[Persistence of a magic-religious ritual to treat indigestion among patients attending a gastroenterology outpatient clinic]. / Persistencia de una práctica de medicina mágico-religiosa para la cura del empacho entre los enfermos que acuden a consultas externas de digestivo.

INTRODUCTION: Knowledge of popular medicine is essential to the practice of integrated medicine. Empacho (stomach upset) is a known folk illness that has been the object of several studies, especially in Iberoamerica and among the Hispanic population in the United States. In the Autonomous Community of Valencia (Spain) a magic-religious ritual known as "trencar lenfit" (TE) is still performed. This ritual has no apparent equivalent among the numerous remedies described for this illness. OBJECTIVES: To study the frequency and characteristics of the practice of TE among patients attending the gastroenterology outpatient clinic of a district hospital. PATIENTS AND METHOD: The geographical area was the region of La Safor (Valencian Community) with three main nuclei (Gandia, where the hospital is situated, Oliva and Tavernes de Valldigna) and 28 smaller municipalities. Random interviews were performed in patients attending a second consultation over a period of 5 months. RESULTS: Of 539 patients interviewed, 320 (59.4%) had undergone TE at some time in their lives and 25.0% had undergone this ritual in the previous 10 years. In 95.9% of cases, the person performing the ritual was a woman. Of the patients who had undergone TE, 40 (12.5%) knew how to perform the ritual, 35 of which were women (p < 0.0001). No significant differences were found between sexes but users were younger (51.8 +/- 15.9 versus. 55.5 +/- 17.7 years +/- SD, p < 0.05). Small municipalities and Oliva showed a frequency of 65.6% versus. 54.0% in Gandia and Tavernes (p < 0.005). Use was greater among natives of the Valencian Community (66.0%) compared with those from other parts of Spain (25.0%) (p < 0.0001). Patients who completed primary or secondary school showed greater use of TE (60.5% and 72.1%, respectively) than the illiterate (42.1%), those who had completed a 3-year higher education course (48.4%) and university graduates (36.0%) (p < 0.001). TE was more frequent among consumers of medicinal herbs than among non-consumers (69.0% versus. 54.3%) (p < 0.001). No relationship was found among TE and the use of alcohol, medication in general and smoking. However, an association was found between the use of psychotropic drugs (69.8% versus. 55.4%) (p < 0.005). No clear association was found with broad diagnostic group or with the functional/organic nature of the digestive disorder studied. Variables found to be significant on univariate analysis remained significant in multivariate analysis (logistic regression). CONCLUSION: The present study confirms the high use of TE among patients attending the gastroenterology outpatient clinic of La Safor and their belief in this ritual. "Experts" in performing TE were widely available, and were almost exclusively women. The profile of maximal use of TE corresponds to a man or woman, aged less than 60 years, a native of the Valencian Community, with primary or secondary school education, residing in particular municipalities (usually small) and consumer of psychotropic drugs and medicinal herbs.

Persistencia de una práctica de medicina mágico-religiosa para la cura del empacho entre los enfermos que acuden a consultas externas de digestivo / Persistence of a magic-religious ritual to treat indigestion among patients attending a gastroenterology outpatient clinic

