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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Rheumatoid arthritis &#40;RA&#41; is a chronic inflammatory disease with articular and extra-articular involvement&#44; which impacts patients&#39; functionality and quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The overall prevalence of this disease varies between &#46;3&#37; and 1&#46;2&#37;&#44; some ethnic differences are shown&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Prevalence in the indigenous population is heterogeneous&#59; in North America the reported prevalence was 5&#37;&#8211;7&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> while in Latin America &#40;LA&#41; a prevalence of &#46;4&#37;&#8211;1&#46;6&#37;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;7</span></a> was estimated&#46; The Latin American Study Group of Rheumatic Diseases in Indigenous Peoples &#40;GLADERPO&#41; conducted epidemiological&#44; anthropological&#44; and genetic studies in several indigenous populations in Argentina&#44; Mexico&#44; and Venezuela&#46; The prevalence of RA in the Qom population in Argentina was the highest reported &#40;2&#46;4&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In Argentina&#44; the Qom &#40;also known as Toba&#41; belong to the Guaycur&#250; language family&#44; who originally inhabited the northeast of the country in the provinces of Chaco&#44; Formosa&#44; and Salta&#46; The process of assimilation of the population is relatively recent &#40;around the 19th and 20th centuries&#41;&#46; Deforestation of the original forests&#44; appropriation of land and climatic catastrophes &#40;significant flooding&#41; have been forcing the Qom to migrate from the 1960s to the present day&#46; The Qom population settled in the territories of the provinces of Buenos Aires and Santa Fe&#44; with Rosario being one of the most densely populated cities in the province of Santa Fe&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In 2008&#44; the Argentine Health Research Forum&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> highlighted the complex epidemiological profile of the indigenous population&#44; as its rate of vulnerability and mortality is higher than that of the rest of the population&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The current complex situation of the indigenous population requires researchers to use a social and epidemiological strategy that combines both quantitative and qualitative techniques&#46; A study conducted in the Mayan community in Mexico&#44; and published by GLADERPO&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> used a strategy that prioritized the experiences of individuals with RA as well as their relationship with the local health system&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">This study took the same approach as the study in Mexico and aimed to describe the experience of Qom individuals with RA&#44; and their experience with the local health system in the city of Rosario&#44; Argentina&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">Qualitative ethnographic study&#46; The objective of this design is based on the theoretical concepts of the trajectory of experiencing the condition and seeking care&#44; to describe and understand the journey of the Qom group in their experience of RA&#44; as well as their experience with the health system&#46; Experiencing the condition is defined as the interpretation and reconstruction of the cultural dimension of the disease by the patient and his&#47;her family from their own specific context&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> Care seeking trajectories refer to the followed by the individual to achieve treatment and rehabilitation for a health problem&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">To meet the objectives of the study&#44; the techniques of semi-structured interviews and non-participatory observations recorded in anthropologists&#39; field diaries were used&#46; Interview and observation guides were used&#44; developed by a multidisciplinary group of researchers &#40;anthropologists&#44; rheumatologists&#44; nurses&#44; and psychologists&#41;&#46; The aspects included in the guide were&#58; daily life &#40;daily activities&#44; type of work undertaken&#44; housing conditions&#44; family relationships&#44; dependence on others&#41; and access to the health system &#40;availability of biomedical resources and treatment&#41;&#44; use of traditional resources and traditional medicine &#40;Appendix B Annex 1&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">This study is nested in a previous epidemiological study undertaken and published by the same team of researchers&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Participating population</span><p id="par0045" class="elsevierStylePara elsevierViewall">Individuals with RA identified in the epidemiological study were invited to participate&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Thirty-three interviews were conducted&#59; in four cases a second interview was deemed necessary due to the valuable information provided&#46; Thirty-eight hours and 15&#8239;minutes of interviews were analysed&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The criterion strategy of information saturation was chosen for the sample&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Information was considered saturated when the data collected no longer provided new categories of analysis or when the relationship between the categories had been validated&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Field work strategy</span><p id="par0055" class="elsevierStylePara elsevierViewall">In all cases&#44; the process included several visits to the homes of the individuals interviewed&#46; A first visit was made to establish initial contact&#44; introduce the interviewers&#44; and obtain informed consent&#46; The home visits began with a presentation given by the Qom cultural facilitator &#40;a Spanish&#47;Qom bilingual community member&#41;&#44; who explained the purpose of the study&#44; the confidentiality of participation&#44; and the future use of the data&#46; The individuals were invited to participate in the study and were given informed consent forms and time to read and understand them&#46; If the individual was illiterate&#44; the consent process was conducted verbally&#46; Signing of informed consent took place in the presence of witnesses&#44; a facilitator&#47;translator&#44; and a representative of the Provincial Ministry of Health&#46; Most of the interviews were conducted in the participants&#39; homes &#40;n&#8239;&#61;&#8239;30&#41; and the remaining few at the local health centre &#40;n&#8239;&#61;&#8239;3&#41;&#46; The participants&#39; homes were preferred as the place for the interview to facilitate the individual&#39;s recollection of significant experiences for his or her narrative&#46; In some cases&#44; a subsequent meeting was necessary to complete the interview&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">All interviews were conducted in Spanish&#44; recorded&#44; and then transcribed into Word documents and enriched with comments from the anthropologists&#39; field diary observations&#44; to complete the process of analysis&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">A reconstruction of trajectories was carried out through the narratives of the participants and that observed by the team of anthropologists&#44; a thematic analysis thereof was then undertaken&#46; The criterion of information saturation was used to define the richness and depth of the study themes&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Two members of the research team read the reconstructed narratives several times to identify the themes and sub-themes&#46; This analysis continued throughout the writing process&#46; A triangulation strategy was implemented to analyse the consistency of the information &#40;data triangulation&#41;&#44; convergence of the analysis &#40;researchers&#39; triangulation&#41; and complementarity of the techniques used&#44; such as non-participatory observation&#44; interviews and clinical information from the participating rheumatologists &#40;methodology triangulation&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Ethical approval</span><p id="par0075" class="elsevierStylePara elsevierViewall">The study was approved by the Research Ethics Committee of the Health Department of the Municipality of Rosario on 22 December 2010 &#40;Resolution No&#46; 1659&#47;2009&#41;&#44; with the support of the Ministry of Health &#40;resolutions 1619&#47;2010 and 0127&#47;2011&#41; and the Ministry of Social Development of the Province of Santa Fe&#44; the Rheumatology Association of Santa Fe&#44; the Faculty of Medical Sciences&#44; National University of Rosario and representatives of local Qom organizations&#46; The study was registered with the Provincial Bioethics Committee of the Province of Santa Fe on July 5&#44; 2012 &#40;registration order number&#58; 13&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Context of the study</span><p id="par0080" class="elsevierStylePara elsevierViewall">The study was carried out in Rosario&#44; province of Santa Fe&#44; Argentina&#46; Rosario is the most populated city in Santa Fe and the third most populated city in Argentina&#46; At the time of the last census in 2010&#44; Rosario had more than 1&#44;190&#44;000 inhabitants&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">There was no official data on the number of Qom individuals established in Rosario&#59; therefore&#44; it was necessary to conduct a population census and map the data collected&#46; The sample included individuals who met the following inclusion criteria&#58; &#8805;18 years of age&#44; who identified themselves as Qom and who had at least six months&#8217; residence in the city of Rosario&#46; The Qom population is located in three districts&#58; North &#40;Barrio La Traves&#237;a&#41;&#44; Northwest &#40;Barrio Pumitas&#41; and West &#40;Barrio Rouill&#243;n&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">This population primarily comprises young&#44; second or third generation Rosario-born people with communicative competence in Spanish&#44; unlike the older population and recent immigrants who still speak Qomlaqtaq &#40;their mother tongue&#41; as their first language&#46; The Qom undertake casual work and are employed informally in jobs that require extreme physical activity&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">In terms of housing conditions&#44; irregular sites mix with urban areas&#46; The Qom have limited access to some public services&#58; running water&#44; irregular electricity supply&#44; transport&#44; and rubbish collection&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The health system in Argentina is divided&#44; historically&#44; into three poorly integrated levels&#58; public health&#44; social security&#44; and private health&#46; The public health system is financed by the state budget and is administered by national&#44; provincial&#44; and local governments&#46; This complex organisation is based on the principle that every citizen has the right to health care&#44; regardless of whether they have social or private cover of any kind&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> In Rosario&#44; the public health system is structured in three levels&#44; according to the primary healthcare strategy&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> At primary level&#44; healthcare is mainly provided by general practitioners&#44; and at secondary and tertiary level by specialists&#44; for example&#44; rheumatologists&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">A total of 29 individuals were interviewed&#44; 25 &#40;86&#46;2&#37;&#41; of whom were women&#44; with an average age of 40&#46;8 &#40;range 26&#8211;55&#41; years and a mean &#40;standard deviation&#41; 5&#46;1 &#40;0&#46;3&#41; years of formal education&#46; All the individuals were beneficiaries of the public health system&#46; The city of Rosario was the birthplace of 15 &#40;51&#46;7&#37;&#41; individuals&#44; and the province of Chaco was the birthplace of 14 &#40;48&#46;2&#37;&#41; individuals&#46; All the patients spoke Spanish and 20 &#40;68&#46;9&#37;&#41; also spoke Qom&#46; Most of the participants live in the Barrio Rouill&#243;n &#40;n&#8239;&#61;&#8239;22&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In relation to RA&#44; all the patients met the 1987 RA classification criteria&#59;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> over 90&#37; were found to be HIV positive and around 60&#37; had radiological changes&#46; Most patients had active and limiting disease&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The following issues were identified&#58; 1&#41; Living with RA&#58; perception of pain&#44; daily activities&#44; type of work undertaken&#44; housing conditions&#44; family relations&#44; use of traditional medicine&#44; and 2&#41; Relationship with the local health system&#58; access to the health system&#44; doctor-patient relationship&#44; continuity of treatment and availability of medication&#46;</p><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Living with rheumatoid arthritis</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Interpretation of symptoms</span><p id="par0120" class="elsevierStylePara elsevierViewall">Symptoms were both normalised and underestimated&#46; The interpretation of symptoms could be one of the reasons for delay in consulting a doctor&#46;<span class="elsevierStyleDisplayedQuote" id="dsq0005"><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">&#8220;I didn&#39;t really notice&#46; I had a pain in my legs&#44; my knee and I thought it was normal &#40;&#8230;&#41;&#8221; &#40;woman&#44; 41 years old&#44; five years with RA&#41;&#46;</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; I didn&#39;t attach any importance to it &#40;&#8230;&#41; neither did I tell the doctor about this &#40;&#8230;&#41;&#8221; &#40;woman&#44; 48 years old&#44; three years with RA&#41;&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; When I came to Rosario in 1980&#44; I started working in 1995 and worked until 1996&#44; when I couldn&#39;t go on any longer because it hurt too much &#40;&#8230;&#41;&#8221; &#40;man&#44; 55 years old&#44; 18 years with RA&#41;&#46;</p></span></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Work and rheumatoid arthritis</span><p id="par0125" class="elsevierStylePara elsevierViewall">Notably&#44; most of the individuals&#44; regardless of gender&#44; undertook physically demanding work&#46; The characteristics of the disease&#44; therefore&#44; have major impact on the productivity and livelihood of the individual and his or her family&#46;<span class="elsevierStyleDisplayedQuote" id="dsq0010"><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; You know&#44; now I can&#39;t even tear cardboard &#40;&#8230;&#41; even if the cardboard isn&#8217;t very thick&#44; I can&#39;t do it&#44; because of my disease&#44; I can&#39;t do anything that requires effort because my hands hurt&#8221; &#40;man&#44; 52 years old&#44; seven years with RA&#41;&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; Now&#44; I don&#39;t work at home or with my family&#44; because of the pain in my body and hands &#40;&#8230;&#41; &#34;I don&#39;t have the strength to do my job &#40;&#8230;&#41;&#8221; &#40;woman&#44; 46 years old&#44; six years with RA&#41;&#46;</p></span></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Dependence&#46; Another consequence of rheumatoid arthritis</span><p id="par0130" class="elsevierStylePara elsevierViewall">The physical limitations of the disease and its consequences on daily routine affect family relationships&#44; mainly due to dependence on others&#46; A feeling of frustration and hopelessness can be perceived in the narratives&#44; especially in the intonation&#46;<span class="elsevierStyleDisplayedQuote" id="dsq0015"><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; It was then that I needed my daughter&#39;s help because I couldn&#8217;t stop myself&#44; I couldn&#8217;t support myself &#40;&#8230;&#41; because of the pain in my hands&#46; I couldn&#39;t even open the tap&#44; or comb my hair&#44; I depended on everyone &#40;&#8230;&#41;&#8221; &#40;woman&#44; 48 years old&#44; three years with RA&#41;&#46;</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; And I didn&#39;t say anything to my wife&#44; how it was hurting me&#44; nothing&#46; I wanted to continue&#44; to continue working &#40;&#8230;&#41;&#46; She helps me in my work &#40;&#8230;&#41;&#8221; &#40;man&#44; 55 years old&#44; 18 years with RA&#41;&#46;</p></span></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Process of seeking help</span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Traditional medicine</span><p id="par0135" class="elsevierStylePara elsevierViewall">In addition to using the public health system&#44; groups of strategies were observed in the population to treat the disease according to their belief&#44; value&#44; and action systems&#44; all of which are different from those of the health system&#46; These strategies can be grouped into three categories&#58; shamanism &#40;practices primarily associated with the conception that illness is the result of an &#39;evil&#39;&#41;&#44; religious healing in the context of native Pentecostal churches&#44; and traditional pharmacopoeia &#40;medicinal herbs&#41;&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Shamanism</span><p id="par0140" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleDisplayedQuote" id="dsq0020"><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; For him&#44; it is as if you&#8217;re operating on the disease&#44; you&#8217;re taking out the disease&#44; it&#8217;s not that it&#8217;s &#40;&#8230;&#41; it&#8217;s as if he&#8217;s operating on the patient&#46; And then he saw that the patient was covered by a white sheet&#44; and they put a plate there &#40;he touches his knees&#41; &#40;&#8230;&#41; And&#44; well&#44; there you have everything&#44; I don&#39;t know&#44; the disease falls into the plate and he shows you what that disease is &#40;&#8230;&#41;&#8221; &#40;man&#44; 50 years old&#44; seven years with RA&#41;&#46;</p></span></p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Religious healing</span><p id="par0145" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleDisplayedQuote" id="dsq0025"><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; I never said anything&#44; I pray&#44; for my life&#44; I ask the Lord to heal whatever I have&#44; I have faith in God&#44; nothing is impossible for God&#44; He can do everything &#40;&#8230;&#41;&#8221; &#40;man&#44; 45 years old&#44; four years with AR&#41;&#46;</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; No&#44; now it doesn&#39;t hurt much&#46; This is why I told Dr G&#46; the last time I went there last year&#44; and he said&#58; Are you taking something&#63; I&#39;m not taking anything now&#44; I told him&#46; Because I go to church&#44; I said&#46; And through the church&#44; the people who are always praying for me&#44; I can&#8217;t take the pills anymore&#44; I said&#46; And now it&#39;s like it helps me &#40;&#8230;&#41; From the gospel to the doctors&#46; It&#39;s like I have more faith in the gospel than in doctors&#44; and healers don&#39;t &#40;she laughs&#44; she&#39;s referring to shamanism&#41; &#40;&#8230;&#41; Even though they are doctors too &#40;&#8230;&#41;&#8221; &#40;woman&#44; 40 years old&#44; four years with RA&#41;&#46;</p></span></p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Traditional pharmacopoeia</span><p id="par0150" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleDisplayedQuote" id="dsq0030"><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; my grandmother&#44; my grandmother&#44; who lives in el Chaco&#44; when I went there in May told me to take &#40;&#8230;&#41; She told me to drink alcohol&#44; tobacco&#44; but I don&#39;t know &#40;&#8230;&#41; I didn&#39;t do it&#46; You mix all that into alcohol and every night you put it where it hurts&#46; Not only where it hurts&#44; but&#44; &#40;&#8230;&#41; in the heads of the bones&#44; in all that and if eases&#44; it eases the pain a lot &#40;&#8230;&#41;&#8221; &#40;woman&#44; 42 years old&#44; five years with RA&#41;&#46;</p></span></p></span></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Relationship with the local health system</span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Doctor-patient relationship</span><p id="par0155" class="elsevierStylePara elsevierViewall">Some disagreements arise in the relationship between patients and doctors&#46; Patients complain about the little time they have to explain things&#44; or about the lack of explanation&#46; It is inferred from the analysis that what patients refer to as a &#34;lack of explanation&#34; is a way of expressing difficulty in understanding it&#44; as well as the impossibility of building a doctor-patient relationship&#46;<span class="elsevierStyleDisplayedQuote" id="dsq0035"><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; and the pain in your body&#44; did the doctor tell you why you have that pain&#63; When I ask the doctor&#44; she always says&#58; we&#39;ll talk later &#40;&#8230;&#41;&#8221; &#40;woman&#44; 31 years old&#44; seven years with RA&#41;&#46;</p><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; You know that doctor was so loved here&#44; he attended you so naturally &#40;&#8230;&#41; because if you need a pill&#44; he&#8217;d say&#58; What happened&#63; What do you need&#63; &#40;&#8230;&#41; He would explain to people&#58; Look&#44; you have this&#44; this&#44; and this &#40;&#8230;&#41; he explained everything&#46; But not this one&#33;&#8221; &#40;man&#44; 52 years old&#44; seven years with RA&#41;&#46;</p></span></p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">About the medication</span><p id="par0160" class="elsevierStylePara elsevierViewall">Even though standard treatment is provided free of charge&#44; some difficulties were observed in the continuity of treatment&#46; After a follow-up visit to the specialist who originally prescribed the treatment&#44; patients can receive medication on a monthly basis at the nearest primary care centre &#40;PCC&#41;&#46; It was noted during the fieldwork that many patients had problems taking the medication as prescribed due to lack of knowledge&#46;<span class="elsevierStyleDisplayedQuote" id="dsq0040"><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; Look&#44; I really don&#39;t know&#44; I don&#39;t know&#46; Because they gave me four pills&#44; but I don&#39;t know which pill is for Chagas disease and which is for RA&#46; I was treated by two doctors and I asked one of them about one of the pills I&#8217;m taking&#46; It&#39;s for your bones&#44; he said&#46; But this is a painkiller&#44; it&#39;s not what&#39;s going to cure you &#40;&#8230;&#41; they&#39;re pain killers&#44; when that pain gets hold of you&#44; it&#39;s going to ease the pain&#8221; &#40;man&#44; 55 years old&#44; 18 years with RA&#41;&#46;</p><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; Yes&#44; I have to stop taking one&#44; but I don&#39;t know which one &#40;&#8230;&#41;&#8221; &#40;woman&#44; 45 years old&#44; five years with RA&#41;&#46;</p></span></p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Access&#46; Availability of appointments</span><p id="par0165" class="elsevierStylePara elsevierViewall">The difficulty in accessing medical appointments &#40;long hours of waiting in the street exposed to different weather conditions&#41; has a negative impact not only on the patient&#39;s health but also on the continuity of treatment&#44; as patients lose interest and abandon treatment&#46;<span class="elsevierStyleDisplayedQuote" id="dsq0045"><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; Yes&#44; yesterday I had an appointment scheduled with the doctor&#44; but I left&#46; Why&#63; There&#8217;s not much time for medical visits&#46; There are too many people&#46; If you&#8217;re late&#44; they won&#8217;t see you &#40;&#8230;&#41;&#8221; &#40;woman&#44; 46 years old&#44; 13 years with RA&#41;&#46;</p><p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; I didn&#39;t have the X-ray &#40;X-ray of the hands&#41;&#46; I couldn&#39;t get it done the other day &#40;&#8230;&#41; I arrived and didn&#39;t ask and I was sure that they were going to take the X-ray&#44; but when I arrived at CEMAR &#40;the name of the health care facility&#41;&#44; they told me that I should have had the X-ray at the hospital &#40;&#8230;&#41;&#8221; &#40;woman&#44; 48 years old&#44; 3 years with RA&#41;&#46;</p></span></p><p id="par0170" class="elsevierStylePara elsevierViewall">As a result of these difficulties&#44; patients adopt different strategies to speed up care&#44; such as skipping the visit with the primary care physician at the PCC and going directly to secondary care&#46; However&#44; this strategy is not sufficient&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Most of the time&#44; the Qom individuals combine both systems of care &#40;traditional and biomedical&#41; in seeking care for their disease&#46;</p></span></span></span></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Discussion</span><p id="par0180" class="elsevierStylePara elsevierViewall">This paper&#44; from a qualitative perspective&#44; is the first investigation of a chronic disease like RA and its impact on daily life conducted in Qom residents of the city of Rosario&#46; The first finding was that most of those interviewed had an aggressive manifestation of the disease&#44; which limited their daily and work activities&#46; This was already described by GLADERPO<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> and coincides with the results presented by Alarc&#243;n et al&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> and Callahan&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> These authors highlighted that indigenous populations present a higher level of deterioration and more aggressive disease progression&#46; Similarly&#44; Barnabe et al&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> described that indigenous patients have greater consequences of RA in relation to the magnitude of symptoms experienced&#44; quality of life&#44; limitations to activities of daily living and in reduced work possibilities&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">The second relevant finding was that&#44; despite living in an urban context and within the vicinity of a PPC&#44; treatment compliance and continuity were not as high as expected&#46; Low adherence to treatment by patients was observed in the abovementioned study&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> In comparison with other studies that focus on the analysis of health system accessibility&#44; most undertaken in rural contexts where geographical distances were a determining factor&#44; low adherence to treatment was also observed&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;26&#8211;29</span></a> In line with this finding&#44; a review of the literature by Loyola-Sanchez et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> which describes arthritis healthcare utilisation by indigenous populations in Australia&#44; Canada&#44; New Zealand and the United States&#44; noted that indigenous populations under-utilize specialist services while at the same time frequently using emergency services due to complications of the disease &#40;i&#46;e&#46; hospitalizations&#41;&#46; Free distribution of medication in the Qom population does not necessarily guarantee that it will get to the patient&#46; The latter may be due to a lack of understanding or awareness of the mechanisms of medication provision and its requirements&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Another