigration policy could lead to a series of negative effects, that commences with the criminalization of immigrants.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">13</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Mexico has the third largest immigrant community in the world, after only China and India. Ninety-five percent of Mexican immigrants are concentrated in the U.S.; of the more than 32 million Mexicans residing there, more than 1 million have technical and higher education, including college and postgraduate levels.</p><p id="par0065" class="elsevierStylePara elsevierViewall">After India, Philippines and China, Mexico is ranked fourth as the origin of highly skilled immigrants living in the U.S., and is the first from the entire American continent as a whole.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">14</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">It is considered that the Mexican economy would have saved the U.S. 81,000 million dollars, over a period of 14 years, corresponding to the costs of the education of immigrants (skilled and unskilled). This amount represents an average of nearly $6 billion a year, equivalent to nearly half a percentage point of the U.S. gross domestic product.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">15</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Even omitting this important fact, if we add all the direct and indirect taxes paid by Mexican immigrants during that period of time, it is calculated that the U.S. economy received around 2.5 times what Mexico obtained in terms of transfer of funds. Thus, the net economic balance of this type of immigration is favorable for the U.S.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">15</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">In the case of Mexico, the recent shifts in immigration policy are even more aggravating because of (1) the insistence of the U.S. in constructing a border wall, (2) the possible cancelation (or renegotiation) of the North American Free Trade Agreement, (3) the presence of 7 million undocumented immigrants in the U.S. and (4) the threat to impose tariffs to protect the heavy industry and manufacturers of the so-called “Rust Belt”.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">16</span></a> The results of this whole adverse setting has provoked the depreciation of the Mexican peso against the dollar.</p><p id="par0085" class="elsevierStylePara elsevierViewall">There is an inverse relationship between the type of change and the funding of science in Mexico since, as the peso continues to depreciate, it also reduces the purchasing power of Mexican scientists, who need to import a large part of their supplies, reagents, materials and equipment from the U.S.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The depreciation also limits or cancels attendance at international meetings, makes it difficult to subscribe to scientific journals, catalogs or specialized repositories, and reduces options for publication in peer-reviewed international journals, many of which require the payment of a fee in dollars.</p><p id="par0095" class="elsevierStylePara elsevierViewall">Making the immigration policy tougher can likewise change the destination and numbers of Mexican fellows. Although, in 2016, the Mexican Council of Science and Technology awarded 1550 grants to postgraduate students and researchers to study in the U.S. (which is still the primary place for human resource training outside of Mexico), a cooling of the relationships between the two countries can reduce and, at some time, channel the flow of researchers toward options like the European Union, China and Japan.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The economic integration between Mexico and the U.S. is intense and increasingly involves the scientific setting. From 1940 to now, for example, Mexican researchers have published a total of 104,057 articles in collaboration with international colleagues; of these, nearly a third (equivalent to 36,057 articles) have been published with U.S. scientists as coauthors.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">17</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">The new immigration rules can have a larger or smaller impact on U.S. government budgetary allocations. For the time being, multiple cuts in public spending have been proposed for the purpose of freeing resources to finance the wall along the Mexico-U.S. border and to increment militarism.</p><p id="par0110" class="elsevierStylePara elsevierViewall">In the initial proposal, which will be spelled out in May, the U.S. government asks to reduce the budget of the National Institutes of Health (NIH) by $5.8 million<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">18</span></a> and cut that of the Prevention and Public Health Fund of the Centers for Disease Control and Prevention (CDC) by nearly 1000 million dollars, in addition to eliminating 403 millions of dollars destined to health professions and programs for nurse training, among others.</p><p id="par0115" class="elsevierStylePara elsevierViewall">These adjustments would have a direct impact on the biomedical research sector, given that funding from the NIH is distributed among more than 2600 institutions around the U.S. and is responsible for the creation of more than 313,000 full- and partial-time jobs.