Introducción: El conocimiento de la medicina popular resulta básico para el ejercicio de una medicina integrada. El empacho es una enfermedad conocida de la medicina popular cuyo estudio ha motivado diversas publicaciones, especialmente en el área iberoamericana y entre la población hispana de Estados Unidos. En la Comunidad Valenciana persiste un ritual de medicina mágico-religiosa conocido como trencar l’enfit (TE) (romper el empacho), sin paralelismo aparente entre los múltiples remedios descritos para esta dolencia. Nuestro objetivo ha sido estudiar la frecuencia y las características de la práctica de TE entre los pacientes que acuden a consultas externas de digestivo de un hospital comarcal. Pacientes y método: El ámbito geográfico fue la comarca de La Safor (Comunidad Valenciana), con 3 núcleos principales (Gandia, sede del hospital, Oliva y Tavernes de Valldigna) y 28 municipios menores. Se realizaron entrevistas de forma aleatoria a los pacientes que acudían a segundas visitas, durante 5 meses. Resultados: De los 539 pacientes entrevistados, 320 (59,4%) habían realizado TE en algún momento de su vida y un 25,0% en los 10 últimos años. La persona que realizaba el ritual fue en un 95,9% de los casos mujer. De los pacientes que habían practicado TE, 40 (12,5%) sabían realizar el ritual; de éstos 35 eran mujeres (p < 0,0001). No hubo diferencias significativas entre sexos, pero fueron más jóvenes los usuarios (media de edad ± desviación estándar: 51,8 ± 15,9 frente a 55,5 ± 17,7 años; p < 0,05). Las poblaciones pequeñas y Oliva presentaron una frecuencia del 65,6%, frente al 54,0% de Gandia y Tavernes (p < 0,005). El uso fue mayor entre las personas originarias de la Comunidad Valenciana (66,0%) que entre las procedentes de otros lugares de España (25,0%) (p < 0,0001). Los pacientes con estudios primarios o EGB-bachillerato presentaron el uso máximo de TE (el 60,5 y el 72,1%, respectivamente), frente a los analfabetos (42,1%), titulados medios (48,4%) y titulados superiores (36,0%) (p < 0,001). Los consumidores de hierbas medicinales habían practicado TE más que quienes no las consumían (el 69,0 frente al 54,3%; p < 0,001). No se encontró relación de la utilización del TE con el consumo de alcohol, tabaco y medicamentos en general, pero sí con el de psicofármacos (el 69,8 frente al 55,4%; p < 0,005). No hubo relación clara con los grandes grupos diagnósticos ni con el carácter funcional/orgánico de la enfermedad digestiva estudiada. El análisis multivariante (regresión logística) confirmó la asociación independiente de las variables significativas en el estudio univariante. Conclusión: Se corrobora una elevada utilización y considerable vigencia de TE entre los pacientes que acuden a consultas externas de digestivo de La Safor. Se constata una amplia difusión de las personas «expertas» en la realización de TE, con predominio casi absoluto del sexo femenino. El perfil de máximo uso de TE se podría acercar al siguiente: varón o mujer, menor de 60 años, de origen valenciano, con estudios medios-primarios, residente en determinadas poblaciones (en general, pequeñas), consumidor/a de psicofármacos y de hierbas medicinales

Introduction: Knowledge of popular medicine is essential to the practice of integrated medicine. Empacho (stomach upset) is a known folk illness that has been the object of several studies, especially in Iberoamerica and among the Hispanic population in the United States. In the Autonomous Community of Valencia (Spain) a magic-religious ritual known as «trencar l’enfit» (TE) is still performed. This ritual has no apparent equivalent among the numerous remedies described for this illness. Objectives: To study the frequency and characteristics of the practice of TE among patients attending the gastroenterology outpatient clinic of a district hospital. Patients and method: The geographical area was the region of La Safor (Valencian Community) with three main nuclei (Gandia, where the hospital is situated, Oliva and Tavernes de Valldigna) and 28 smaller municipalities. Random interviews were performed in patients attending a second consultation over a period of 5 months. Results: Of 539 patients interviewed, 320 (59.4%) had undergone TE at some time in their lives and 25.0% had undergone this ritual in the previous 10 years. In 95.9% of cases, the person performing the ritual was a woman. Of the patients who had undergone TE, 40 (12.5%) knew how to perform the ritual, 35 of which were women (p < 0.0001). No significant differences were found between sexes but users were younger (51.8 ± 15.9 versus. 55.5 ± 17.7 years ± SD, p < 0.05). Small municipalities and Oliva showed a frequency of 65.6% versus. 54.0% in Gandia and Tavernes (p < 0.005). Use was greater among natives of the Valencian Community (66.0%) compared with those from other parts of Spain (25.0%) (p < 0.0001). Patients who completed primary or secondary school showed greater use of TE (60.5% and 72.1%, respectively) than the illiterate (42.1%), those who had completed a 3-year higher education course (48.4%) and university graduates (36.0%) (p < 0.001). TE was more frequent among consumers of medicinal herbs than among non-consumers (69.0% versus. 54.3%) (p < 0.001). No relationship was found among TE and the use of alcohol, medication in general and smoking. However, an association was found between the use of psychotropic drugs (69.8% versus. 55.4%) (p < 0.005). No clear association was found with broad diagnostic group or with the functional/organic nature of the digestive disorder studied. Variables found to be significant on univariate analysis remained significant in multivariate analysis (logistic regression). Conclusion: The present study confirms the high use of TE among patients attending the gastroenterology outpatient clinic of La Safor and their belief in this ritual. «Experts» in performing TE were widely available, and were almost exclusively women. The profile of maximal use of TE corresponds to a man or woman, aged less than 60 years, a native of the Valencian Community, with primary or secondary school education, residing in particular municipalities (usually small) and consumer of psychotropic drugs and medicinal herbs