relevant point was the doctor-patient relationship&#46; A high rate of professional staff turnover&#44; as well as a lack of sensitivity to ethnic specifics&#44; could affect the relationship between the PCC and patients&#59; facts observed in other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;31&#44;32</span></a> A research study conducted in an indigenous community in Alberta&#44; Canada&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> in which patients with RA and local health service professionals were interviewed&#44; found that the underutilization of specialist treatment was due to a lack of knowledge about how to access health care&#46; The authors emphasised the need for a culturally sensitive health system&#46; Similarly&#44; a systematic review of the specialist literature&#44; conducted by Fradgley et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> on the main barriers to specialist care experienced by individuals with chronic diseases&#44; highlighted a lack of understanding of the health system and poor relationship between health professionals and communities as the most common obstacles&#46; Lin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> described&#44; in a recent review&#44; that communication difficulties between health professionals and indigenous people were the main reasons why indigenous people did not access the health system&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Thus&#44; we believe that the main anthropological contribution should be to facilitate mutual understanding between health professionals and their patients&#44; improving their relationships and dispelling the common misconception that obstacles to healthcare are the result of failures on the part of the patients&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">The main difficulties include language differences between interviewers and respondents&#46; Another constraint was the well-known pattern of continuous movement between Rosario and the Qom communities in the Chaco region&#46; This point was highlighted in the cohort of RA patients belonging to the Qom community&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Migration was the main cause of visits lost to follow-up&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">The main strength of this paper was its multidisciplinary approach&#44; guided by the fundamental objective of improving indigenous patients&#39; access to the health system&#46; The clinical and epidemiological understanding of this disease is complemented by the social approach of anthropology&#46; The meeting of these different disciplines allows us to obtain a better understanding of the consequences of living with RA in this social group&#46; The field work was and still is conducted by the same group of professionals&#44; which has consolidated the relationship with the community&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">We can conclude that RA is a disease that has a negative impact on the daily life of the Qom population living in Rosario&#46; A new care strategy needs to be adopted&#44; prioritising multidisciplinary work in which not only medical staff&#44; but also other actors such as social workers&#44; anthropologists&#44; and community leaders&#44; play a fundamental role&#46;</p></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Sources of funding</span><p id="par0215" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Conflict of interests</span><p id="par0220" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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                      "titulo" => "Dependence&#46; Another consequence of rheumatoid arthritis"
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    "fechaRecibido" => "2020-01-31"
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            0 => "Health Care System"
            1 => "Indigenous people"
            2 => "Rheumatoid arthritis"
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            0 => "Sistema de Salud"
            1 => "Pueblos ind&#237;genas"
            2 => "Artritis reumatoide"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Rheumatoid arthritis &#40;RA&#41; is a chronic disease which impacts patients&#8217; quality of life&#46; The prevalence of RA in the <span class="elsevierStyleItalic">qom</span> population was 2&#46;4&#37; and represented an aggressive and disabling disease&#46; The study goal was to describe the experience of the indigenous <span class="elsevierStyleItalic">qom</span> community individual suffering from RA&#44; along with their experience with the local health care system in the city of Rosario&#44; Santa Fe&#44; Argentina&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Qualitative Study using techniques of participant observation and semi-structured interviews&#59; following a guideline developed by a multidisciplinary research group comprising anthropologists&#44; rheumatologists&#44; nurses&#44; and psychologists&#46; A triangulation strategy was implemented for the analysis&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 33 interviews were conducted in 29 individuals with RA&#46; The results showed a &#8220;normalization&#8221; of their symptoms and of their limitations in performing daily tasks&#46; The individuals&#8217; relationship with the local health care system was complex and limited in several aspects &#40;e&#46;g&#46; access to health care&#44; continuity of treatment&#44; complexity of medical care pathway and lack of cultural competence&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">RA is a disease that has a negative impact on the daily lives of the <span class="elsevierStyleItalic">qom</span> people living in Rosario&#46; Improving the relationship between this population and the local health care system as well as the implementation of multidisciplinary work should be priorities&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La artritis reumatoide &#40;AR&#41; es una enfermedad cr&#243;nica que impacta la vida de los pacientes&#46; La prevalencia de AR en la poblaci&#243;n <span class="elsevierStyleItalic">qom</span> fue de 2&#44;4&#37; y represent&#243; una enfermedad agresiva y limitante&#46; El objetivo del estudio fue describir la experiencia de los individuos de la comunidad ind&#237;gena <span class="elsevierStyleItalic">qom</span> que sufr&#237;an de AR&#44; y su experiencia con el sistema de salud local en la ciudad de Rosario&#44; Santa Fe&#44; Argentina&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiales y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio cualitativo de corte etnogr&#225;fico utilizando t&#233;cnicas de observaci&#243;n de los participantes y entrevistas semi-estructuradas&#59; siguiendo una gu&#237;a desarrollada por un grupo multidisciplinario de antrop&#243;logos&#44; reumat&#243;logos&#44; enfermeras y psic&#243;logos&#46; Se realiz&#243; un an&#225;lisis tem&#225;tico basado en las narrativas reconstruidas y una estrategia de triangulaci&#243;n entre investigadores&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un total de 33 entrevistas en 29 individuos con AR&#46; Los resultados mostraron una &#8220;normalizaci&#243;n&#8221; de los s&#237;ntomas y de sus limitaciones al realizar tareas diarias&#46; La relaci&#243;n entre los individuos y el sistema de salud local fue complejo y limitado en diferentes aspectos &#40;por ej&#46; acceso al sistema de salud&#44; continuidad del tratamiento&#44; complejidad en las v&#237;as de acceso a la asistencia m&#233;dica y falta de competencia cultural&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La AR es una enfermedad que tiene un impacto negativo en la vida diaria de la poblaci&#243;n<span class="elsevierStyleItalic">qom</span> que vive en Rosario&#46; Mejorar la relaci&#243;n entre esta poblaci&#243;n y el sistema de salud&#44; as&#237; como tambi&#233;n implementar un trabajo multidisciplinario debe ser una prioridad&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Quintana R&#44; Fern&#225;ndez S&#44; Orzuza SM&#44; Silvestre AMR&#44; Bensi A&#44; Go&#241;i M&#44; et al&#46; &#171;Vivir con artritis reumatoide&#187; en una poblaci&#243;n ind&#237;gena <span class="elsevierStyleItalic">qom</span> en la Argentina&#46; Un estudio cualitativo&#46; Reumatol Clin&#46; 2021&#59;17&#58;543&#8211;548&#46;</p>"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Updated projected prevalence of self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitation among US adults&#44; 2015-2040"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;M&#46; Hootman"
                            1 => "C&#46;G&#46; Helmick"
                            2 => "K&#46;E&#46; Barbour"
                            3 => "K&#46;A&#46; Theis"
                            4 => "M&#46;A&#46; Boring"
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                    0 => array:2 [
                      "doi" => "10.1002/art.39692"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Rheumatol"
                        "fecha" => "2016"
                        "volumen" => "68"
                        "paginaInicial" => "1582"
                        "paginaFinal" => "1587"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27015600"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The burden of musculoskeletal disease&#8212;a global perspective"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "P&#46;M&#46; Brooks"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.1007/s10067-006-0240-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Rheumatol"
                        "fecha" => "2006"
                        "volumen" => "25"
                        "paginaInicial" => "778"
                        "paginaFinal" => "781"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16609823"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rheumatoid arthritis in American Indians and Alaska Natives&#58; a review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46;D&#46; Ferucci"
                            1 => "D&#46;W&#46; Templin"
                            2 => "A&#46;P&#46; Lanier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.semarthrit.2004.08.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Arthritis Rheum"
                        "fecha" => "2005"
                        "volumen" => "34"
                        "paginaInicial" => "662"
                        "paginaFinal" => "667"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15692959"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of patients with rheumatoid arthritis in Latin America&#58; a consensus position paper from Pan-American League of Associations of Rheumatology and Grupo Latino Americano De Estudio De Artritis Reumatoide"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Massardo"
                            1 => "M&#46;E&#46; Suarez-Almazor"
                            2 => "M&#46;H&#46; Cardiel"
                            3 => "A&#46; Nava"
                            4 => "R&#46;A&#46; Levy"
                            5 => "I&#46; Laurindo"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/RHU.0b013e3181a90cd8"
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                        "tituloSerie" => "J Clin Rheumatol"
                        "fecha" => "2009"
                        "volumen" => "15"
                        "paginaInicial" => "203"
                        "paginaFinal" => "210"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19502907"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The prevalence of rheumatoid arthritis in Argentina&#58; a capture-recapture study in a city of Buenos Aires province"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Scublinsky"
                            1 => "H&#46; Venarotti"
                            2 => "G&#46; Citera"
                            3 => "O&#46;D&#46; Messina"
                            4 => "E&#46; Scheines"
                            5 => "O&#46; Rillo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/RHU.0b013e3181f3bfdd"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Rheumatol"
                        "fecha" => "2010"
                        "volumen" => "16"
                        "paginaInicial" => "317"
                        "paginaFinal" => "321"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20859227"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology of the rheumatic diseases in Mexico&#46; A study of 5 regions based on the COPCORD methodology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46; Pelaez-Ballestas"
                            1 => "L&#46;H&#46; Sanin"
                            2 => "J&#46; Moreno-Montoya"
                            3 => "J&#46; Alvarez-Nemegyei"
                            4 => "R&#46; Burgos-Vargas"
                            5 => "M&#46; Garza-Elizondo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3899/jrheum.100951"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Rheumatol Suppl"
                        "fecha" => "2011"
                        "volumen" => "86"
                        "paginaInicial" => "3"
                        "paginaFinal" => "8"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21196592"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of early rheumatoid arthritis in a multinational inception cohort of Latin American patients&#58; the GLADAR experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;H&#46; Cardiel"
                            1 => "B&#46;A&#46; Pons-Estel"
                            2 => "M&#46;P&#46; Sacnun"
                            3 => "D&#46; Wojdyla"
                            4 => "V&#46; Saurit"
                            5 => "J&#46;C&#46; Marcos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/RHU.0b013e31826d6610"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Rheumatol"
                        "fecha" => "2012"
                        "volumen" => "18"