<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">19,20</span></a> The cuts could undermine the economic stability of the universities, of U.S. medical schools and of centers for training specialists, many of which depend on funds of this type.</p><p id="par0120" class="elsevierStylePara elsevierViewall">In addition, the effects on public spending, together with the generated uncertainty, could provoke an increase in uncovered health care, as well as a reduction in the number of insured patients in hospitals. An example of this would be the recent legislative failure to replace the Patient Protection and Affordable Care Act by the so-called American Health Care Act.</p><p id="par0125" class="elsevierStylePara elsevierViewall">In the case of Mexico, the announced budget cuts cast doubts on a large part of the funds for scientific collaboration with Mexico. The National Science Foundation, to mention a case, is currently backing approximately 200 projects with Mexican collaborators,<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">21</span></a> which could be affected by the announced adjustments.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Another impact for Mexico would be provided by the proposal to eliminated Fogarty International Center, an institution that invests 69 million dollars every year to encourage joint work on the part of health research centers in different countries with the NIH.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">18</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Although the scenarios for Mexico are in general pessimist and are influenced by uncertainty, the depreciation in the exchange rate could have an unforeseen collateral effect: an increase in medical tourism.</p><p id="par0140" class="elsevierStylePara elsevierViewall">In agreement with the CDC,<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">22</span></a> Mexico is now the second destiny in the world for this activity, with an expanding market for plastic surgery, odontology, cardiology, orthopedic surgery, bariatric surgery, fertility, transplantation and eye surgery.</p><p id="par0145" class="elsevierStylePara elsevierViewall">The offer of health care services is attractive because of considerable comparative advantages, such as the enormous differences in the cost of certain procedures and the emphasis on rehabilitation after surgery,<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">23</span></a> a common border, skilled specialists, a wide range of available procedures, avant-gardism in infrastructures, as well as high-quality services with international accreditation.</p><p id="par0150" class="elsevierStylePara elsevierViewall">The Mexican Secretariat of Economy estimates that medical tourism reached 3300 million dollars in 2015 and that it increased by 7% in 2016. On average, the savings in dollars for an individual from the U.S. ranges between 40% and 65% for a variety of specialties and procedures.<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">24</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">In the case of rheumatic and musculoskeletal diseases, the growing cost of medications prescribed in the U.S. has become an additional cause for concern. Given that biological agents are now part of the arsenal of therapies for several rheumatic conditions, such as rheumatoid arthritis, lupus erythematosus, spondyloarthritis and certain systemic vasculitides, the cost of treatment has increased.<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">25,26</span></a> This situation could lead to the search for new options in countries like Mexico, in order that patients with chronic conditions not incur in catastrophic expenses. In short, it is highly probable that the impact of immigration restrictions and the proposed budget cuts be differentiated. In their case, Mexican rheumatologists devoted to research should expect:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1)</span><p id="par0160" class="elsevierStylePara elsevierViewall">changes in the international funding of clinical, biomedical and technological research projects;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2)</span><p id="par0165" class="elsevierStylePara elsevierViewall">a lesser capacity to carry out projects because of the depreciation of the Mexican peso; and</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3)</span><p id="par0170" class="elsevierStylePara elsevierViewall">a decrease in the opportunities to do postgraduate studies and send students as fellows to other countries.</p></li></ul></p><p id="par0175" class="elsevierStylePara elsevierViewall">All of these situations could make it even more difficult to train young scientists since, rheumatology is an integrating activity within the basic research setting, as well as multidisciplinary in the clinical field, with a constant interaction with other health professionals.</p><p id="par0180" class="elsevierStylePara elsevierViewall">However, the depreciation of the Mexican peso and uncertainty resulting from the reform of the U.S. health system could open a window of opportunity toward the future for the clinical exercise of the profession, stimulated by a growing demand provided by a search for high-quality specialized care, through medical tourism.