[Generic drugs in a district hospital. Intervention strategies]. / Especialidades farmacéuticas genéricas en un hospital comarcal. Impacto de dos estrategias de intervención.

OBJECTIVE: To know the prescription of generic drugs in specialized attention and the impact of two different intervention strategies: MATERIAL AND METHODS: Intervention trial with evaluation and later comparison. The data on the use of generic drugs are obtained from the medical reports. After an informative note of general character we repeated the taking of data one month later. In the service of Medicine we also analysed each doctor's profile prescriptions and a personalized informative note was edited and accompanied by a brief verbal explication of the campaign. Then repeated the collection of data to the week and the month. RESULTS: 1545 reports were revised (3460 prescribed drugs). 42% of the medication could be prescribed as generic but it was only made in 10% (21% in Internal Medicine). After the informative note no significant variations were observed. Only in Internal Medicine an initial increment was obtained (21 to 56%, RR 0.38, IC 0.26-0.55) that it disappeared at month. COMMENTS: The utility of the intervention to generic promotion is limited and transitory. Besides improve the information, seems necessary the implication of the physician in the promotion campaigns.

Especialidades farmacéuticas genéricas en un hospital comarcal. Impacto de dos estrategias de intervención / Generic drugs in a distric hospital. Intervention strategies

Objetivo: Conocer los hábitos de prescripción de especialidades farmacéuticas genéricas en atención hospitalizada y el impacto de dos diferentes estrategias de intervención. Material y métodos: Se diseña un estudio de intervención con evaluación previa y comparación posterior. A partir de los informes de alta generados en el Hospital Comarcal Francisco de Borja de Gandía se recogieron los fármacos prescritos, la proporción de ellos en los que existe alternativa como EFG disponible y porcentaje que se pauto como tal. Tras una notar informativa de carácter general se repitió la toma de datos al mes. En el Servicio de Medicina Interna se analizó también el perfil presciptor de cada facultativo, redactándose una hoja informativa personalizada que se distribuyo de forma personal, acompañada de una breve explicación verbal. Se repitió la toma de datos a la semana y al mes. Resultados: Se revisaron un total de 1545 informes de alta y 3460 fármacos prescritos. En la toma de datos basal el 42 por ciento de la medicación prescrita podría haberse pautado como EFG pero se prescribió como tal en el 10 por ciento (21 por ciento en el Servicio de Medicina Interna). Tras la nota informativa general no se objetivaron variaciones significativas en el porcentaje de utilización de EFG. En Medicina Interna, se obtuvo un significativo incremento a la semana de la intervención, del 21 por ciento se paso al l 56,8 por ciento (RR 0.38 IC al 95 por ciento (0,26- 0,55) pero que tendía a desvanecerse al mes (27 por ciento) perdiendo significación estadística. Comentarios: La utilidad de campañas de promoción del uso de EFG es limitada y transitoria por lo que además de mejorar la información respecto a la disponibilidad y eficacia de las EFG, se debería contemplar la implicación del prescriptor tanto en la atención primaria como en la especializada (AU)