                        "paginaInicial" => "327"
                        "paginaFinal" => "335"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23047532"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of musculoskeletal disorders and rheumatic diseases in the indigenous Qom population of Rosario&#44; Argentina"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Quintana"
                            1 => "A&#46;M&#46; Silvestre"
                            2 => "M&#46; Goni"
                            3 => "V&#46; Garcia"
                            4 => "N&#46; Mathern"
                            5 => "M&#46; Jorfen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10067-016-3192-2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Rheumatol"
                        "fecha" => "2016"
                        "volumen" => "35"
                        "paginaInicial" => "5"
                        "paginaFinal" => "14"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26852314"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Indymedia Argentina Centro de Medios Independientes&#44; Luis C&#233;sar Bou&#46; Losindios Tobas en Rosario&#44; Argentina&#58; nuevos pobres urbanos&#46; 2003&#46; Available from&#58; <a target="_blank" href="http://argentina.indymedia.org/news/2003/04/101871.php">http&#58;&#47;&#47;argentina&#46;indymedia&#46;org&#47;news&#47;2003&#47;04&#47;101871&#46;php</a>&#46;"
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Foro de Investigaci&#243;n en Salud de Argentina &#40;2008&#41; Estado de conocimiento y agenda de prioridades para la toma de decisiones en Argentina&#46; Situaci&#243;n de salud&#44; intervenciones y l&#237;neas de investigaci&#243;n para la toma de decisiones en salud con pueblos ind&#237;genas en Argentina&#46; &#91;consultado en enero 2018&#93; Available from&#58; <a target="_blank" href="http://www.saludinvestiga.org.ar/pdf/policy-brief/2008-indigenas.pdf">http&#58;&#47;&#47;www&#46;saludinvestiga&#46;org&#46;ar&#47;pdf&#47;policy-brief&#47;2008-indigenas&#46;pdf</a>&#46;"
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Barriers to accessing the culturally sensitive healthcare that could decrease the disabling effects of arthritis in a rural Mayan community&#58; a qualitative inquiry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Loyola-Sanchez"
                            1 => "J&#46; Richardson"
                            2 => "S&#46; Wilkins"
                            3 => "J&#46;N&#46; Lavis"
                            4 => "M&#46;G&#46; Wilson"
                            5 => "J&#46; Alvarez-Nemegyei"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10067-015-3061-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Rheumatol"
                        "fecha" => "2016"
                        "volumen" => "35"
                        "paginaInicial" => "1287"
                        "paginaFinal" => "1298"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26334916"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The illness narratives&#46; Suffering&#44; healing&#44; &#38; the human condition"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46; Kleinman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "1988"
                        "editorial" => "Basic Books"
                        "editorialLocalizacion" => "New York"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Medicine&#44; rationality&#44; &#38; experience&#46; An anthropological perspective"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "B&#46;J&#46; Good"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2001"
                        "editorial" => "Cambridge University Press"
                        "editorialLocalizacion" => "New York"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Help-seeking trajectory in patient with rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "I&#46; Pel&#225;ez"
                            1 => "C&#46; Infante"
                            2 => "R&#46; Quintana"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10067-015-3013-z"
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Rheum"
                        "fecha" => "2015"
                        "volumen" => "34"
                        "paginaInicial" => "S17"
                        "paginaFinal" => "S28"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Illness trajectories in Mexican children with juvenile idiopathic arthritis and their parents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "I&#46; Pelaez-Ballestas"
                            1 => "M&#46; Romero-Mendoza"
                            2 => "L&#46; Ramos-Lira"
                            3 => "R&#46; Caballero"
                            4 => "A&#46; Hernandez-Garduno"
                            5 => "R&#46; Burgos-Vargas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/rheumatology/kel122"
                      "Revista" => array:5 [
                        "tituloSerie" => "Rheumatology &#40;Oxford&#41;"
                        "fecha" => "2006"
                        "volumen" => "45"
                        "paginaInicial" => "1399"
                        "paginaFinal" => "1403"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Qualitative Research in Health Care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46; Pope"
                            1 => "N&#46; Mays"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "edicion" => "2nd edition"
                        "fecha" => "2000"
                        "editorial" => "BMJ Books"
                        "editorialLocalizacion" => "London"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Qualitative Research Methods&#46; A Health Focus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46;L&#46; Rice"
                            1 => "D&#46; Ezzy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "1999"
                        "editorial" => "Oxford University Press"
                        "editorialLocalizacion" => "Oxford"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The use of triangulation in qualitative research"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "N&#46; Carter"
                            1 => "D&#46; Bryant-Lukosius"
                            2 => "A&#46; DiCenso"
                            3 => "J&#46; Blythe"
                            4 => "A&#46;J&#46; Neville"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1188/14.ONF.545-547"
                      "Revista" => array:6 [
                        "tituloSerie" => "Oncol Nurs Forum"
                        "fecha" => "2014"
                        "volumen" => "41"
                        "paginaInicial" => "545"
                        "paginaFinal" => "547"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25158659"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Instituto Nacional de Estad&#237;stica y Censos &#40;INDEC&#41;&#46; Censo Nacio-nal de Poblaci&#243;n&#44; Hogares y Viviendas 2010&#46; 2012&#46; Available from&#58; <a target="_blank" href="https://www.indec.gob.ar/ftp/cuadros/poblacion/censo2010tomo1.pdf">https&#58;&#47;&#47;www&#46;indec&#46;gob&#46;ar&#47;ftp&#47;cuadros&#47;poblacion&#47;censo2010tomo1&#46;pdf</a>&#46;"
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Bell&#243; M&#44; Becerril-Montekio VM&#46; &#91;The health system of Argentina&#93;&#46; Salud PublicaMex&#46; 2011&#59;53&#58;s96&#8211;108&#46;"
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Municipalidad de Rosario &#40;Argentina&#41;&#46; Salud P&#250;blica&#46; Available from&#58; <a target="_blank" href="https://www.rosario.gob.ar/web/servicios/salud">https&#58;&#47;&#47;www&#46;rosario&#46;gob&#46;ar&#47;web&#47;servicios&#47;salud</a>&#46;"
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46;C&#46; Arnett"
                            1 => "S&#46;M&#46; Edworthy"
                            2 => "D&#46;A&#46; Bloch"
                            3 => "D&#46;J&#46; McShane"
                            4 => "J&#46;F&#46; Fries"
                            5 => "N&#46;S&#46; Cooper"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/art.1780310302"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Rheum"
                        "fecha" => "1988"
                        "volumen" => "31"
                        "paginaInicial" => "315"
                        "paginaFinal" => "324"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3358796"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rheumatoid arthritis in the indigenous qom population of Rosario&#44; Argentina&#58; aggressive and disabling disease with inadequate adherence to treatment in a community-based cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Quintana"
                            1 => "M&#46; Goni"
                            2 => "N&#46; Mathern"
                            3 => "M&#46; Jorfen"
                            4 => "S&#46; Conti"
                            5 => "R&#46; Nieto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10067-018-4103-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Rheumatol"
                        "fecha" => "2018"
                        "volumen" => "37"
                        "paginaInicial" => "2323"
                        "paginaFinal" => "2330"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29675622"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Contribution of ethnic group and socioeconomic status to degree of disability in rheumatoid arthritis in Chilean patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46;M&#46; Alarcon"
                            1 => "S&#46; Munoz"
                            2 => "J&#46;S&#46; Kaufman"
                            3 => "C&#46; Martinez"
                            4 => "P&#46; Riedemann"
                            5 => "S&#46; Kaliski"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00296-014-3123-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rheumatol Int"
                        "fecha" => "2015"
                        "volumen" => "35"
                        "paginaInicial" => "685"
                        "paginaFinal" => "689"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25178741"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Social epidemiology and rheumatic disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "L&#46;F&#46; Callahan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00002281-200303000-00004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Rheumatol"
                        "fecha" => "2003"
                        "volumen" => "15"
                        "paginaInicial" => "110"
                        "paginaFinal" => "115"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12598796"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
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                        "link" => array:1 [
                          0 => array:2 [
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                        "link" => array:1 [
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                        "link" => array:1 [
                          0 => array:2 [
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                            "web" => "Medline"
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                        "volumen" => "46"
                        "paginaInicial" => "665"
                        "paginaFinal" => "674"
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                    ]
                  ]
                ]
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                    0 => array:2 [
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                        "link" => array:1 [
                          0 => array:2 [
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                  ]
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                    0 => array:2 [
                      "titulo" => "Health literacy&#58; health professionals&#8217; understandings and their perceptions of barriers that Indigenous patients encounter"
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                            3 => "S&#46; Crengle"
                            4 => "M&#46; Kelaher"
                            5 => "S&#46; Reid"
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                    0 => array:2 [
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                        "volumen" => "14"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25471387"
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                      ]
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                  ]
                ]
              ]
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                    0 => array:2 [
                      "titulo" => "Discordant indigenous and provider frames explain challenges in improving access to arthritis care&#58; a qualitative study using constructivist grounded theory"
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                            2 => "C&#46;A&#46; Jones"
                            3 => "L&#46;F&#46; Crowshoe"
                            4 => "D&#46;A&#46; Marshall"
                            5 => "J&#46; Homik"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24916481"
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              ]
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                          0 => array:2 [
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                            4 => "R&#46; Goucke"
                            5 => "J&#46; Coffin"
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Original Article
«Living with rheumatoid arthritis» in an indigenous qom population in Argentina. A qualitative study
«Vivir con artritis reumatoide» en una población indígena qom en la Argentina. Un estudio cualitativo
Rosana Quintanaa,
Corresponding author
rosanaquintana@gmail.com

Corresponding author.