</p><p id="par0185" class="elsevierStylePara elsevierViewall">The scenarios mentioned here are not definitive, but they offer an analytical basis for impending discussion on the probable impacts that the shifts may have on the present and future of rheumatology in Mexico, as well as on the type of strategies and public policies to be implemented to prevent that these effects become more severe, given that the immigration policy underway is contrary to the deontological and behavioral concepts and to the professional performance of rheumatologists.<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">27</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Pineda C, Sandoval H. Impactos probables de la reforma migratoria estadounidense: algunos escenarios para la reumatología mexicana. Reumatol Clin. 2017;13:185–188.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">CDC, Centers for Disease Control and Prevention; DACA, Deferred Action for Childhood Arrivals; NIH, National Institutes of Health.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Source</span>: designed by the authors.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">U.S.</th><th class="td" title="table-head " colspan="2" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">Mexico</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Immigration policy <elsevierMultimedia ident="201707050008594531"></elsevierMultimedia> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Fiscal policy <elsevierMultimedia ident="201707050008594532"></elsevierMultimedia> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Social policy \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Foreign exchange policy \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Health policy \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Feasible type of impact \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Immigrant deportations; restriction for entry of refugees; access controls \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Budget cuts in NIH, CDC and other key components of the U.S. biomedical research system \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pressure on social factors that determine health \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Depreciation of the Mexican peso against the dollar \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pressure on the care-giving capacity of the health system \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Supply \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleBold">↓</span>International medical graduates<br><span class="elsevierStyleBold">↓</span>Foreign physicians<br><span class="elsevierStyleBold">↑</span>Unattended U.S. population in rural and poorer zones<br><span class="elsevierStyleBold">↑</span>Offer of retail clinics<br><span class="elsevierStyleBold">↓</span>Resettling severely-ill patients for treatment<br><span class="elsevierStyleBold">↑</span>Unattended immigrant population \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleBold">↓</span>Population covered in hospitals<br><span class="elsevierStyleBold">↑</span>Uninsured patients<br><span class="elsevierStyleBold">↓</span>Scientific productivity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleBold">↑</span>Uncertainty because of the implementation of DACA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleBold">↓</span>Importation of materials and scientific equipment<br><span class="elsevierStyleBold">↓</span>Scientific productivity (meetings, scientific articles)<br>↑Medical tourism \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleBold">↑</span>Incidence of diseases in immigrant groups<br><span class="elsevierStyleBold">↑</span>Burden of disease on the border<br><span class="elsevierStyleBold">↑</span>Pressure on the health care system \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Demand \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleBold">↓</span>Costs of helping the immigrant population<br><span class="elsevierStyleBold">↑</span>Costs associated with toughening immigration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleBold">↓</span>Budget allocation for NIH<br><span class="elsevierStyleBold">↓</span>Scientific innovation<br><span class="elsevierStyleBold">↓</span>Frontiers of knowledge \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleBold">↑</span>Out-of-pocket expense<br><span class="elsevierStyleBold">↑</span>Catastrophic expenses \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleBold">↓</span>Costs of fellows<br><span class="elsevierStyleBold">↓</span>Costs to access databases, catalogs and journals \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleBold">↑</span>Public spending for emergency care for immigrants and deported individuals \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1453233.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Probable Impacts of the Immigration Policy of the United States (U.S.) on Other Public Policies in the U.S. and Mexico.