, Sofía Fernándezb, Stella M. Orzuzab, Adriana M.R. Silvestrea, Ana Bensib, Mario Goñic, Paola Iglesiasb, Nora Mathernd, Vanina García-Biancoa, Andrés Honerib, Bernardo A. Pons-Estela, Marcela Valdatab, Ingris Peláez-Ballestase
a Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Argentina
b Centro de Estudios Aplicados a Problemáticas Socio-culturales (CEAPROS), Facultad de Humanidades y Artes, Universidad Nacional de Rosario, Argentina
c Centro de Especialidades Médicas Ambulatorias de Rosario, Secretaría de Salud Pública, Municipalidad de Rosario, Argentina
d Instituto de Reumatología, Ortopedia y Fisiatría, Rosario, Argentina
e Hospital General de Mexico Dr. Eduardo Liceaga, Mexico City, Mexico
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Rheumatoid arthritis &#40;RA&#41; is a chronic inflammatory disease with articular and extra-articular involvement&#44; which impacts patients&#39; functionality and quality of life&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The overall prevalence of this disease varies between &#46;3&#37; and 1&#46;2&#37;&#44; some ethnic differences are shown&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Prevalence in the indigenous population is heterogeneous&#59; in North America the reported prevalence was 5&#37;&#8211;7&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> while in Latin America &#40;LA&#41; a prevalence of &#46;4&#37;&#8211;1&#46;6&#37;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;7</span></a> was estimated&#46; The Latin American Study Group of Rheumatic Diseases in Indigenous Peoples &#40;GLADERPO&#41; conducted epidemiological&#44; anthropological&#44; and genetic studies in several indigenous populations in Argentina&#44; Mexico&#44; and Venezuela&#46; The prevalence of RA in the Qom population in Argentina was the highest reported &#40;2&#46;4&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In Argentina&#44; the Qom &#40;also known as Toba&#41; belong to the Guaycur&#250; language family&#44; who originally inhabited the northeast of the country in the provinces of Chaco&#44; Formosa&#44; and Salta&#46; The process of assimilation of the population is relatively recent &#40;around the 19th and 20th centuries&#41;&#46; Deforestation of the original forests&#44; appropriation of land and climatic catastrophes &#40;significant flooding&#41; have been forcing the Qom to migrate from the 1960s to the present day&#46; The Qom population settled in the territories of the provinces of Buenos Aires and Santa Fe&#44; with Rosario being one of the most densely populated cities in the province of Santa Fe&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In 2008&#44; the Argentine Health Research Forum&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> highlighted the complex epidemiological profile of the indigenous population&#44; as its rate of vulnerability and mortality is higher than that of the rest of the population&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The current complex situation of the indigenous population requires researchers to use a social and epidemiological strategy that combines both quantitative and qualitative techniques&#46; A study conducted in the Mayan community in Mexico&#44; and published by GLADERPO&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> used a strategy that prioritized the experiences of individuals with RA as well as their relationship with the local health system&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">This study took the same approach as the study in Mexico and aimed to describe the experience of Qom individuals with RA&#44; and their experience with the local health system in the city of Rosario&#44; Argentina&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">Qualitative ethnographic study&#46; The objective of this design is based on the theoretical concepts of the trajectory of experiencing the condition and seeking care&#44; to describe and understand the journey of the Qom group in their experience of RA&#44; as well as their experience with the health system&#46; Experiencing the condition is defined as the interpretation and reconstruction of the cultural dimension of the disease by the patient and his&#47;her family from their own specific context&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> Care seeking trajectories refer to the followed by the individual to achieve treatment and rehabilitation for a health problem&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">To meet the objectives of the study&#44; the techniques of semi-structured interviews and non-participatory observations recorded in anthropologists&#39; field diaries were used&#46; Interview and observation guides were used&#44; developed by a multidisciplinary group of researchers &#40;anthropologists&#44; rheumatologists&#44; nurses&#44; and psychologists&#41;&#46; The aspects included in the guide were&#58; daily life &#40;daily activities&#44; type of work undertaken&#44; housing conditions&#44; family relationships&#44; dependence on others&#41; and access to the health system &#40;availability of biomedical resources and treatment&#41;&#44; use of traditional resources and traditional medicine &#40;Appendix B Annex 1&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">This study is nested in a previous epidemiological study undertaken and published by the same team of researchers&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Participating population</span><p id="par0045" class="elsevierStylePara elsevierViewall">Individuals with RA identified in the epidemiological study were invited to participate&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Thirty-three interviews were conducted&#59; in four cases a second interview was deemed necessary due to the valuable information provided&#46; Thirty-eight hours and 15&#8239;minutes of interviews were analysed&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The criterion strategy of information saturation was chosen for the sample&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Information was considered saturated when the data collected no longer provided new categories of analysis or when the relationship between the categories had been validated&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Field work strategy</span><p id="par0055" class="elsevierStylePara elsevierViewall">In all cases&#44; the process included several visits to the homes of the individuals interviewed&#46; A first visit was made to establish initial contact&#44; introduce the interviewers&#44; and obtain informed consent&#46; The home visits began with a presentation given by the Qom cultural facilitator &#40;a Spanish&#47;Qom bilingual community member&#41;&#44; who explained the purpose of the study&#44; the confidentiality of participation&#44; and the future use of the data&#46; The individuals were invited to participate in the study and were given informed consent forms and time to read and understand them&#46; If the individual was illiterate&#44; the consent process was conducted verbally&#46; Signing of informed consent took place in the presence of witnesses&#44; a facilitator&#47;translator&#44; and a representative of the Provincial Ministry of Health&#46; Most of the interviews were conducted in the participants&#39; homes &#40;n&#8239;&#61;&#8239;30&#41; and the remaining few at the local health centre &#40;n&#8239;&#61;&#8239;3&#41;&#46; The participants&#39; homes were preferred as the place for the interview to facilitate the individual&#39;s recollection of significant experiences for his or her narrative&#46; 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This analysis continued throughout the writing process&#46; A triangulation strategy was implemented to analyse the consistency of the information &#40;data triangulation&#41;&#44; convergence of the analysis &#40;researchers&#39; triangulation&#41; and complementarity of the techniques used&#44; such as non-participatory observation&#44; interviews and clinical information from the participating rheumatologists &#40;methodology triangulation&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Ethical approval</span><p id="par0075" class="elsevierStylePara elsevierViewall">The study was approved by the Research Ethics Committee of the Health Department of the Municipality of Rosario on 22 December 2010 &#40;Resolution No&#46; 1659&#47;2009&#41;&#44; with the support of the Ministry of Health &#40;resolutions 1619&#47;2010 and 0127&#47;2011&#41; 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therefore&#44; it was necessary to conduct a population census and map the data collected&#46; The sample included individuals who met the following inclusion criteria&#58; &#8805;18 years of age&#44; who identified themselves as Qom and who had at least six months&#8217; residence in the city of Rosario&#46; The Qom population is located in three districts&#58; North &#40;Barrio La Traves&#237;a&#41;&#44; Northwest &#40;Barrio Pumitas&#41; and West &#40;Barrio Rouill&#243;n&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">This population primarily comprises young&#44; second or third generation Rosario-born people with communicative competence in Spanish&#44; unlike the older population and recent immigrants who still speak Qomlaqtaq &#40;their mother tongue&#41; as their first language&#46; The Qom undertake casual work and are employed informally in jobs that require extreme physical activity&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">In terms of housing conditions&#44; irregular sites mix with urban areas&#46; The Qom have limited access to some public services&#58; running water&#44; irregular electricity supply&#44; transport&#44; and rubbish collection&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The health system in Argentina is divided&#44; historically&#44; into three poorly integrated levels&#58; public health&#44; social security&#44; and private health&#46; The public health system is financed by the state budget and is administered by national&#44; provincial&#44; and local governments&#46; This complex organisation is based on the principle that every citizen has the right to health care&#44; regardless of whether they have social or private cover of any kind&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> In Rosario&#44; the public health system is structured in three levels&#44; according to the primary healthcare strategy&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> At primary level&#44; healthcare is mainly provided by general practitioners&#44; and at secondary and tertiary level by specialists&#44; for example&#44; rheumatologists&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">A total of 29 individuals were interviewed&#44; 25 &#40;86&#46;2&#37;&#41; of whom were women&#44; with an average age of 40&#46;8 &#40;range 26&#8211;55&#41; years and a mean &#40;standard deviation&#41; 5&#46;1 &#40;0&#46;3&#41; years of formal education&#46; All the individuals were beneficiaries of the public health system&#46; The city of Rosario was the birthplace of 15 &#40;51&#46;7&#37;&#41; individuals&#44; and the province of Chaco was the birthplace of 14 &#40;48&#46;2&#37;&#41; individuals&#46; All the patients spoke Spanish and 20 &#40;68&#46;9&#37;&#41; also spoke Qom&#46; Most of the participants live in the Barrio Rouill&#243;n &#40;n&#8239;&#61;&#8239;22&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In relation to RA&#44; all the patients met the 1987 RA classification criteria&#59;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> over 90&#37; were found to be HIV positive and around 60&#37; had radiological changes&#46; Most patients had active and limiting disease&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">The following issues were identified&#58; 1&#41; Living with RA&#58; perception of pain&#44; daily activities&#44; type of work undertaken&#44; housing conditions&#44; family relations&#44; use of traditional medicine&#44; and 2&#41; Relationship with the local health system&#58; access to the health system&#44; doctor-patient relationship&#44; continuity of treatment and availability of medication&#46;</p><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Living with rheumatoid arthritis</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Interpretation of symptoms</span><p id="par0120" class="elsevierStylePara elsevierViewall">Symptoms were both normalised and underestimated&#46; The interpretation of symptoms could be one of the reasons for delay in consulting a doctor&#46;<span class="elsevierStyleDisplayedQuote" id="dsq0005"><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">&#8220;I didn&#39;t really notice&#46; I had a pain in my legs&#44; my knee and I thought it was normal &#40;&#8230;&#41;&#8221; &#40;woman&#44; 41 years old&#44; five years with RA&#41;&#46;</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; I didn&#39;t attach any importance to it &#40;&#8230;&#41; neither did I tell the doctor about this &#40;&#8230;&#41;&#8221; &#40;woman&#44; 48 years old&#44; three years with RA&#41;&#46;</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; When I came to Rosario in 1980&#44; I started working in 1995 and worked until 1996&#44; when I couldn&#39;t go on any longer because it hurt too much &#40;&#8230;&#41;&#8221; &#40;man&#44; 55 years old&#44; 18 years with RA&#41;&#46;</p></span></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Work and rheumatoid arthritis</span><p id="par0125" class="elsevierStylePara elsevierViewall">Notably&#44; most of the individuals&#44; regardless of gender&#44; undertook physically demanding work&#46; The characteristics of the disease&#44; therefore&#44; have major impact on the productivity and livelihood of the individual and his or her family&#46;<span class="elsevierStyleDisplayedQuote" id="dsq0010"><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; You know&#44; now I can&#39;t even tear cardboard &#40;&#8230;&#41; even if the cardboard isn&#8217;t very thick&#44; I can&#39;t do it&#44; because of my disease&#44; I can&#39;t do anything that requires effort because my hands hurt&#8221; &#40;man&#44; 52 years old&#44; seven years with RA&#41;&#46;</p><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; Now&#44; I don&#39;t work at home or with my family&#44; because of the pain in my body and hands &#40;&#8230;&#41; &#34;I don&#39;t have the strength to do my job &#40;&#8230;&#41;&#8221; &#40;woman&#44; 46 years old&#44; six years with RA&#41;&#46;</p></span></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Dependence&#46; Another consequence of rheumatoid arthritis</span><p id="par0130" class="elsevierStylePara elsevierViewall">The physical limitations of the disease and its consequences on daily routine affect family relationships&#44; mainly due to dependence on others&#46; A feeling of frustration and hopelessness can be perceived in the narratives&#44; especially in the intonation&#46;<span class="elsevierStyleDisplayedQuote" id="dsq0015"><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; It