</p>" ] ] 1 => array:5 [ "identificador" => "201707050008594531" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 115 "Ancho" => 176 "Tamanyo" => 2229 ] ] ] 2 => array:5 [ "identificador" => "201707050008594532" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => false "mostrarDisplay" => true "figura" => array:1 [ 0 => array:4 [ "imagen" => "fx1.jpeg" "Alto" => 115 "Ancho" => 176 "Tamanyo" => 2229 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:27 [ 0 => array:3 [ "identificador" => "bib0140" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "International exchange and American medicine" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Armstrong" 1 => "M.E. Anderson" 2 => "J.M. Carethers" 3 => "J. Loscalzo" 4 => "M.S. Parmacek" 5 => "R.M. Wachter" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMp1701339" "Revista" => array:3 [ "tituloSerie" => "N Engl J Med" "fecha" => "2017" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27040451" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0145" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The importance of international medical graduates in the United States" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "W.W. Pinsky" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7326/M17-0505" "Revista" => array:2 [ "tituloSerie" => "Ann Intern Med" "fecha" => "2017" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0150" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "International medical graduates: from brain drain to potential gain" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.H. Majeed" 1 => "A.A. Ali" 2 => "F. Saeed" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5116/ijme.5869.008a" "Revista" => array:6 [ "tituloSerie" => "Int J Med Educ" "fecha" => "2017" "volumen" => "8" "paginaInicial" => "37" "paginaFinal" => "38" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28161694" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0155" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Trump makes translational research great again?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.L. Mann" 1 => "M.R. Can" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "JACC Basic Transl Sci" "fecha" => "2017" "volumen" => "2" "paginaInicial" => "101" "paginaFinal" => "103" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0160" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Executive order protecting the nation from foreign terrorist entry into the United States [White House web site]. Available from: <a href="https://www.whitehouse.gov/the-press-office/2017/03/06/executive-order-protecting-nation-foreign-terrorist-entry-united-states">https://www.whitehouse.gov/the-press-office/2017/03/06/executive-order-protecting-nation-foreign-terrorist-entry-united-states</a> [accessed 16.03.17]." ] ] ] 5 => array:3 [ "identificador" => "bib0165" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[American Medical Association web site]. Available from: <span class="elsevierStyleInterRef" id="intr0015" href="https://www.ama-assn.org/ama-urges-trump-administration-clarify-immigration-executive-order">https://www.ama-assn.org/ama-urges-trump-administration-clarify-immigration-executive-order</span> [accessed 16.03.17]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "AMA letter to the U.S. Department of Homeland Security" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.L. Madara" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2017" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0170" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Abutaleb Y, Cooke K, Rosenberg M. Ban sparks panic among refugees awaiting urgent medical care in U.S. [Reuters web site] Available from: <a href="http://www.reuters.com/article/us-usa-trump-immigration-medical-idUSKBN15E2FY">http://www.reuters.com/article/us-usa-trump-immigration-medical-idUSKBN15E2FY</a> [accessed 30.01.17]." ] ] ] 7 => array:3 [ "identificador" => "bib0175" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Funsalud. Estudio sobre la práctica de la atención médica en consultorios médicos adyacentes a farmacias privadas [Fundación Mexicana para la Salud web site]. Available from: <a href="http://funsalud.org.mx/portal/wp-content/uploads/2015/07/Informe-final-CAF-v300615-e-book.pdf">http://funsalud.org.mx/portal/wp-content/uploads/2015/07/Informe-final-CAF-v300615-e-book.pdf</a> [accessed 20.03.17]." ] ] ] 8 => array:3 [ "identificador" => "bib0180" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Accenture. US Retail health clinics expected to nearly double by 2017. [Accenture consulting web site]. Available from: <a href="https://www.accenture.com/t20151218T203107__w__/us-en/_acnmedia/PDF-2/Accenture-Retail-Health-Clinics-POV.pdf">https://www.accenture.com/t20151218T203107__w__/us-en/_acnmedia/PDF-2/Accenture-Retail-Health-Clinics-POV.pdf#zoom=50</a> [accessed 16.03.17]." ] ] ] 9 => array:3 [ "identificador" => "bib0185" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Factores asociados a malestar psicológico o trastornos mentales comunes en poblaciones migrantes a lo largo del mundo" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D. Jurado" 1 => "R.D. Alarcón" 2 => "J.M. Martínez-Ortega" 3 => "Y. Mendieta-Marichal" 4 => "L. Gutiérrez-Rojas" 5 => "M. Gurpegui" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rpsm.2016.04.004" "Revista" => array:6 [ "tituloSerie" => "Rev Psiquiatr Salud Ment" "fecha" => "2017" "volumen" => "10" "paginaInicial" => "45" "paginaFinal" => "58" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27291831" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0190" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Migration and infectious diseases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F. Castelli" 1 => "G. Sulis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cmi.2017.03.012" "Revista" => array:3 [ "tituloSerie" => "Clin Microbiol Infect" "fecha" => "2017" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11866852" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0195" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Molecular epidemiology of <span class="elsevierStyleItalic">Mycobacterium tuberculosis</span> in Baja California, Mexico. A result of human migration?