was then that I needed my daughter&#39;s help because I couldn&#8217;t stop myself&#44; I couldn&#8217;t support myself &#40;&#8230;&#41; because of the pain in my hands&#46; I couldn&#39;t even open the tap&#44; or comb my hair&#44; I depended on everyone &#40;&#8230;&#41;&#8221; &#40;woman&#44; 48 years old&#44; three years with RA&#41;&#46;</p><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; And I didn&#39;t say anything to my wife&#44; how it was hurting me&#44; nothing&#46; I wanted to continue&#44; to continue working &#40;&#8230;&#41;&#46; She helps me in my work &#40;&#8230;&#41;&#8221; &#40;man&#44; 55 years old&#44; 18 years with RA&#41;&#46;</p></span></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Process of seeking help</span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Traditional medicine</span><p id="par0135" class="elsevierStylePara elsevierViewall">In addition to using the public health system&#44; groups of strategies were observed in the population to treat the disease according to their belief&#44; value&#44; and action systems&#44; all of which are different from those of the health system&#46; These strategies can be grouped into three categories&#58; shamanism &#40;practices primarily associated with the conception that illness is the result of an &#39;evil&#39;&#41;&#44; religious healing in the context of native Pentecostal churches&#44; and traditional pharmacopoeia &#40;medicinal herbs&#41;&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Shamanism</span><p id="par0140" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleDisplayedQuote" id="dsq0020"><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; For him&#44; it is as if you&#8217;re operating on the disease&#44; you&#8217;re taking out the disease&#44; it&#8217;s not that it&#8217;s &#40;&#8230;&#41; it&#8217;s as if he&#8217;s operating on the patient&#46; And then he saw that the patient was covered by a white sheet&#44; and they put a plate there &#40;he touches his knees&#41; &#40;&#8230;&#41; And&#44; well&#44; there you have everything&#44; I don&#39;t know&#44; the disease falls into the plate and he shows you what that disease is &#40;&#8230;&#41;&#8221; &#40;man&#44; 50 years old&#44; seven years with RA&#41;&#46;</p></span></p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Religious healing</span><p id="par0145" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleDisplayedQuote" id="dsq0025"><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; I never said anything&#44; I pray&#44; for my life&#44; I ask the Lord to heal whatever I have&#44; I have faith in God&#44; nothing is impossible for God&#44; He can do everything &#40;&#8230;&#41;&#8221; &#40;man&#44; 45 years old&#44; four years with AR&#41;&#46;</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; No&#44; now it doesn&#39;t hurt much&#46; This is why I told Dr G&#46; the last time I went there last year&#44; and he said&#58; Are you taking something&#63; I&#39;m not taking anything now&#44; I told him&#46; Because I go to church&#44; I said&#46; And through the church&#44; the people who are always praying for me&#44; I can&#8217;t take the pills anymore&#44; I said&#46; And now it&#39;s like it helps me &#40;&#8230;&#41; From the gospel to the doctors&#46; It&#39;s like I have more faith in the gospel than in doctors&#44; and healers don&#39;t &#40;she laughs&#44; she&#39;s referring to shamanism&#41; &#40;&#8230;&#41; Even though they are doctors too &#40;&#8230;&#41;&#8221; &#40;woman&#44; 40 years old&#44; four years with RA&#41;&#46;</p></span></p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Traditional pharmacopoeia</span><p id="par0150" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleDisplayedQuote" id="dsq0030"><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; my grandmother&#44; my grandmother&#44; who lives in el Chaco&#44; when I went there in May told me to take &#40;&#8230;&#41; She told me to drink alcohol&#44; tobacco&#44; but I don&#39;t know &#40;&#8230;&#41; I didn&#39;t do it&#46; You mix all that into alcohol and every night you put it where it hurts&#46; Not only where it hurts&#44; but&#44; &#40;&#8230;&#41; in the heads of the bones&#44; in all that and if eases&#44; it eases the pain a lot &#40;&#8230;&#41;&#8221; &#40;woman&#44; 42 years old&#44; five years with RA&#41;&#46;</p></span></p></span></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Relationship with the local health system</span><span id="sec0095" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0155">Doctor-patient relationship</span><p id="par0155" class="elsevierStylePara elsevierViewall">Some disagreements arise in the relationship between patients and doctors&#46; Patients complain about the little time they have to explain things&#44; or about the lack of explanation&#46; It is inferred from the analysis that what patients refer to as a &#34;lack of explanation&#34; is a way of expressing difficulty in understanding it&#44; as well as the impossibility of building a doctor-patient relationship&#46;<span class="elsevierStyleDisplayedQuote" id="dsq0035"><p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; and the pain in your body&#44; did the doctor tell you why you have that pain&#63; When I ask the doctor&#44; she always says&#58; we&#39;ll talk later &#40;&#8230;&#41;&#8221; &#40;woman&#44; 31 years old&#44; seven years with RA&#41;&#46;</p><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; You know that doctor was so loved here&#44; he attended you so naturally &#40;&#8230;&#41; because if you need a pill&#44; he&#8217;d say&#58; What happened&#63; What do you need&#63; &#40;&#8230;&#41; He would explain to people&#58; Look&#44; you have this&#44; this&#44; and this &#40;&#8230;&#41; he explained everything&#46; But not this one&#33;&#8221; &#40;man&#44; 52 years old&#44; seven years with RA&#41;&#46;</p></span></p></span><span id="sec0100" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0160">About the medication</span><p id="par0160" class="elsevierStylePara elsevierViewall">Even though standard treatment is provided free of charge&#44; some difficulties were observed in the continuity of treatment&#46; After a follow-up visit to the specialist who originally prescribed the treatment&#44; patients can receive medication on a monthly basis at the nearest primary care centre &#40;PCC&#41;&#46; It was noted during the fieldwork that many patients had problems taking the medication as prescribed due to lack of knowledge&#46;<span class="elsevierStyleDisplayedQuote" id="dsq0040"><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; Look&#44; I really don&#39;t know&#44; I don&#39;t know&#46; Because they gave me four pills&#44; but I don&#39;t know which pill is for Chagas disease and which is for RA&#46; I was treated by two doctors and I asked one of them about one of the pills I&#8217;m taking&#46; It&#39;s for your bones&#44; he said&#46; But this is a painkiller&#44; it&#39;s not what&#39;s going to cure you &#40;&#8230;&#41; they&#39;re pain killers&#44; when that pain gets hold of you&#44; it&#39;s going to ease the pain&#8221; &#40;man&#44; 55 years old&#44; 18 years with RA&#41;&#46;</p><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; Yes&#44; I have to stop taking one&#44; but I don&#39;t know which one &#40;&#8230;&#41;&#8221; &#40;woman&#44; 45 years old&#44; five years with RA&#41;&#46;</p></span></p></span><span id="sec0105" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0165">Access&#46; Availability of appointments</span><p id="par0165" class="elsevierStylePara elsevierViewall">The difficulty in accessing medical appointments &#40;long hours of waiting in the street exposed to different weather conditions&#41; has a negative impact not only on the patient&#39;s health but also on the continuity of treatment&#44; as patients lose interest and abandon treatment&#46;<span class="elsevierStyleDisplayedQuote" id="dsq0045"><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; Yes&#44; yesterday I had an appointment scheduled with the doctor&#44; but I left&#46; Why&#63; There&#8217;s not much time for medical visits&#46; There are too many people&#46; If you&#8217;re late&#44; they won&#8217;t see you &#40;&#8230;&#41;&#8221; &#40;woman&#44; 46 years old&#44; 13 years with RA&#41;&#46;</p><p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">&#8220;&#40;&#8230;&#41; I didn&#39;t have the X-ray &#40;X-ray of the hands&#41;&#46; I couldn&#39;t get it done the other day &#40;&#8230;&#41; I arrived and didn&#39;t ask and I was sure that they were going to take the X-ray&#44; but when I arrived at CEMAR &#40;the name of the health care facility&#41;&#44; they told me that I should have had the X-ray at the hospital &#40;&#8230;&#41;&#8221; &#40;woman&#44; 48 years old&#44; 3 years with RA&#41;&#46;</p></span></p><p id="par0170" class="elsevierStylePara elsevierViewall">As a result of these difficulties&#44; patients adopt different strategies to speed up care&#44; such as skipping the visit with the primary care physician at the PCC and going directly to secondary care&#46; However&#44; this strategy is not sufficient&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Most of the time&#44; the Qom individuals combine both systems of care &#40;traditional and biomedical&#41; in seeking care for their disease&#46;</p></span></span></span></span><span id="sec0110" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0170">Discussion</span><p id="par0180" class="elsevierStylePara elsevierViewall">This paper&#44; from a qualitative perspective&#44; is the first investigation of a chronic disease like RA and its impact on daily life conducted in Qom residents of the city of Rosario&#46; The first finding was that most of those interviewed had an aggressive manifestation of the disease&#44; which limited their daily and work activities&#46; This was already described by GLADERPO<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> and coincides with the results presented by Alarc&#243;n et al&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> and Callahan&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> These authors highlighted that indigenous populations present a higher level of deterioration and more aggressive disease progression&#46; Similarly&#44; Barnabe et al&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> described that indigenous patients have greater consequences of RA in relation to the magnitude of symptoms experienced&#44; quality of life&#44; limitations to activities of daily living and in reduced work possibilities&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">The second relevant finding was that&#44; despite living in an urban context and within the vicinity of a PPC&#44; treatment compliance and continuity were not as high as expected&#46; Low adherence to treatment by patients was observed in the abovementioned study&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> In comparison with other studies that focus on the analysis of health system accessibility&#44; most undertaken in rural contexts where geographical distances were a determining factor&#44; low adherence to treatment was also observed&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;26&#8211;29</span></a> In line with this finding&#44; a review of the literature by Loyola-Sanchez et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> which describes arthritis healthcare utilisation by indigenous populations in Australia&#44; Canada&#44; New Zealand and the United States&#44; noted that indigenous populations under-utilize specialist services while at the same time frequently using emergency services due to complications of the disease &#40;i&#46;e&#46; hospitalizations&#41;&#46; Free distribution of medication in the Qom population does not necessarily guarantee that it will get to the patient&#46; The latter may be due to a lack of understanding or awareness of the mechanisms of medication provision and its requirements&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Another relevant point was the doctor-patient relationship&#46; A high rate of professional staff turnover&#44; as well as a lack of sensitivity to ethnic specifics&#44; could affect the relationship between the PCC and patients&#59; facts observed in other studies&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;31&#44;32</span></a> A research study conducted in an indigenous community in Alberta&#44; Canada&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> in which patients with RA and local health service professionals were interviewed&#44; found that the underutilization of specialist treatment was due to a lack of knowledge about how to access health care&#46; The authors emphasised the need for a culturally sensitive health system&#46; Similarly&#44; a systematic review of the specialist literature&#44; conducted by Fradgley et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> on the main barriers to specialist care experienced by individuals with chronic diseases&#44; highlighted a lack of understanding of the health system and poor relationship between health professionals and communities as the most common obstacles&#46; Lin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> described&#44; in a recent review&#44; that communication difficulties between health professionals and indigenous people were the main reasons why indigenous people did not access the health system&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Thus&#44; we believe that the main anthropological contribution should be to facilitate mutual understanding between health professionals and their patients&#44; improving their relationships and dispelling the common misconception that obstacles to healthcare are the result of failures on the part of the patients&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">The main difficulties include language differences between interviewers and respondents&#46; Another constraint was the well-known pattern of continuous movement between Rosario and the Qom communities in the Chaco region&#46; This point was highlighted in the cohort of RA patients belonging to the Qom community&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Migration was the main cause of visits lost to follow-up&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">The main strength of this paper was its multidisciplinary approach&#44; guided by the fundamental objective of improving indigenous patients&#39; access to the health system&#46; The clinical and epidemiological understanding of this disease is complemented by the social approach of anthropology&#46; The meeting of these different disciplines allows us to obtain a better understanding of the consequences of living with RA in this social group&#46; The field work was and still is conducted by the same group of professionals&#44; which has consolidated the relationship with the community&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">We can conclude that RA is a disease that has a negative impact on the daily life of the Qom population living in Rosario&#46; A new care strategy needs to be adopted&#44; prioritising multidisciplinary work in which not only medical staff&#44; but also other actors such as social workers&#44; anthropologists&#44; and community leaders&#44; play a fundamental role&#46;</p></span><span id="sec0115" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0175">Sources of funding</span><p id="par0215" class="elsevierStylePara elsevierViewall">None&#46;</p></span><span id="sec0120" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0180">Conflict of interests</span><p id="par0220" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare&#46;</p></span></span>"