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C.A. Flores-López" 1 => "R. Zenteno-Cuevas" 2 => "R. Laniado-Laborín" 3 => "Y. Reynaud" 4 => "R.A. García-Ortiz" 5 => "J.A. González-y-Merchand" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.meegid.2016.07.001" "Revista" => array:2 [ "tituloSerie" => "Infect Genet Evol" "fecha" => "2016" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0200" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The impact and implications of undocumented immigration on individual and collective health in the United States" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D.K. Hilfinger Messias" 1 => "M.M. McEwen" 2 => "L. Clark" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.outlook.2014.11.004" "Revista" => array:6 [ "tituloSerie" => "Nurs Outlook" "fecha" => "2015" "volumen" => "63" "paginaInicial" => "86" "paginaFinal" => "94" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25645486" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0205" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Gurrieri J, Texido E, Artola J. Migración calificada y desarrollo, desafíos para América del Sur. [Organización Internacional para las Migraciones web site]. Available from: <a href="https://www.iom.int/es/news/estudio-sobremigracion-calificada-y-desarrollo-desafios-para-america-del-sur">https://www.iom.int/es/news/estudio-sobremigracion-calificada-y-desarrollo-desafios-para-america-del-sur</a> [accessed 7.04.17]." ] ] ] 14 => array:3 [ "identificador" => "bib0210" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Albo A, Díaz J. Migración mexicana altamente calificada en EE. UU. y Transferencia de México a Estados Unidos a través del gasto en la educación de los migrantes. [BBVA Research web site]. Available from: <a href="https://www.bbvaresearch.com/KETD/fbin/mult/WP_1125_Mexico_tcm346-266762.pdf">https://www.bbvaresearch.com/KETD/fbin/mult/WP_1125_Mexico_tcm346-266762.pdf</a> [accessed 10.04.17]." ] ] ] 15 => array:3 [ "identificador" => "bib0215" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Donald Trump: Der Auto-Boom und Mexiko" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "F. Dudenhöffer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Wirtschaftsdienst" "fecha" => "2017" "volumen" => "97" "paginaInicial" => "148" "paginaFinal" => "150" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0220" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mexican and U.S. scientists partners" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Lazcano" 1 => "A. Ortiz-Ortega" 2 => "S. Armendariz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1126/science.aan0171" "Revista" => array:5 [ "tituloSerie" => "Science" "fecha" => "2017" "volumen" => "355" "paginaInicial" => "1139" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28302817" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0225" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "America first: a budget blueprint to make America Great again. [Govinfo web site]. Available from: <a href="https://www.whitehouse.gov/sites/whitehouse.gov/files/omb/budget/fy2018/2018_blueprint.pdf">https://www.whitehouse.gov/sites/whitehouse.gov/files/omb/budget/fy2018/2018_blueprint.pdf</a> [accessed 7.04.17]." ] ] ] 18 => array:3 [ "identificador" => "bib0230" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Size and characteristics of the biomedical research workforce associated with U.S National Institutes of Health extramural grants" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.R. Pool" 1 => "R.M. Wagner" 2 => "L.L. Scott" 3 => "D. Roy Chowdhury" 4 => "R. Berhane" 5 => "C. Wu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1096/fj.14-264358" "Revista" => array:6 [ "tituloSerie" => "FASEB J" "fecha" => "2016" "volumen" => "30" "paginaInicial" => "1023" "paginaFinal" => "1036" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26625903" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0235" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mapping biomedical research in the USA" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "B. Owens" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lancet" "fecha" => "2014" "volumen" => "384" "paginaInicial" => "11" "paginaFinal" => "14" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25003180" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0240" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mexican scientists feel the Trump effect" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L. Wade" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1126/science.355.6324.440" "Revista" => array:6 [ "tituloSerie" => "Science" "fecha" => "2017" "volumen" => "355" "paginaInicial" => "440" "paginaFinal" => "441" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28154026" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0245" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "CDC Yellow Book. [Centers for Disease Control and Prevention Travelers’ Health web site]. Available