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                      "titulo" => "About the medication"
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          "titulo" => "Discussion"
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    "fechaRecibido" => "2020-01-31"
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          "clase" => "keyword"
          "titulo" => "Keywords"
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          "palabras" => array:5 [
            0 => "Health Care System"
            1 => "Indigenous people"
            2 => "Rheumatoid arthritis"
            3 => "<span class="elsevierStyleItalic">Qom</span> community"
            4 => "Qualitative research"
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          "palabras" => array:5 [
            0 => "Sistema de Salud"
            1 => "Pueblos ind&#237;genas"
            2 => "Artritis reumatoide"
            3 => "Comunidad <span class="elsevierStyleItalic">qom</span>"
            4 => "Investigaci&#243;n cualitativa"
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      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Rheumatoid arthritis &#40;RA&#41; is a chronic disease which impacts patients&#8217; quality of life&#46; The prevalence of RA in the <span class="elsevierStyleItalic">qom</span> population was 2&#46;4&#37; and represented an aggressive and disabling disease&#46; The study goal was to describe the experience of the indigenous <span class="elsevierStyleItalic">qom</span> community individual suffering from RA&#44; along with their experience with the local health care system in the city of Rosario&#44; Santa Fe&#44; Argentina&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Qualitative Study using techniques of participant observation and semi-structured interviews&#59; following a guideline developed by a multidisciplinary research group comprising anthropologists&#44; rheumatologists&#44; nurses&#44; and psychologists&#46; A triangulation strategy was implemented for the analysis&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 33 interviews were conducted in 29 individuals with RA&#46; The results showed a &#8220;normalization&#8221; of their symptoms and of their limitations in performing daily tasks&#46; The individuals&#8217; relationship with the local health care system was complex and limited in several aspects &#40;e&#46;g&#46; access to health care&#44; continuity of treatment&#44; complexity of medical care pathway and lack of cultural competence&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">RA is a disease that has a negative impact on the daily lives of the <span class="elsevierStyleItalic">qom</span> people living in Rosario&#46; Improving the relationship between this population and the local health care system as well as the implementation of multidisciplinary work should be priorities&#46;</p></span>"
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            "titulo" => "Introduction"
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        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La artritis reumatoide &#40;AR&#41; es una enfermedad cr&#243;nica que impacta la vida de los pacientes&#46; La prevalencia de AR en la poblaci&#243;n <span class="elsevierStyleItalic">qom</span> fue de 2&#44;4&#37; y represent&#243; una enfermedad agresiva y limitante&#46; El objetivo del estudio fue describir la experiencia de los individuos de la comunidad ind&#237;gena <span class="elsevierStyleItalic">qom</span> que sufr&#237;an de AR&#44; y su experiencia con el sistema de salud local en la ciudad de Rosario&#44; Santa Fe&#44; Argentina&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Materiales y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio cualitativo de corte etnogr&#225;fico utilizando t&#233;cnicas de observaci&#243;n de los participantes y entrevistas semi-estructuradas&#59; siguiendo una gu&#237;a desarrollada por un grupo multidisciplinario de antrop&#243;logos&#44; reumat&#243;logos&#44; enfermeras y psic&#243;logos&#46; Se realiz&#243; un an&#225;lisis tem&#225;tico basado en las narrativas reconstruidas y una estrategia de triangulaci&#243;n entre investigadores&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un total de 33 entrevistas en 29 individuos con AR&#46; Los resultados mostraron una &#8220;normalizaci&#243;n&#8221; de los s&#237;ntomas y de sus limitaciones al realizar tareas diarias&#46; La relaci&#243;n entre los individuos y el sistema de salud local fue complejo y limitado en diferentes aspectos &#40;por ej&#46; acceso al sistema de salud&#44; continuidad del tratamiento&#44; complejidad en las v&#237;as de acceso a la asistencia m&#233;dica y falta de competencia cultural&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La AR es una enfermedad que tiene un impacto negativo en la vida diaria de la poblaci&#243;n<span class="elsevierStyleItalic">qom</span> que vive en Rosario&#46; Mejorar la relaci&#243;n entre esta poblaci&#243;n y el sistema de salud&#44; as&#237; como tambi&#233;n implementar un trabajo multidisciplinario debe ser una prioridad&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Quintana R&#44; Fern&#225;ndez S&#44; Orzuza SM&#44; Silvestre AMR&#44; Bensi A&#44; Go&#241;i M&#44; et al&#46; &#171;Vivir con artritis reumatoide&#187; en una poblaci&#243;n ind&#237;gena <span class="elsevierStyleItalic">qom</span> en la Argentina&#46; Un estudio cualitativo&#46; Reumatol Clin&#46; 2021&#59;17&#58;543&#8211;548&#46;</p>"
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      "seccion" => array:1 [
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          "bibliografiaReferencia" => array:35 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Updated projected prevalence of self-reported doctor-diagnosed arthritis and arthritis-attributable activity limitation among US adults&#44; 2015-2040"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46;M&#46; Hootman"
                            1 => "C&#46;G&#46; Helmick"
                            2 => "K&#46;E&#46; Barbour"
                            3 => "K&#46;A&#46; Theis"
                            4 => "M&#46;A&#46; Boring"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/art.39692"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Rheumatol"
                        "fecha" => "2016"
                        "volumen" => "68"
                        "paginaInicial" => "1582"
                        "paginaFinal" => "1587"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27015600"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The burden of musculoskeletal disease&#8212;a global perspective"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "P&#46;M&#46; Brooks"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10067-006-0240-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Rheumatol"
                        "fecha" => "2006"
                        "volumen" => "25"
                        "paginaInicial" => "778"
                        "paginaFinal" => "781"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16609823"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rheumatoid arthritis in American Indians and Alaska Natives&#58; a review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46;D&#46; Ferucci"
                            1 => "D&#46;W&#46; Templin"
                            2 => "A&#46;P&#46; Lanier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.semarthrit.2004.08.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Semin Arthritis Rheum"
                        "fecha" => "2005"
                        "volumen" => "34"
                        "paginaInicial" => "662"
                        "paginaFinal" => "667"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15692959"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of patients with rheumatoid arthritis in Latin America&#58; a consensus position paper from Pan-American League of Associations of Rheumatology and Grupo Latino Americano De Estudio De Artritis Reumatoide"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Massardo"
                            1 => "M&#46;E&#46; Suarez-Almazor"
                            2 => "M&#46;H&#46; Cardiel"
                            3 => "A&#46; Nava"
                            4 => "R&#46;A&#46; Levy"
                            5 => "I&#46; Laurindo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/RHU.0b013e3181a90cd8"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Rheumatol"
                        "fecha" => "2009"
                        "volumen" => "15"
                        "paginaInicial" => "203"
                        "paginaFinal" => "210"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19502907"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The prevalence of rheumatoid arthritis in Argentina&#58; a capture-recapture study in a city of Buenos Aires province"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Scublinsky"
                            1 => "H&#46; Venarotti"
                            2 => "G&#46; Citera"
                            3 => "O&#46;D&#46; Messina"
                            4 => "E&#46; Scheines"
                            5 => "O&#46; Rillo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/RHU.0b013e3181f3bfdd"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Rheumatol"
                        "fecha" => "2010"
                        "volumen" => "16"
                        "paginaInicial" => "317"
                        "paginaFinal" => "321"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20859227"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology of the rheumatic diseases in Mexico&#46; A study of 5 regions based on the COPCORD methodology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "I&#46; Pelaez-Ballestas"
                            1 => "L&#46;H&#46; Sanin"
                            2 => "J&#46; Moreno-Montoya"
                            3 => "J&#46; Alvarez-Nemegyei"
                            4 => "R&#46; Burgos-Vargas"
                            5 => "M&#46; Garza-Elizondo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3899/jrheum.100951"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Rheumatol Suppl"
                        "fecha" => "2011"
                        "volumen" => "86"
                        "paginaInicial" => "3"
                        "paginaFinal" => "8"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21196592"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of early rheumatoid arthritis in a multinational inception cohort of Latin American patients&#58; the GLADAR experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;H&#46; Cardiel"
                            1 => "B&#46;A&#46; Pons-Estel"
                            2 => "M&#46;P&#46; Sacnun"
                            3 => "D&#46; Wojdyla"
                            4 => "V&#46; Saurit"
                            5 => "J&#46;C&#46; Marcos"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/RHU.0b013e31826d6610"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Rheumatol"
                        "fecha" => "2012"
                        "volumen" => "18"
                        "paginaInicial" => "327"
                        "paginaFinal" => "335"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23047532"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of musculoskeletal disorders and rheumatic diseases in the indigenous Qom population of Rosario&#44; Argentina"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Quintana"
                            1 => "A&#46;M&#46; Silvestre"
                            2 => "M&#46; Goni"
                            3 => "V&#46; Garcia"
                            4 => "N&#46; Mathern"
                            5 => "M&#46; Jorfen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10067-016-3192-2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Rheumatol"
                        "fecha" => "2016"
                        "volumen" => "35"
                        "paginaInicial" => "5"
                        "paginaFinal" => "14"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26852314"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Indymedia Argentina Centro de Medios Independientes&#44; Luis C&#233;sar Bou&#46; Losindios Tobas en Rosario&#44; Argentina&#58; nuevos pobres urbanos&#46; 2003&#46; Available from&#58; <a target="_blank" href="http://argentina.indymedia.org/news/2003/04/101871.php">http&#58;&#47;&#47;argentina&#46;indymedia&#46;org&#47;news&#47;2003&#47;04&#47;101871&#46;php</a>&#46;"
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Foro de Investigaci&#243;n en Salud de Argentina &#40;2008&#41; Estado de conocimiento y agenda de prioridades para la toma de decisiones en Argentina&#46; Situaci&#243;n de salud&#44; intervenciones y l&#237;neas de investigaci&#243;n para la toma de decisiones en salud con pueblos ind&#237;genas en Argentina&#46; &#91;consultado en enero 2018&#93; Available from&#58; <a target="_blank" href="http://www.saludinvestiga.org.ar/pdf/policy-brief/2008-indigenas.pdf">http&#58;&#47;&#47;www&#46;saludinvestiga&#46;org&#46;ar&#47;pdf&#47;policy-brief&#47;2008-indigenas&#46;pdf</a>&#46;"
                ]
              ]
            ]
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              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Barriers to accessing the culturally sensitive healthcare that could decrease the disabling effects of arthritis in a rural Mayan community&#58; a qualitative inquiry"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Loyola-Sanchez"
                            1 => "J&#46; Richardson"
                            2 => "S&#46; Wilkins"
                            3 => "J&#46;N&#46; Lavis"
                            4 => "M&#46;G&#46; Wilson"
                            5 => "J&#46; Alvarez-Nemegyei"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10067-015-3061-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Rheumatol"
                        "fecha" => "2016"
                        "volumen" => "35"
                        "paginaInicial" => "1287"
                        "paginaFinal" => "1298"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26334916"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The illness narratives&#46; Suffering&#44; healing&#44; &#38; the human condition"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46; Kleinman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "1988"
                        "editorial" => "Basic Books"
                        "editorialLocalizacion" => "New York"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Medicine&#44; rationality&#44; &#38; experience&#46; An anthropological perspective"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "B&#46;J&#46; Good"
                          ]
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2001"
                        "editorial" => "Cambridge University Press"
                        "editorialLocalizacion" => "New York"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Help-seeking trajectory in patient with rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "I&#46; Pel&#225;ez"
                            1 => "C&#46; Infante"
                            2 => "R&#46; Quintana"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10067-015-3013-z"
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Rheum"
                        "fecha" => "2015"
                        "volumen" => "34"
                        "paginaInicial" => "S17"
                        "paginaFinal" => "S28"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Illness trajectories in Mexican children with juvenile idiopathic arthritis and their parents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "I&#46; Pelaez-Ballestas"
                            1 => "M&#46; Romero-Mendoza"
                            2 => "L&#46; Ramos-Lira"
                            3 => "R&#46; Caballero"
                            4 => "A&#46; Hernandez-Garduno"
                            5 => "R&#46; Burgos-Vargas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/rheumatology/kel122"
                      "Revista" => array:5 [
                        "tituloSerie" => "Rheumatology &#40;Oxford&#41;"
                        "fecha" => "2006"
                        "volumen" => "45"
                        "paginaInicial" => "1399"
                        "paginaFinal" => "1403"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Qualitative Research in Health Care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46; Pope"
                            1 => "N&#46; Mays"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "edicion" => "2nd edition"
                        "fecha" => "2000"
                        "editorial" => "BMJ Books"
                        "editorialLocalizacion" => "London"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Qualitative Research Methods&#46; A Health Focus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46;L&#46; Rice"
                            1 => "D&#46; Ezzy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "1999"
                        "editorial" => "Oxford University Press"
                        "editorialLocalizacion" => "Oxford"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The use of triangulation in qualitative research"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "N&#46; Carter"
                            1 => "D&#46; Bryant-Lukosius"
                            2 => "A&#46; DiCenso"
                            3 => "J&#46; Blythe"
                            4 => "A&#46;J&#46; Neville"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1188/14.ONF.545-547"
                      "Revista" => array:6 [
                        "tituloSerie" => "Oncol Nurs Forum"
                        "fecha" => "2014"
                        "volumen" => "41"
                        "paginaInicial" => "545"
                        "paginaFinal" => "547"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25158659"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Instituto Nacional de Estad&#237;stica y Censos &#40;INDEC&#41;&#46; Censo Nacio-nal de Poblaci&#243;n&#44; Hogares y Viviendas 2010&#46; 2012&#46; Available from&#58; <a target="_blank" href="https://www.indec.gob.ar/ftp/cuadros/poblacion/censo2010tomo1.pdf">https&#58;&#47;&#47;www&#46;indec&#46;gob&#46;ar&#47;ftp&#47;cuadros&#47;poblacion&#47;censo2010tomo1&#46;pdf</a>&#46;"
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Bell&#243; M&#44; Becerril-Montekio VM&#46; &#91;The health system of Argentina&#93;&#46; Salud PublicaMex&#46; 2011&#59;53&#58;s96&#8211;108&#46;"
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Municipalidad de Rosario &#40;Argentina&#41;&#46; Salud P&#250;blica&#46; Available from&#58; <a target="_blank" href="https://www.rosario.gob.ar/web/servicios/salud">https&#58;&#47;&#47;www&#46;rosario&#46;gob&#46;ar&#47;web&#47;servicios&#47;salud</a>&#46;"
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46;C&#46; Arnett"
                            1 => "S&#46;M&#46; Edworthy"
                            2 => "D&#46;A&#46; Bloch"
                            3 => "D&#46;J&#46; McShane"
                            4 => "J&#46;F&#46; Fries"
                            5 => "N&#46;S&#46; Cooper"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/art.1780310302"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arthritis Rheum"
                        "fecha" => "1988"
                        "volumen" => "31"
                        "paginaInicial" => "315"
                        "paginaFinal" => "324"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3358796"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Rheumatoid arthritis in the indigenous qom population of Rosario&#44; Argentina&#58; aggressive and disabling disease with inadequate adherence to treatment in a community-based cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Quintana"
                            1 => "M&#46; Goni"
                            2 => "N&#46; Mathern"
                            3 => "M&#46; Jorfen"
                            4 => "S&#46; Conti"
                            5 => "R&#46; Nieto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10067-018-4103-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Rheumatol"
                        "fecha" => "2018"
                        "volumen" => "37"
                        "paginaInicial" => "2323"
                        "paginaFinal" => "2330"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29675622"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Contribution of ethnic group and socioeconomic status to degree of disability in rheumatoid arthritis in Chilean patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "A&#46;M&#46; Alarcon"
                            1 => "S&#46; Munoz"
                            2 => "J&#46;S&#46; Kaufman"
                            3 => "C&#46; Martinez"
                            4 => "P&#46; Riedemann"
                            5 => "S&#46; Kaliski"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00296-014-3123-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rheumatol Int"
                        "fecha" => "2015"
                        "volumen" => "35"
                        "paginaInicial" => "685"
                        "paginaFinal" => "689"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25178741"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Social epidemiology and rheumatic disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "L&#46;F&#46; Callahan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/00002281-200303000-00004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Rheumatol"
                        "fecha" => "2003"
                        "volumen" => "15"
                        "paginaInicial" => "110"
                        "paginaFinal" => "115"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12598796"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patient-reported outcomes&#44; resource use&#44; and social participation of patients with rheumatoid arthritis treated with biologics in Alberta&#58; experience of indigenous and non-indigenous patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Barnabe"
                            1 => "L&#46; Crane"
                            2 => "T&#46; White"
                            3 => "B&#46; Hemmelgarn"
                            4 => "G&#46;G&#46; Kaplan"
                            5 => "L&#46; Martin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3899/jrheum.170778"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Rheumatol"
                        "fecha" => "2018"
                        "volumen" => "45"
                        "paginaInicial" => "760"
                        "paginaFinal" => "765"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29449496"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Anthropological and socio-medical health care research in developing countries"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46; Kroeger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/0277-9536(83)90248-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Soc Sci Med"
                        "fecha" => "1983"
                        "volumen" => "17"
                        "paginaInicial" => "147"
                        "paginaFinal" => "161"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6836349"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Utilization of selected hospitals&#44; health centres and health stations in central&#44; southern and western Ethiopia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "H&#46; Kloos"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/0277-9536(90)90052-t"
                      "Revista" => array:6 [
                        "tituloSerie" => "Soc Sci Med"
                        "fecha" => "1990"
                        "volumen" => "31"
                        "paginaInicial" => "101"
                        "paginaFinal" => "114"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2389147"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Visits to rheumatologists for arthritis&#58; the role of access to primary care physicians&#44; geographic availability of rheumatologists&#44; and socioeconomic status"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46;M&#46; Badley"
                            1 => "M&#46; Canizares"
                            2 => "A&#46;C&#46; Gunz"
                            3 => "A&#46;M&#46; Davis"
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                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/acr.22413"
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                        "tituloSerie" => "Arthritis Care Res &#40;Hoboken&#41;"
                        "fecha" => "2015"
                        "volumen" => "67"
                        "paginaInicial" => "230"
                        "paginaFinal" => "239"
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Healthcare utilization for arthritis by indigenous populations of Australia&#44; Canada&#44; New Zealand&#44; and the United States&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Loyola-Sanchez"
                            1 => "K&#46; Hurd"
                            2 => "C&#46; Barnabe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.semarthrit.2016.10.011"
                      "Revista" => array:5 [
                        "tituloSerie" => "Semin Arthritis Rheum"
                        "fecha" => "2017"
                        "volumen" => "46"
                        "paginaInicial" => "665"
                        "paginaFinal" => "674"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Motivations for inadequate persistence with disease modifying anti-rheumatic drugs in early rheumatoid arthritis&#58; the patient&#8217;s perspective"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "V&#46; Pascual-Ramos"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1471-2474-14-336"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Musculoskelet Disord"
                        "fecha" => "2013"
                        "volumen" => "14"
                        "paginaInicial" => "336"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24289729"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0160"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Health literacy&#58; health professionals&#8217; understandings and their perceptions of barriers that Indigenous patients encounter"
                      "autores" => array:1 [
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Lambert"
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                            3 => "S&#46; Crengle"
                            4 => "M&#46; Kelaher"
                            5 => "S&#46; Reid"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s12913-014-0614-1"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Health Serv Res"
                        "fecha" => "2014"
                        "volumen" => "14"
                        "paginaInicial" => "614"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25471387"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0165"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Discordant indigenous and provider frames explain challenges in improving access to arthritis care&#58; a qualitative study using constructivist grounded theory"
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                          "etal" => true
                          "autores" => array:6 [
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                            3 => "L&#46;F&#46; Crowshoe"
                            4 => "D&#46;A&#46; Marshall"
                            5 => "J&#46; Homik"
                          ]
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                      ]
                    ]
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                    0 => array:2 [
                      "doi" => "10.1186/1475-9276-13-46"
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Equity Health"
                        "fecha" => "2014"
                        "volumen" => "13"
                        "paginaInicial" => "46"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24916481"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0170"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A systematic review of barriers to optimal outpatient specialist services for individuals with prevalent chronic diseases&#58; what are the unique and common barriers experienced by patients in high income countries&#63;"
                      "autores" => array:1 [
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                            4 => "R&#46; Goucke"
                            5 => "J&#46; Coffin"
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                        "tituloSerie" => "Arthritis Care Res &#40;Hoboken&#41;"
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Article information
ISSN: 21735743
Original language: English
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Idiomas
Reumatología Clínica (English Edition)
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