from: <a href="https://wwwnc.cdc.gov/travel/page/yellowbook-home-2014">https://wwwnc.cdc.gov/travel/page/yellowbook-home-2014</a> [accessed 16.03.16]." ] ] ] 22 => array:3 [ "identificador" => "bib0250" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Manatt Jones Global Strategies. Mexican Healthcare System Challenges and Opportunities. [Mannat web site]. Available from: <a href="https://www.manatt.com/Insights/White-Papers/2015/Mexican-Healthcare-System-Challenges-and-Opportuni">https://www.manatt.com/Insights/White-Papers/2015/Mexican-Healthcare-System-Challenges-and-Opportuni</a> [accessed 22.03.15]." ] ] ] 23 => array:3 [ "identificador" => "bib0255" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Patients beyond borders: everybody's guide to affordable, world-class medical travel. [Patients Beyond Borders web site]. Available from: <a href="http://www.patientsbeyondborders.com/">http://www.patientsbeyondborders.com/</a> [accessed 22.03.16]." ] ] ] 24 => array:3 [ "identificador" => "bib0260" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Catastrophic health expenses and impoverishment of households of patients with rheumatoid arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Álvarez-Hernández" 1 => "I. Peláez-Ballestas" 2 => "A. Boonen" 3 => "J. Vázquez-Mellado" 4 => "A. Hernández-Garduño" 5 => "F.C. Rivera" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.reuma.2012.05.002" "Revista" => array:6 [ "tituloSerie" => "Reumatol Clín" "fecha" => "2012" "volumen" => "8" "paginaInicial" => "168" "paginaFinal" => "173" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22704914" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0265" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The high cost of prescription drugs in the United States: origins and prospects for reform" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.S. Kesselheim" 1 => "J. Avorn" 2 => "A. Sarpatwari" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2016.11237" "Revista" => array:6 [ "tituloSerie" => "JAMA" "fecha" => "2016" "volumen" => "316" "paginaInicial" => "858" "paginaFinal" => "871" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27552619" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0270" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Presidents’ Day reflections. Why Donald Trump could not be a rheumatologist" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.S. Panush" 1 => "E.L. Matteson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Rheumatol" "fecha" => "2017" "volumen" => "59" "paginaInicial" => "18" "paginaFinal" => "22" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack288221" "titulo" => "Acknowledgement" "texto" => "<p id="par0190" class="elsevierStylePara elsevierViewall">The authors wish to thank Dr. Pedro Iván Pérez Neri, a researcher in medical sciences at the Manuel Velasco Suárez Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001300000004/v1_201707050008/S2173574317300692/v1_201707050008/en/main.assets" "Apartado" => array:4 [ "identificador" => "17335" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001300000004/v1_201707050008/S2173574317300692/v1_201707050008/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574317300692?idApp=UINPBA00004M" ]
Year/Month | Html | Total | |
---|---|---|---|
2024 November | 6 | 9 | 15 |
2024 October | 22 | 34 | 56 |
2024 September | 47 | 30 | 77 |
2024 August | 56 | 50 | 106 |
2024 July | 30 | 29 | 59 |
2024 June | 37 | 24 | 61 |
2024 May | 44 | 28 | 72 |
2024 April | 34 | 17 | 51 |
2024 March | 41 | 27 | 68 |
2024 February | 51 | 22 | 73 |
2024 January | 18 | 22 | 40 |
2023 December | 21 | 19 | 40 |
2023 November | 34 | 22 | 56 |
2023 October | 23 | 26 | 49 |
2023 September | 85 | 33 | 118 |
2023 August | 17 | 9 | 26 |
2023 July | 30 | 30 | 60 |
2023 June | 29 | 20 | 49 |
2023 May | 39 | 29 | 68 |
2023 April | 29 | 17 | 46 |
2023 March | 87 | 33 | 120 |
2023 February | 49 | 33 | 82 |
2023 January | 24 | 18 | 42 |
2022 December | 72 | 52 | 124 |
2022 November | 69 | 34 | 103 |
2022 October | 47 | 30 | 77 |
2022 September | 26 | 39 | 65 |
2022 August | 32 | 33 | 65 |
2022 July | 31 | 30 | 61 |
2022 June | 33 | 27 | 60 |
2022 May | 31 | 34 | 65 |
2022 April | 40 | 39 | 79 |
2022 March | 43 | 44 | 87 |
2022 February | 38 | 26 | 64 |
2022 January | 38 | 40 | 78 |
2021 December | 25 | 35 | 60 |
2021 November | 32 | 36 | 68 |
2021 October | 45 | 49 | 94 |
2021 September | 29 | 45 | 74 |
2021 August | 23 | 43 | 66 |
2021 July | 26 | 34 | 60 |
2021 June | 18 | 32 | 50 |
2021 May | 40 | 44 | 84 |
2021 April | 43 | 75 | 118 |
2021 March | 29 | 17 | 46 |
2021 February | 27 | 18 | 45 |
2021 January | 23 | 18 | 41 |
2020 December | 19 | 23 | 42 |
2020 November | 35 | 24 | 59 |
2020 October | 19 | 10 | 29 |
2020 September | 25 | 26 | 51 |
2020 August | 26 | 17 | 43 |
2020 July | 17 | 21 | 38 |
2020 June | 27 | 14 | 41 |
2020 May | 20 | 15 | 35 |
2020 April | 10 | 11 | 21 |
2020 March | 23 | 5 | 28 |
2019 September | 1 | 0 | 1 |
2019 August | 1 | 0 | 1 |
2019 January | 1 | 0 | 1 |
2018 December | 10 | 0 | 10 |
2018 May | 5 | 2 | 7 |
2018 April | 35 | 12 | 47 |
2018 March | 59 | 15 | 74 |
2018 February | 29 | 12 | 41 |
2018 January | 23 | 12 | 35 |
2017 December | 34 | 17 | 51 |
2017 November | 47 | 15 | 62 |
2017 October | 35 | 11 | 46 |
2017 September | 29 | 13 | 42 |
2017 August | 51 | 27 | 78 |
2017 July | 59 | 30 | 89 |
2017 June | 4 | 9 | 13 |